Radiology:主动脉壁间血肿究竟该不该做手术?做个多排螺旋CT吧!

2021-08-24 shaosai MedSci原创

主动脉壁间血肿(IMH)不同于典型的主动脉夹层,是一种属于急性主动脉综合征范畴的一类疾病。IMH的特点是没有内膜缺陷或真假腔之间的直接沟通。

主动脉壁血肿(IMH)不同于典型主动脉夹层是一种属于急性主动脉综合征范畴的一类疾病。IMH的特点是没有内膜缺陷或真假腔之间的直接沟通。尽管B型IMH患者可以进行保守治疗,但相当多的患者会出现器官缺血、主动脉破裂危及生命的并发症,因此需要进行手术干预。患有IMH的患者可能会在真假腔之间形成血流沟通,被称为溃疡样突起或局灶性内膜破坏(FID)。有血流沟通的患者比没有血流沟通的患者疾病进展的发生率高。此外,最近的一项研究表明,急性和慢性FID在B型IMH患者的临床过程中发挥不同的作用。

CT是在急诊中广泛应用的影像学检查之一,可以提供详细的三维信息,从而可以做到整个主动脉FID的早期识别。

近日,发表在Radiology杂志的一项研究评估CT检测到的FIDs大小与疾病进展之间的关系为临床进一步阐明IMH的发病机制和临床预后提供了有价值的参考依据

项回顾性研究2011年1月至2017年3月期间,在症状发生后24小时内入院接受多CT检查的B型IMH患者进行了评估。FID定义为局灶性凸出于主动脉腔外的袋状造影剂填充沟通口大于3mm。FID被定义为FID的长度和宽度大于等于10毫米,深度大于等于5毫米。主动脉相关事件定义为主动脉破裂、手术或血管内主动脉修复、主动脉逐渐扩大和主动脉夹层的发展等综合情况。

本研究共对76名患者(平均年龄,72岁±11[标准差];54名男性)进行了评估。50名患者(66%;76名中的50名)有91个存在FIDs。28名患者有大FIDs,22名患者有小FIDs。28名大FID患者中有15名发生了主动脉相关事件,22名小FID患者中有2名26名无FID的患者中有4名发生了主动脉相关事件。大FIDs患者的主动脉相关无事件生存率低于小FIDs或无FIDs患者(小FIDS,3年后分别为63%±10 vs 90%±7 [P = .001];无FIDS,3年后分别为63%±10 vs 84%±7 [P = .005])。多变量分析显示,主动脉最大直径大于等于40毫米(危险比,4.8;95%CI:1.8,12.6;P = .001)和大FID(危险比,3.2;95%CI:1.1,8.9;P = .03)是主动脉相关事件的独立预测因子

 

 多排CT图像显示的小和大FIDs的代表病例。轴向和纵向多平面重建图像显示一个小FID(左侧;箭头),其长度为7毫米,宽度为8毫米,深度为3毫米。轴向和纵向多平面重建图像显示的一个大FID(右侧;箭头),它的长度为16毫米,宽度为12毫米,深度为9毫米。

本研究发现大多数B型壁血肿(IMH)患者均可在入院时所行的CT图像上检测到局灶性内膜破坏(FID)。同时大FID与IMH疾病的进展有关这提示临床早期介入胸腔内主动脉修复术对于有大FID的患者来说十分必要这为临床进一步的诊治提供了影像学支持

原文出处

Kenichi Ishizu,Shuichiro Kaji,Masaki Nakashima.Focal Intimal Disruption Size at Multidetector CT and Disease Progression in Type B Aortic Intramural Hematoma.DOI:10.1148/radiol.2021204385

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    2021-08-25 Doctoryangbai

    升主动脉的壁间血肿还是应该尽早做,保守治疗死亡率极高

    0

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    2021-08-25 查查佳佳

    卡通了阿轲五魔

    0

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    2021-08-24 仓央嘉措

    学习了 平时确实不是做的

    0