多层螺旋CT 血管成像在大动脉炎中的应用

多层螺旋CT 血管成像在大动脉炎中的应用
马祥兴 张伟 马晓峰 王青 于德新 李笃民 崔凤玉 李传福
【摘要】 目的 探讨多层螺旋CT( MSCT) 血管成像在诊断大动脉炎中的临床应用价值。方法
对临床拟诊大动脉炎的14 例患者进行MSCT 血管成像, 扫描范围自颈2 椎体水平至耻骨联合水平,
图像后处理方法包括多平面重组、最大密度投影、容积重组、血管内镜及血管分析, 充分显示受累血管
的部位、范围及程度。结果 14 例患者CT 表现为不同程度的动脉管壁增厚, 管腔狭窄或闭塞, 管腔
狭窄具有向心性的特点, 部分伴狭窄后扩张。按管腔情况包括狭窄-阻塞型8 例, 混合型6 例。重组
图像结合轴面图像观察, 可以清晰显示受累大血管及其分支血管的狭窄程度或闭塞情况以及侧支血
管形成情况。依据Lupi-Herrea 分类法包括Ⅰ型5 例, Ⅱ型2 例, Ⅲ型6 例, Ⅳ 型1 例, CT 结果均与其
临床表现相符。结论 MSCT 血管成像同时显示大动脉炎的管腔情况和管壁改变, 后者对于早期诊
断及治疗、改善预后具有重要意义, 可以作为此病的首选检查方法。
【关键词】 Takayasu 动脉炎; 体层摄影术, X 线计算机; 血管造影术
Multi-slice CT a ngiogra phy in the diagnosis of Takaya su′s art er itis MA Xia ng-xing , ZHANG Wei,
MA Xiao-feng, WANG Qing, YU De-xin, LI Du-min, CUI Feng-yu, LI Chuan-fu. The Imaging Center, Qilu
Hospital of Sha ndong University, J inan 250012, China
【Abstra ct 】 Objective To evaluate the clinical value of multi-slice CT ( MSCT) angiography in the
diagnosis of Takayasu′s arteritis. Methods Fourteen patients underwent MSCT angiography with use of
90 ml contrast media at a rate of 3. 5 ml / s. Images were generated for vascular assessment with various
reconstructional techniques , including multi-planar reformat ( MPR) , maximum intensity projection ( MIP) ,
volume rendering ( VR) , CT virtual endoscopy ( CTVE) and advanced vessel analysis ( AVA) . Results
MSCT angiography findings was consistent with the clinical changes of Takayasu′s arteritis in all cases. The
integrated information including reconstructional and transverse images clearly presented various luminal
abnormalities, such as stenosis , occlusion and dilatation in the affected aorta, as well as its major branches
and collateral circulation. Furthermore, it depicted mural abnormities, especially concentric arterial wall
thickening. Steno-occlusive type ( 8 /14) was more common than mixed type ( 6 /14) . According to Lupi-
Herrea′s classification, typeⅠ in 5 cases, type Ⅱ in 2, type Ⅲ in 6 and type Ⅳ in 1 were recorded in the
present study. Conclusion MSCT angiography is reliable imaging modality for the detection of Takayasu′s
arteritis. It is useful for early diagnosis because it allows evaluation of wall thickness rather than merely the
luminal diameter, which is especially important for prognosis. It might be used as the first choice in the
diagnosis of this disease as a simple, convenient and noninvasive method.
【Key wor ds】 Takayasu′s arteritis ; Tomography, X-ray computed; Angiography

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