做血管造影有危险吗【螺旋CT血管造影诊断主动脉瘤的临床应用价值】
[摘要] 目的 探讨多层螺旋CT血管造影在诊断腹主动脉瘤中的应用价值。 方法 收集我院腹主动脉瘤患者44例，均行多层螺旋CT扫描检查后，采用不同重建方式进行图像后处理，观察病变部位影像学特征。 结果 44例患者均能够显示清晰瘤体以及周围血管与瘤体的位置关系，且可观察附壁血栓并能准确测量动脉瘤的三维数据。本组44例腹主动脉瘤患者螺旋CT血管造影资料显示，均存在附壁血栓症状，其中，合并髂动脉瘤4例，有动脉瘤破裂迹象4例。多平面重建可清晰显示动脉瘤局限部位及其与周围组织、血管解剖关系，而最大密度投影法、容积再现技术能进一步对管腔各段较精确测量。 结论 螺旋CT血管造影扫描检查腹主动脉瘤具有操作简便、快速、直观及诊断准确等特点，是一种腹主动脉瘤有效的检查方法。
[关键词] 腹主动脉瘤；血管造影术；多层螺旋CT
[中图分类号] R543.1+6 [文献标识码] B [文章编号] 1673-7210（2012）07（a）-0103-03
Clinical application value of spiral CT angiography in diagnosis of aortic aneurysm
LAI Zhenhui LI Wanjun CUI Dong WU Weiqing
Department of Radiology, Traditional Chinese Medicine Hospital of Guangzhou City, Guangdong Province, Guangzhou 510130, China
[Abstract] Objective To explore the application value of multislice spiral CT angiography in the diagnosis of abdominal aortic aneurysm. Methods 44 patients with abdominal aortic aneurysm in our hospital were selected to receive multislice spiral CT scanning, after which different reconstruction methods were used for image post-processing and the imaging characteristics of lesions were observed. Results All the 44 patients showed clear aneurysm and the location relationship between surrounding vessels and aneurysm. The mural thrombus could be observed and the three-dimensional data of aneurysm could be accurately measured. The spiral CT angiography data of 44 patients with abdominal aortic aneurysm showed that mural thrombus symptoms were found in all the patients. Among them, 4 patients had combined iliac aneurysm and 4 patients had aneurysm rupture signs. Multi-planar reconstruction could clearly show the location of aneurysm and its relationship with surrounding tissue and vessels. And the maximum intensity projection method and volume rendering technique could further measure the segments of lumen more accurately. Conclusion Spiral CT angiography is easily operative, fast, clear and accurate in the examination of abdominal aortic aneurysm, thereby is an effective examination method in the diagnosis of abdominal aortic aneurysm.
[Key words] Abdominal aortic aneurysm; Angiography; Multislice spiral CT
主动脉瘤（abdominal aortic aneurysm，AAA）是一种危害患者安全的高风险疾病，西方国家发病较高。随着生活水平的提高，我国居民膳食结构出现重大改变，AAA发病率也呈逐年升高的趋势[1-2]。早期发现，及时治疗能够有效降低AAA死亡率。螺旋CT具有高分辨率、大范围扫描及三维重建等特点及功能，大大提高了对AAA的诊断准确率，而多排螺旋CT三维血管成像（spiral CT angiography，SCTA）是术前腹主动脉内支架植入及术后评估的首选检查手段，对DSA金标准的诊断地位形成有力挑战[3]。本组研究中，进一步探讨了多排螺旋CT在AAA中的临床应用，现报道如下：
1资料与方法
1.1 一般资料
选取我院2011年1～7月收治的44例AAA患者，均经病理或手术证实，均行MSCTA检查。其中，男30例，女14例，年龄32～75岁，平均（64.9±17.3岁）。真性动脉瘤42例（95.5%），假性动脉瘤2例（4.5%），患者临床症状为突发性腹部疼痛20例，与脉搏一致的搏动性腹部包块24例，无典型症状者10例于体检检查时发现。症状明显者就诊原因多为主动脉瘤已较大，对周围脏器构成压迫。剔除标准：妊娠期妇女及行外科手术患者。