Evaluation Of Abdominal Aortic Aneurysm And Aortic Intramural Hematoma With MSCTA

Part I Evaluation of MSCTA for Abdominal Aortic AneurysmObjective To investigate the diagnostic value of mutislice computed tomography angiography (MSCTA) for abdominal aortic aneurysm (AAA).Materials and Methods The clinical information and MSCT data of 60 patients with AAA were collected from January 2009 to January 2011. All kinds of diameters of AAA and the angles of aneurysm neck were measured and classified by two readers with a variety of MSCT post-rocessing techniques.Results There were 59 cases (98.3%) of infrarenal abdominal aortic aneurysm in the 60 patients. The shape of aneurysm body, involved location, calcification of aneurysm wall and thrombosis of aneurysm lumen were showed intuitively with MSCT post-rocessing techniques. The proximal and distal diameters of aneurysm neck, length and size of aneurysm body, twisted angle of aneurysm neck, diameter of iliac artery could be measured accurately. The 59 cases of infrarenal AAA were objectively classified. The diameters of proximal aneurysm neck was 1.4~2.5cm(avg. 9cm±0.3cm);the length of proximal aneurysm neck was 0~4.5cm(avg. 2.6cm±1.2cm); the length of aneurysm body was 5.4~17.6cm(avg. 8.8cm±2.8cm); the largest diameters of aneurysm body was 2.7~7.4cm(avg. 4.7cm±1.4cm);the length of proximal aneurysm neck was 0.4~4.7cm(avg. 1.9cm±1.2cm);the angle of aneurysm neck was 0°~103°(avg. 32.8°±27.4°)。According with the three types and five points system, the I type, IIA type, IIB type IIC type and III type were 8 cases(13.6%), 24 cases(40.7%), 1case(1.7%), 15 cases(25.4%), and 11 cases(18.6%), respectively.Conclusion MSCTA can display intuitively the shape of AAA, provide accurately all kinds of diameters of AAA, display the thrombosis of aneurysm lumen and identify the basic lesions of AAA. MSCTA of AAA can provide the theoretical basis for clinical diagnosis and treatment options. Objective To investigate the value of MSCTA for abdominal aortic aneurysm(AAA) before endovascular stent repair.Materials and methods Seventeen infrarenal AAA confirmed by MSCT and clinical data would have endovascular repair. Firstly, the related preoperative parameters of DSA were recorded and compared with that measured by MSCTA. The significant differences between the two measurement methods were analyzed. Secondly, the sizes of stent for endovascular repair were recorded and compared them with the stent recommended by Terarecon EVAR software. The reliability of Terarecon EVAR software on the stent program was analyzed.Results The measurements of length and diameter of the proximal aneurysm neck, length of the AAA body, maximum diameter of AAA body were not significantly different (P value> 0.05) between by DSA and CTA. The length and diameter of stent were significantly different between the practical application of endovascular repair and recommended by Terarecon EVAR software.Conclusions The MSCTA can provided reliable measurement parameters for clinical therapy. There are some extent differences between the stent program recommended by Terarecon EVAR software and the practical application of endovascular repair. However the stent program recommended by Terarecon EVAR software can narrow the range for choosing the stents. It play the guideline for clinical doctors.Part III The Dignostic Value of MSCTA in Aortic Intramural HematomaObjective To evaluate the diagnostic value and clinical application value of MSCTA in aortic intramural hematoma (IMH). Methods Thirty-seven patients suspected aortic disease were performed MSCTA and diagnosed as IMH. The multiplanar reconstruction (MPR), curved planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) were recruited to delineate intramural hematoma. To analyze and summarize the CT signs of IMH.Results Thirty-seven patients had sudden chest and back or abdominal pain history. Based on Stanford classification, 7 patients were diagnosed as type A, and the others as type B IMH. 10 cases only involved the thoracic aorta, 27 cases involved the thoracic aorta and abdominal aorta. The main features of IMH in MSCT included: crescent thickening of the aortic wall in 29 cases, circular thickening in 8 cases, aortic atherosclerosis in 26 cases, calcification ingression in 18 cases, penetrating ulcer in 17 cases, single in 8 cases and multiple in 9 cases. Involve the major branches of aorta in 12 cases, 6 cases combined with abdominal aortic aneurysm or iliac aneurysm. pleural effusion in 13 cases, pericardial effusion in 5 cases.Conclusion MSCTA can detect IMH clearly, display the range, section features of IMH and the existence of penetrating ulcer. It can identify other disease of aorta, to provide a reliable theoretical basis for clinical diagnosis and treatment options.