Matsuoka Y
Department of Radiology, Nagasaki University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 1992 Jul 25;52(7):979-92.
Thirteen cases of acute aortic dissection with non-opacified false lumen of the ascending aorta were examined by CT and other imaging modalities. On the basis of the initial CT findings, these cases were classified into two types; one was pure non-opacified dissection not associated with opacified false lumen (Type N, n = 7), the other was non-opacified dissection of the ascending aorta associated with opacified false lumen of the following aorta (Type N+O, n = 6). On examining the relation between the entry site and the false lumen in Type N+O, the dissection of the ascending aorta was considered to be retrograde. Retrograde dissection seemed to be an important factor in the development of the non-opacified dissection of the ascending aorta. During the follow-up period, re-dissection in the ascending aorta occurred in four of the 13 cases (Type N = 3, Type N+O = 1). The re-dissection occurred within the first four weeks in all of them, and the diagnosis of re-dissection was possible at its early stage. In one case, ulcerlike projection (ULP) was detected by aortography. In another case, ULP was identified by cine-MR imaging. Contrast CT also revealed enlargement and small opacification of the false lumen. In two other cases, similar CT findings were observed. Three of the four patients recovered by surgical treatment. One died the day after the diagnosis of re-dissection. Early diagnosis and earliest possible surgical intervention for re-dissection were considered necessary to save the patients with re-dissected false lumen in the ascending aorta. Close observations with several imaging modalities, mainly CT examination, should be paid in the patients with non-opacified dissection of the ascending aorta for at least four weeks after the onset of dissection.
对13例升主动脉假腔未显影的急性主动脉夹层患者进行了CT及其他影像学检查。根据最初的CT表现，这些病例分为两种类型：一种是单纯的假腔未显影夹层，不伴有显影的假腔（N型，n = 7），另一种是升主动脉假腔未显影夹层，伴有降主动脉显影的假腔（N+O型，n = 6）。在研究N+O型的破口部位与假腔的关系时，升主动脉夹层被认为是逆行性的。逆行夹层似乎是升主动脉假腔未显影夹层形成的一个重要因素。在随访期间，13例患者中有4例升主动脉再次夹层（N型 = 3例，N+O型 = 1例）。所有再次夹层均发生在最初4周内，且在早期即可诊断。1例经主动脉造影发现溃疡样突出（ULP）。另1例经电影磁共振成像发现ULP。增强CT也显示假腔扩大和小范围显影。另外2例也观察到类似的CT表现。4例患者中有3例经手术治疗康复。1例在再次夹层诊断后次日死亡。对于升主动脉再次夹层且假腔有显影的患者，早期诊断并尽早进行手术干预被认为是必要的。对于升主动脉假腔未显影夹层患者，在夹层发病后至少4周内，应以CT检查为主，采用多种影像学检查手段进行密切观察。
