计算机断层扫描成像显示主动脉瘤的不对称扩张。

Asymmetric expansion of aortic aneurysms on computed tomography imaging.

机构信息

Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-5302, USA.

出版信息

J Vasc Surg. 2013 Feb;57(2):390-398.e3. doi: 10.1016/j.jvs.2012.08.044. Epub 2012 Nov 20.

DOI:10.1016/j.jvs.2012.08.044

PMID:23182153

Abstract

OBJECTIVE

To investigate whether wall growth during aneurysm development spares the aortic wall between the intercostal or lumbar arteries or, alternatively, is uniform around the circumference.

METHODS

Computed tomography scans of 155 patients with aortic aneurysms (40 thoracic, 50 thoracoabdominal, and 65 abdominal) in a single hospital of a large academic institution were retrospectively inspected. Computed tomography studies of 100 control subjects (40 thoracic and 60 abdominal) were also reviewed. In all 255 patients, the ratio of the arc length between the origins of the intercostal or lumbar arteries (interbranch arc length) to the remainder of the aortic residual circumference was calculated. These ratios were compared between all subjects with aneurysms and the controls at each vertebral body level and between those with thoracic or thoracoabdominal or abdominal aneurysms and controls at each vertebral body level.

RESULTS

Interbranch arc lengths and residual aortic circumferences were larger in aneurysm patients than in control subjects, but the differences were statistically significant only at T4 and from T8 to L4 (P = .009 to P < .001) and from T4 to L4 (P < .001), respectively. The ratio of interbranch arc length to residual circumference in aneurysmal aortas was significantly smaller than that in controls at 12 out of 13 levels from T4 to L4 (P = .004 to P < .001). There was a statistically significant smaller ratio at 8 out of 9 levels for thoracic aneurysms (P = .006 to P < .001), 12 out of 13 levels for thoracoabdominal aneurysms (P = .008 to P < .001), and 3 out of 4 levels for abdominal aneurysms compared with controls (P = .006 to P < .001).

CONCLUSIONS

Wall growth in aortic aneurysms is asymmetric, with greater aneurysmal growth in the anterior aorta wall and relative sparing of the portion of aortic wall between the intercostal or lumbar arteries. The mechanisms effecting this asymmetric growth have not been fully characterized.

摘要

目的

研究在动脉瘤发展过程中，壁的生长是否会使肋间动脉或腰动脉之间的主动脉壁得到保护，或者是否会在整个圆周上均匀生长。

方法

回顾性检查了一家大型学术机构的 155 名主动脉瘤患者（40 例胸主动脉瘤、50 例胸腹主动脉瘤和 65 例腹主动脉瘤）的计算机断层扫描，同时还检查了 100 名对照者（40 例胸主动脉和 60 例腹主动脉）的计算机断层扫描。在所有 255 名患者中，计算了肋间动脉或腰动脉起源之间的弧长（分支间弧长）与主动脉剩余周长的比值。在每个椎体水平上，将所有动脉瘤患者与对照组、胸主动脉瘤或胸腹主动脉瘤患者与对照组的这些比值进行比较。

结果

在动脉瘤患者中，分支间弧长和残余主动脉周长均大于对照组，但仅在 T4 及 T8 至 L4（P=0.009 至 P<0.001）和 T4 至 L4（P<0.001）水平差异有统计学意义。在 T4 至 L4 的 13 个水平中的 12 个水平（P=0.004 至 P<0.001），动脉瘤主动脉的分支间弧长与残余周长的比值明显小于对照组。在胸主动脉瘤的 9 个水平中有 8 个水平（P=0.006 至 P<0.001）、胸腹主动脉瘤的 13 个水平中有 12 个水平（P=0.008 至 P<0.001）和腹主动脉瘤的 4 个水平中有 3 个水平（P=0.006 至 P<0.001），其比值明显小于对照组。