Pernes J M, Grenier P, Desbleds M T, de Brux J L
Service de Radiologie Cardio-Vasculaire, Hôpital Broussais, Paris, France.
J Comput Assist Tomogr. 1987 Nov-Dec;11(6):975-81. doi: 10.1097/00004728-198711000-00009.
Thirty patients with suspected or known chronic aortic dissection were imaged with magnetic resonance (MR), CT, and angiography. Five of these patients had previously undergone surgical repair of the ascending aorta for a type A dissection. Magnetic resonance demonstrated an intimal flap and a double lumen in 25 cases. In four cases with a thrombosed false lumen, proved angiographically, an intimal flap and double channel were not seen. In two of four aortic dissections with a thrombosed false lumen, CT made the diagnosis by showing displaced intimal calcifications not visualized on MR. In one case the aortic dissection was made on CT and angiography but was not supported by MR which showed an aortic aneurysm, subsequently confirmed at surgery. Magnetic resonance, CT, and aortography differentiated between type A (nine patients) or B (20 patients) dissection in all cases and demonstrated extension into the abdominal aorta. Extension into the iliac arteries was seen on MR in three patients but missed in nine patients. Magnetic resonance differentiated the true and false lumen in all but one case. Thrombosis of the false channel was identified in four cases by a decrease in signal intensity on the second echo image. Cardiac gating and longitudinal contiguous sections seemed to be more suitable for appreciation of the relationships with arch vessels. Transverse contiguous slices allowed determination of the origin of celiac, mesenteric, and renal arteries from either the true or the false lumen. This study confirms that MR is an accurate and noninvasive method for the evaluation and follow-up of chronic aortic dissection, obviating the need for iodinated contrast media.
30例疑似或确诊为慢性主动脉夹层的患者接受了磁共振成像（MR）、CT和血管造影检查。其中5例患者此前因A型夹层接受了升主动脉手术修复。磁共振成像显示25例存在内膜瓣和双腔。在4例经血管造影证实为假腔血栓形成的病例中，未发现内膜瓣和双通道。在4例假腔血栓形成的主动脉夹层中，有2例CT通过显示磁共振成像未发现的移位内膜钙化做出诊断。1例患者CT和血管造影诊断为主动脉夹层，但磁共振成像显示为主动脉瘤，随后手术证实。磁共振成像、CT和主动脉造影在所有病例中均能区分A型（9例患者）或B型（20例患者）夹层，并显示夹层延伸至腹主动脉。3例患者磁共振成像显示夹层延伸至髂动脉，但9例患者未发现。除1例病例外，磁共振成像在所有病例中均能区分真腔和假腔。4例病例通过第二回波图像信号强度降低确定了假腔血栓形成。心脏门控和纵向连续切片似乎更适合观察与主动脉弓血管的关系。横向连续切片可确定腹腔干、肠系膜动脉和肾动脉是起源于真腔还是假腔。本研究证实，磁共振成像是评估和随访慢性主动脉夹层的一种准确且无创的方法，无需使用碘化造影剂。
