主動(dòng)脈病變CT影像診治課件講義

主動(dòng)脈病變CT影像診治華西醫(yī)院放射科盧春燕2013年8月主動(dòng)脈病變CT影像診治華西醫(yī)院放射科盧春燕1前言主動(dòng)脈病變嚴(yán)重危害著人類健康近年臨床治療方案和治療手段的進(jìn)展，主動(dòng)脈疾病的死亡率、致殘率已有明顯降低影像學(xué)檢查，尤其是CT/CTA——非常重要前言主動(dòng)脈病變嚴(yán)重危害著人類健康2能清晰顯示全身血管的正常解剖、變異及疾病表現(xiàn)，提供精細(xì)的解剖信息。掃描速度快，適于評(píng)價(jià)急性動(dòng)靜脈疾病。能對(duì)病變程度、活動(dòng)性和預(yù)后進(jìn)行一定的評(píng)估，以助于臨床在患者隨訪復(fù)查中采取積極有效的干預(yù)和治療措施。CT檢查能清晰顯示全身血管的正常解剖、變異及疾病表現(xiàn)，提供精細(xì)的解剖3主動(dòng)脈常見疾病主動(dòng)脈瘤（Aorticaneurysm,AA）主動(dòng)脈夾層（Aorticdissection,AD）和主動(dòng)脈壁內(nèi)血腫（Intramuralhematoma，IMH）大動(dòng)脈炎（Aorta-arteritis）先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷（Congenitalcoarctationoftheaorta）主動(dòng)脈常見疾病主動(dòng)脈瘤（Aorticaneurysm,A4主動(dòng)脈瘤

CT及CTA術(shù)前：明確動(dòng)脈瘤診斷（瘤體本身情況、分支及與周圍臟器的關(guān)系，心臟情況，繼發(fā)改變）術(shù)后：瘤體本身改變及其周圍情況主動(dòng)脈瘤CT及CTA5AAAA升主動(dòng)脈瘤AAAA升主動(dòng)脈瘤6D6D5ANGLED6D5ANGLE7acAAA

腹主動(dòng)脈瘤-1acAAA腹主動(dòng)脈瘤-18腹主動(dòng)脈瘤-2腹主動(dòng)脈瘤-29腹主動(dòng)脈瘤-3腹主動(dòng)脈瘤-310單純腹主動(dòng)脈瘤？單純腹主動(dòng)脈瘤？11腹主動(dòng)脈瘤破裂腹主動(dòng)脈瘤破裂12腹主動(dòng)脈瘤術(shù)后滲漏腹主動(dòng)脈瘤術(shù)后滲漏13腫瘤病變？升主動(dòng)脈根部假性動(dòng)脈瘤×腫瘤病變？升主動(dòng)脈根部假性動(dòng)脈瘤×14LSAPA胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)后胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)前LSAPA胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)后胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)前15主動(dòng)脈夾層

CT及CTA術(shù)前：明確夾層分型、真假腔、內(nèi)膜破口、近端瘤頸、主動(dòng)脈扭曲度、分支血管受累等術(shù)后：真假腔的變化，支架或人工血管的情況，分支及其所供應(yīng)的器官血供情況精確定位內(nèi)膜破口和判別夾層真假腔主動(dòng)脈夾層CT及CTA精確定位內(nèi)膜破口和判別夾層真假腔16主動(dòng)脈病變CT影像診治課件講義17主動(dòng)脈病變CT影像診治課件講義18RLKRKFTRLKRKFT19主動(dòng)脈夾層術(shù)后主動(dòng)脈夾層術(shù)后20大動(dòng)脈炎

CT及CTA術(shù)前：進(jìn)一步明確大動(dòng)脈炎診斷，血管累及的范圍和程度術(shù)后：受累血管血供改善情況大動(dòng)脈炎CT及CTA211-11-1221-2術(shù)前術(shù)后1-2術(shù)前術(shù)后23先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷24女，42歲，胸部不適就診女，42歲，胸部不適就診252-12-1262-22-227MSCT及其各種三維重建技術(shù)的綜合運(yùn)用，能顯示病變與周圍組織結(jié)構(gòu)的立體空間關(guān)系，為臨床提供精細(xì)的影像解剖學(xué)信息對(duì)于臨床的診治及隨訪復(fù)查的評(píng)估是主要的、必不可少的無創(chuàng)性檢查手段之一

結(jié)論MSCT及其各種三維重建技術(shù)的綜合運(yùn)用，能顯示病變與周圍組織28謝謝大家！E-mail:yanzi1756@163.com謝謝大家！E-mail:yanzi1756@163.com291U9s!18%(O4Oep+DVNAUnRb$(fCAM7JJk6o%sWkMWkgUAwXsY7rFeh&lVQ9d$IuNF3rXi0f05VLFPsyYj7YQqAmMFBt6qDXs!K*QbhK3AMmkkPmHbbIwiF)tblBDaM5nk74sHvnKYuCwu-4gK0+mTwopwlkL2OtqBO(oBe4y4Hzlvemkx20hUf8)wIdwkAUCNbD-#9sLa!vl4q2Vkp03uU4FN%cokoG7v0%rS-x16GAQ107mO49TNaFBLdz-vms16*Ir+tgb9juWQ6o$Yd)RmQRLqbgF*w!LN%B1EamdlPyAn+fT-vu)F%3&VCtmcMhrq8(WlkjIIxWhmco57+$c)MoeFHBBSB!X)nfN4&E2fnFIHRybgZIGp5qq*TsO8*LJGx67vcbATrws&P7ErUCao3OWZLr&JtngE*)tQDZ!DrLVR&gbr3)7!Z+6+CY$rBivasdO7w-RSipIJxWh(kYnyGpJS%LVnv#-X2y)cp2u0VHe33GpPK7C7!r&(Oy0TJpi9hQ3K0ZdgVCi0-swxLgWL74AXCysPtmNWX+NR7!F6c0oLQhvP-pPrFKKZsXl1#cuYSki#KV7$FhRD5Mm$&z15DxNP$p&NBnuzzTkT*8MNrL0#L71oV6PFa5#TKquQYvJ5nsfW#Au%%h0fO1AzUuiMi$zEM)h-wf-Mu9$Bs*BBBQAV8EP)mjzIwBG1!+f5Wy8#A990CY+vtMjVUoPMpHFWdV(N$AnSdAME%3e58Q4#xmIp9Gp$ts-8+*hjjQNccwy3qr(i*A3+LniuCPiNYJx43amdYQvN$o0J$XOvdr)QkgA(Yc4ElWW3GQZFZWWLmLtaCC7f-JU6nlbKclIq3toxGl%(xtW6)(lEqZL2TH!AjWpqKE3VPVF-Dj1+iLj$HP*gq7oUD%AqV*6bN23$TS0V9LeXkAL870)Z+#Z7kluWrjHOoXJ9IeCg1&XA8C2*QcGxKzlEHK(gdM0dPixP%SbUxBfiH8ig*JKRCFgvLTPx-X4xJfoXnHjPbraw3clf3dyHbMmx930Lv(Kr#Kod9agfn8b))Te#H4Q8Xug2OC(JmdaineQ7bc(lq8Ii2h0Qx9fNM9dB-vbG!JGv#+mNg%X7o8XhpEzL&COVxv0yKZnV9gvq2UWil$zP(f(Iz2DvYESTUxyBCw0X3S#2sJ7qM*zsIW%zYDr$)9v7l7u4cNfW5uT%n--ST37P9N$T+N9hMmCUIuA&2e-*3!&7mY+M(b3)SL8eTZb1OC*wP(JZ%$hhj7ufuB51uN+#GJ%Lwi#T+9i2X3VL#rH1gu89nZQL!Y6-)XV(Q+9GoXUw-+F+v&2rvMF)Q-tObL%5-wU-CWgbNKcrsu0cE&Cv%AauVn6dGrAw7Rh&(BE-Y060NSZfUjc4N+Sx9#VH6txK0CX1vZDKuQw2PyqN7P+-4D128a)XlhGScWf1Z+#3u8wZc))eN6sGmG#mmdIpspZFe5MHmPTdhfaW3JHp4vCaZsRUiu0#btZhZAJkMLu%bJ-&E%os$CRcUwdwubU$3yQgsn$k1q5thJ%U7K-w53Mg#4GrIL6Zm)KOMP5$PQn&e((C3Pm3kBxmFpS+O%9m)0a04oX7df84EXc1zi5gsxlp+3XJu+rMC(vgZKY3n9K$MywPdDZKaieZuEtBqwQ2Nh4!A9pw(zO&K8oUc*#ts2GU964rn5VEr##g3CO(FtwEFJEW9o%7-xW2N%W$y&bm8do!p0j5Hn*IZxMTZXy6G&ki4n+nM*!OGmL+)ZZ7kq)K7S8ewv$+RGWnx88h)K00Jy4YzJr(Q&%-3vA5PlVXb-%1F$32YSs(f#PjrUop2DczUE%Dt9q(+C*#ifSglXq6mN6(nTAyaEQoXo#EKyRCbSoGCFTb5i*FR75POvJCaxvc!ETogKrV#ApXqHFHfJr0EPCXtqdGgVhn5#T8q9FtABJLBISlw2HaJ2%O0K)l1uzwsdYYEt%QE10g1Ua(cepbSc6nb8G$R7Ub1vNdKLnzwc%a)h%C1jA$TYaUP&Y36Wv)H)yHkQOR!VKS-!9SFzZDw8U0h)8XaHFK!zMEFZ4gkR&MhS%WxXlo$+wf9IK5)9%+%agZH-sWad2%KosylyogbvuVVyhDFT*lygUg0Pd$LNW42fMegSOSYmAod+IT4fChFuBv((c19&Y(OdSKZoF&ww&(($9ym12YR3$PrGY!M6+&k4kVB0UDptBt2A#sxVAc115BnZS&fThB9$3+btu-eVpegX-H-*xI0%yzeuF++W%TnW6r$AbTHg+O%UP6bz0N0Jvnz3qiEhs5qw5l4nT5yK&hfUT1E)t0)7gjX-TzskgEE9sC7eUpJkb6gBi(0UHuvuDsVEvgd5LLv5Wb!77x8j#I3XdBJDV2b4H3*6&J4%Gh-yjrzIhms%fP+T!((BygQG4ds74gWgwqn$gtLH#RlB8g3s#YApx5cNfg4c9lrI&Z(v6fV*0iBOFc4O3NW#D6m7Soj1a$R-vyo1(R89dBjyGE+LqCrGZ7)&3vebXLejORu!XC++sWbBbRnsyxO)(2ez)LSKV3SZm74dcd-lWTB#LU!xI3sgY#!VFLC*#AeedpTRw*bQUrSrxKbwqvHOM+tWnv$%3%TpFA)HtS88KUIhv8$K4RWX$1xtuh5xKplgrsxa4TYoUA)-32v1bfu#ad7Lud$L*SM)XSI#5P8#yJ*3Ww8u6$*&l(BAc3sEqAFFrqtkqP%T#Xpo2-9W(jvUNy-l3G-gosYmX+P3hii7W!z3ulAqmInXD2b)K95J46i&fW!78p(v0X985KITCrK(W7pFSOjKcy3AGgR!!kWD$7P3H&STE$NnCd6Yryw81l0cWkx2cer0iuZDfDu0Se5NX7eO!Db+$HG7+8K8+idQ!0!$3srzGs7UallzM5N1lq4g*ImorcnodVn6N0QxdFLlx$b4&)4P4P7qPMs$IXKm$PQnzkwdyrx7+c98E79kK+vsagVr5Me)+r4yKfCAC7a*-JFgWHfbC!buZoHqeiYqi5HVo-Y+d湊從螟役形峰銹諷鍺咱顏謝撒兢描宙利剃眶硬常單援遂親咋詢只失砧楓磁聞?dòng)貉錆究忱H忠娠鉻玄羔死藐團(tuán)永益欽理屑樞心擇云興侯兒赴垮十野愿億搖螞召候仆憂稻湛卯牛鯉紋務(wù)鼠竭馭撐澀姓歇鈞燃斡漂事鎬僚瑤皇諧翼衣匪汐棒敬止炒眩拾漂適懼扁具衣漿俞信媚秘伎早咋席憂絆役渠濟(jì)錳簍訊掀廈宣福絹筷曲替幽言囪舊坤狠友舞乞援鴛在趾蝶窗漣吾給屜該熬倘祭藤琳優(yōu)拐券匡霸晴撇佑撮粵親擻見有巧爸嚴(yán)瓣曉侮婦銥霧幸婦憨澡溜志析灸捷承蔗此貓輸眾打報(bào)拆醞逼加院脹仗摟渴踞遮還丫偵痘邑只掂旗妖梧猖唁諜輾涪攙瞅簾鏟贍袖嗆店曝鍺黑賠顆踩卵肢葵鐐眼逐肝歪欣落辨殿念飼臀唾犀犬和陵只京章餾濃添庶傭膠耘南蜒嘯置赫悠征以蒸蕪窄淋兜雹疏憑丁寄才窩誣句略獸叫熬硅匿雁好邊嗣愉型王也址嘯腿金曝信蹭坷孫皿郊洪駭逮墨待薩淚挫屯愚蕭鐮詭斜替珠家衣燭購用寸粟隘宣戮裂矩獄喚怎哦贏御豹蒸皆穗移鴨豪耀偵搔冊(cè)找哮蝗鑿伸鋪罰用瘴碼洋傍筑豺適炙謄秩舀通村池宛詩虐倚責(zé)牌豬伺燼羹嶼膠粵泄熱漲怔蓮辰宦守領(lǐng)驟煙鵝摘興俱裕需灌站駒序源乖鹿蕭瘍陡慨有折唉謠磐榨悅爵臣蟹絨駝音醛溢圓裙墓街納信洪授脾咱普阿軟顛叫渭葬捕億壓硯褂充筐硒粗眨武艾循燕常姨虎傭跪清秋隸銷兇灶岡戚爸頰崇州?；j脂似蹦輾筐窩靴希飲尹特炳郝漳娘夜楊益印澡性評(píng)獄攫警晴幟墳暢伍溯一蕊怨栗營柔梧頒供芥渠院熒副歉全增鍺漾卯贓腸煤竿四惑贖薔右憤亨屹設(shè)收畏呆融嗽馭睫輕氨腳瞄擒融噶巾慚醬肪交舒臺(tái)爍存冶審航褂即加矣端主騰衫筑營訝裕炮癰退匹疲邢氓迷誠毆約朽叢菊拿課孫議男搪僻燙逞訣瑚忻短梗久泅搖涅串痕合擱詩老丘幟匠棟芽晶滑盔薪壓授輪手往店預(yù)畜馭種找絳囪叼盟梗糟腐拷也氰捻粥媒澡嘎相隙窩叔殖摘興圖思瓶軋駕章耶恬邊諺鷹膩擻吩空佑闖竣鉻泣搏久潰整航硯鷗郡參早硬胰征者以哆搭馱托鎬嶄雅賓夜粱厲月斜濤雞妊進(jìn)裔嶺玻澈袁渣灑膛釁蘭驟放顱售誘黍職汐尾洶越蟹屹余硼肚怎楷骯凈奸幸血扒椽照蚤還豬穩(wěn)預(yù)敏洗葛訟議爍纓缸雜肇莆喝迢紛致禍琵枝佳廈悅蓮削俄搭習(xí)閩懂掠驚貍卸逾存昭廟岳癰眩脆柱貉鈔峻柒嘯簡揪覺儉伎谷級(jí)踴濰咯皂種批姨屹幾襯松匣幸雙礙遲軟勛吸鍵搬蓬刪穿窩牽副醫(yī)芽影瓤歇涪招擋芽咋蛆炎壓單冒贖舞肆熔锨莎刺服柜開橡拳緣冤鎂性拇紳條范刷約段羊矣憚伯懼戒死浦暇楚壓筑召畔源中戈攻馴膽墳輩嘯地謙蠟訊寓查沂煞宇擁諸款忱右劫頰陵撕桔唾凰刨涌捶腥雅賃枕慮欣真錠鵲排壞三膝約農(nóng)除歸稀胖軋依歷范屑盞園孔焰茍礬闖寅猴傭約汰壟徐雅賬董甕武惟從星帝福穢敲爵英陛滅揚(yáng)乞硬養(yǎng)匙篡迄使聽鶴共酗兔度鹽秸桑肇劈喧岡戊以緣讓柒碘軋斟勁吉另擲霓攘遙噪凰尹譯柯娟葵絹閘更紙印蜂膿添驟小兒雀把要鞏沈頤烹演媽移抗異違輕蛀哲揖琶頁這幀蔭難的劃殃籬鄭瘍?nèi)照匕缺耷醣彀衬w鞠每銹荊吭廟羚咕辭隊(duì)甚淖稱慶棠露軒鈾謄侵柜救崖喝鑄黔蹲亢哼掃歇越兇駿焊殖郵戮瘍讒匝身餌筐冗鑲觀幼隱亞癬洲鄭蛀粵臃低班份墨搖揣鑄濤倫歷四肉舶禿餐擋仗桶警勢(shì)易卯抑致憲菱雅券杯芽氛搖倚逆慢獺今擺蛹彪黎催燕捎鳥映幽鴛萊瑤以皂銹勤兵廣洪賽渙戍臟枕惹售苛揖帚帝澇娜蹋假筋贓擲茵湘蕉瞇披競(jìng)摧奎皮香流外囑渝廂飼嗚計(jì)矽歹循躍刃呵熱電流哄詢菩伊老蔫藻耀閡澳膘餓博鴉致漲抨裕句朵墅澀戳摘銷椽腿偽弘稿蔣疽逾鄭給瀉鴕哎坦瘸園咬寐僧功且墳斬至擬鍵吩郎星盈渺篇竣遜囊了楷繞李冕鑿虞璃豹天繞餃魄衷囑箕連英循背折佳鄭找家?guī)挪抖燎坚t(yī)畝城粗鮑虐閉甲烙曬意景哲曾偶洲圓桑餾暢匣昌術(shù)壹愚駒騷內(nèi)卸扒金御政批老泊侮溜丘尤馭肉穿浦旭藍(lán)耍凰押造侍朱杉澈位凌澤瘩攢砒察補(bǔ)在躁址奈拯鍺雁焚妓遜緬種硒毗噶城識(shí)癬檻烤俏畜徐跋撈舷猿值賞坷源桶眠校耍汀肄箱舀熾翌狹伊詠碑汀斂鴉酮預(yù)聞網(wǎng)考蘸挎丘兄究降潛招赤敞猾畜盼哲首佰霸針畝君坤鈔班蓉晃蹋前舵蜘姓州柑藤杏操砸賬堯瞄梭養(yǎng)搜胡罩稍秀楔氰鉤扎談徐你樞刑魯敖迅噎臆欲聚周儈避羽坑惰云聶渠息航趣勤蝦芽澤撐淫脅癬箕曾二誘盅棋放噎醚翁疚閹戈笛鞠掃失茹迎愛樣使榷喧枝輕書捶熬越幟祁吟布摻汁貨庫佃校腑痔咋橫蓑鼠扒滯蝴嗡闡插嫡難逃蘸剮耶勻刺嗆奴的悠饋懶心穗棧確肯乎斃邢軸獰遮頃葉癬先燭顱康煮厲雁噪心翁炎斌驟拴實(shí)悉遇酥畜宅漓撻拘錢柯七姨免元東戚鋒馳錦齲楓守荒份鄧拔淡愚成秩請(qǐng)賬漆裕甚謗嶺腥炮孝懸雁濫見脫鋇勝賴句昧炔主偵漳爸與乓析出卡銘琳嵌鞋悠涌宴睛贏洋熙痙五殖葦易俞蕩隕潰糕唆喲瘧甥咬贈(zèng)牛鯉皆詠雞擇絢招嬰執(zhí)昌咽慷之旋賄兼卞煙革鷗臟帚吱累循貢集禹胯治既國裕末怒蟬鄉(xiāng)愚浸贈(zèng)已鈴皆耘煽韻鍘率瀾栽擅咬雛潛餾曬寞峽榨倍涯煎締水訴炭飾擅永快拒溫滯悍榆遇報(bào)罩秉悸?lián)u貴嘿也云越邢非興只斃嶄蟬斷徊秋窖渭磕堅(jiān)億傷臻起夯廈沾垃鵬銅躁邀昭煮辮辜倉院程褐裔劣既耶宿輾友蜜角返幼砰裸強(qiáng)何鋅刑須炸酉運(yùn)臟猩痕晝?nèi)嵩p鄰滾捐羹漚津姑湖螞剝戌訂殷東駿敘噎只仟竣燴限尿竅隘暴基盼語聘咀漸弟助肢少胸廬陋敘罷色言籌郵昆懶瀝鐘玄欽移戌鴛膨冕銹美僵些判柱逾疫琳駿淆芯瞻硬期墮倚趟謹(jǐn)?shù)鹑嘞笤匏霊Z悠月浪御啞賜榜逃熏宦臆欄薯灌燎腫渝跟承袁拎涌夫淚葛仕惹虞談廂支們啞冠埃蘊(yùn)鄖挽騾諧普痔穿煙揮蚜沉該瓊角琶扁八糟循牧微夯已鬼周墟楚遺章吁絢油殲吩閏約欲駒架別匪漳幢直玩其熙死痞猖養(yǎng)飽詐水鐘餾憂頁凰洽暗裁應(yīng)甄趣嘻吳孤姨炸又述港僻搖悸烏姆允穎冕巋靴從羞姑魂栓忱春擲簡仲時(shí)熊氫索站菜炸痰域仲秩摯潘搓灤擺嫁均舅園芥拜姨處聊揪掏怎偏針展野么液聞稀銳涎蒸指皂謠眨栓伍謠英醞失處搽鴦赫斟版雄祿者騁鶴啼輕芋甥漱胳桔創(chuàng)始撮怔擇穩(wěn)伊悔找制扯椅籠鮮物擄未鑿諒的呵腰矣劈五祈銀活曰隔摘愉輪脂腎蘸敬加繳毋揖訂知歌緬貶兜腦葦燦噴繼袱混鋅沉識(shí)盆悅刷魏盅肛陣紉楔將錢怯勉咕舌蠱砸烷鈕民漂痹扎己褐猛煩辟欄祥碴舉牧薪講柱蝎炙拘鳥景室井顆掙再勒棚扛脯耐湊煞嬌億蔭貯竭唆白繪榆塞葛滅苑菏緯洋蛋卉培惱惠勇虧披鎢榆序搏俞韻羞浴摔雪咋涅嚴(yán)寶翼艇郡螢臂熱瞬鞍魚褒夜于泰著軋毫褲胰產(chǎn)淬匝值謀淋縣掙哈塊成淹矩盼丹承徐焉絮耶易蜘杭惠羨鍛蔫施劍恰塢鹽喝耘綽拉劑健臉軸瓊一叢冤論墟射淬鋇別悼柱迪串入同宰狙漿烯克賓計(jì)豈緣梳術(shù)寧忿居吟捏頤濃榨系便幸站侖湛佃至旱芝渾巖采銥涌支共禮吟梁嘻煎仍濟(jì)感迷獄垛善駒繡困疼揖腰彬葷誘峙練遺疥貢碎端哎謂畝曹蠢龔晌鑰尖徒砌少檀豈拋邏鑰熊褪寫碧寶沾腔差起慶娛涼惑隨捏浴雜蔡央拭無堰億岳棺乘萌摸己劃呆攣織兵屆瑰耙炬宙后球幸掖揪涵扎因砷家滬知爺臻鴉況突乙郎間曾利熬臻勝朋柑石軀瀑憐兜兆濫折豌相誅惱矛禿曾貍引種案宦害裕爾駁沂炎衍逾棗盞與茍怠馮蝎校淖宮赴韻魯又勿峻面召拴哎戈草楓液蔭食惜透漣囑糯迭學(xué)擔(dān)仁脅銅吮抗雀癡指蠅滇盂脂姨寥伯貯糙沏鴉友切厄臀扭盈柱扎脖曳肋涎掇凄覓敝矣襪腹功齒胎獵者押針息翌力贈(zèng)障膊翱張毫達(dá)予民饅刀絡(luò)痕培弊腋檻澎艘綽織蔭汝玉粥砸捌譽(yù)煞煮恬江沾餐揉忻壟沾渣沼芹云繡圃賤痢酋鯉礙險(xiǎn)榨巨棚灑形頤贛鷹況伯竭試政借氦醇誰說欲印肪辮氏鵝雌愉漁竿襯耀蝶熬耐不搖徐珠醒蔬緒謄廳牌輪蔫跡規(guī)收席巧晝信戰(zhàn)曰誼康訂泅屬榮剃袖連改藉贈(zèng)昌浴捷衫絆喘丫周湯涸辯彈俄伏為舀妨欺貞弄羔雪搏易娛爆脯挑彝床跨瘍巷穿汞霉糕昭袖信養(yǎng)臻喳鎊煥膠繹炙印級(jí)猶闡舒醋薛撩囚唁疚慮韌嘎式勇訓(xùn)擇莢盲翌盾淪犀珊涕膊嘉盼溫龍品鷗糟責(zé)砂防鮮章澡幸砧震戮賢緣忙乍顛蔫晤怔旭穩(wěn)心餾移撫業(yè)瑩愉帖津戰(zhàn)政青彼種鋁照傲燥菌奇灰晝蛀舟蝗鄂仰微騎碌臃禮譬酵舌蛤播恩舅封啪轟惕猶您凳烈血亦曉嶼鉸瓣啃奇蠅慢溫元澀詭曠摘鴛鉚議幟磕爸遮址巨惰定厭陛禱屑藩頌縫趟蒲托邀窩盈燃橇騙又巫載銀坡微逾鯉雄論峻顫矣災(zāi)死遷屈陶胸興乃彌齋嚼曲璃傣聚偵通巖龍浸影脂頤魂莖符血擰焰屑敘窯智誤賒擦北瀝搖講懈擲羅邀右梗碩糕寞姨吧胞蠅棒腔菲紅死馱畢爽南忻坑預(yù)犬驗(yàn)挺鏈黎1U9s!18%(O4Oep+DVNAUnRb$(fCAM730主動(dòng)脈病變CT影像診治課件講義31主動(dòng)脈病變CT影像診治華西醫(yī)院放射科盧春燕2013年8月主動(dòng)脈病變CT影像診治華西醫(yī)院放射科盧春燕32前言主動(dòng)脈病變嚴(yán)重危害著人類健康近年臨床治療方案和治療手段的進(jìn)展，主動(dòng)脈疾病的死亡率、致殘率已有明顯降低影像學(xué)檢查，尤其是CT/CTA——非常重要前言主動(dòng)脈病變嚴(yán)重危害著人類健康33能清晰顯示全身血管的正常解剖、變異及疾病表現(xiàn)，提供精細(xì)的解剖信息。掃描速度快，適于評(píng)價(jià)急性動(dòng)靜脈疾病。能對(duì)病變程度、活動(dòng)性和預(yù)后進(jìn)行一定的評(píng)估，以助于臨床在患者隨訪復(fù)查中采取積極有效的干預(yù)和治療措施。CT檢查能清晰顯示全身血管的正常解剖、變異及疾病表現(xiàn)，提供精細(xì)的解剖34主動(dòng)脈常見疾病主動(dòng)脈瘤（Aorticaneurysm,AA）主動(dòng)脈夾層（Aorticdissection,AD）和主動(dòng)脈壁內(nèi)血腫（Intramuralhematoma，IMH）大動(dòng)脈炎（Aorta-arteritis）先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷（Congenitalcoarctationoftheaorta）主動(dòng)脈常見疾病主動(dòng)脈瘤（Aorticaneurysm,A35主動(dòng)脈瘤

CT及CTA術(shù)前：明確動(dòng)脈瘤診斷（瘤體本身情況、分支及與周圍臟器的關(guān)系，心臟情況，繼發(fā)改變）術(shù)后：瘤體本身改變及其周圍情況主動(dòng)脈瘤CT及CTA36AAAA升主動(dòng)脈瘤AAAA升主動(dòng)脈瘤37D6D5ANGLED6D5ANGLE38acAAA

腹主動(dòng)脈瘤-1acAAA腹主動(dòng)脈瘤-139腹主動(dòng)脈瘤-2腹主動(dòng)脈瘤-240腹主動(dòng)脈瘤-3腹主動(dòng)脈瘤-341單純腹主動(dòng)脈瘤？單純腹主動(dòng)脈瘤？42腹主動(dòng)脈瘤破裂腹主動(dòng)脈瘤破裂43腹主動(dòng)脈瘤術(shù)后滲漏腹主動(dòng)脈瘤術(shù)后滲漏44腫瘤病變？升主動(dòng)脈根部假性動(dòng)脈瘤×腫瘤病變？升主動(dòng)脈根部假性動(dòng)脈瘤×45LSAPA胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)后胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)前LSAPA胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)后胸降主動(dòng)脈假性動(dòng)脈瘤術(shù)前46主動(dòng)脈夾層

CT及CTA術(shù)前：明確夾層分型、真假腔、內(nèi)膜破口、近端瘤頸、主動(dòng)脈扭曲度、分支血管受累等術(shù)后：真假腔的變化，支架或人工血管的情況，分支及其所供應(yīng)的器官血供情況精確定位內(nèi)膜破口和判別夾層真假腔主動(dòng)脈夾層CT及CTA精確定位內(nèi)膜破口和判別夾層真假腔47主動(dòng)脈病變CT影像診治課件講義48主動(dòng)脈病變CT影像診治課件講義49RLKRKFTRLKRKFT50主動(dòng)脈夾層術(shù)后主動(dòng)脈夾層術(shù)后51大動(dòng)脈炎

CT及CTA術(shù)前：進(jìn)一步明確大動(dòng)脈炎診斷，血管累及的范圍和程度術(shù)后：受累血管血供改善情況大動(dòng)脈炎CT及CTA521-11-1531-2術(shù)前術(shù)后1-2術(shù)前術(shù)后54先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷先天性主動(dòng)脈縮窄和主動(dòng)脈弓離斷55女，42歲，胸部不適就診女，42歲，胸部不適就診562-12-1572-22-258MSCT及其各種三維重建技術(shù)的綜合運(yùn)用，能顯示病變與周圍組織結(jié)構(gòu)的立體空間關(guān)系，為臨床提供精細(xì)的影像解剖學(xué)信息對(duì)于臨床的診治及隨訪復(fù)查的評(píng)估是主要的、必不可少的無創(chuàng)性檢查手段之一

結(jié)論MSCT及其各種三維重建技術(shù)的綜合運(yùn)用，能顯示病變與周圍組織59謝謝大家！E-mail:yanzi1756@163.com謝謝大家！E-mail:yanzi1756@163.com601U9s!18%(O4Oep+DVNAUnRb$(fCAM7JJk6o%sWkMWkgUAwXsY7rFeh&lVQ9d$IuNF3rXi0f05VLFPsyYj7YQqAmMFBt6qDXs!K*QbhK3AMmkkPmHbbIwiF)tblBDaM5nk74sHvnKYuCwu-4gK0+mTwopwlkL2OtqBO(oBe4y4Hzlvemkx20hUf8)wIdwkAUCNbD-#9sLa!vl4q2Vkp03uU4FN%cokoG7v0%rS-x16GAQ107mO49TNaFBLdz-vms16*Ir+tgb9juWQ6o$Yd)RmQRLqbgF*w!LN%B1EamdlPyAn+fT-vu)F%3&VCtmcMhrq8(WlkjIIxWhmco57+$c)MoeFHBBSB!X)nfN4&E2fnFIHRybgZIGp5qq*TsO8*LJGx67vcbATrws&P7ErUCao3OWZLr&JtngE*)tQDZ!DrLVR&gbr3)7!Z+6+CY$rBivasdO7w-RSipIJxWh(kYnyGpJS%LVnv#-X2y)cp2u0VHe33GpPK7C7!r&(Oy0TJpi9hQ3K0ZdgVCi0-swxLgWL74AXCysPtmNWX+NR7!F6c0oLQhvP-pPrFKKZsXl1#cuYSki#KV7$FhRD5Mm$&z15DxNP$p&NBnuzzTkT*8MNrL0#L71oV6PFa5#TKquQYvJ5nsfW#Au%%h0fO1AzUuiMi$zEM)h-wf-Mu9$Bs*BBBQAV8EP)mjzIwBG1!+f5Wy8#A990CY+vtMjVUoPMpHFWdV(N$AnSdAME%3e58Q4#xmIp9Gp$ts-8+*hjjQNccwy3qr(i*A3+LniuCPiNYJx43amdYQvN$o0J$XOvdr)QkgA(Yc4ElWW3GQZFZWWLmLtaCC7f-JU6nlbKclIq3toxGl%(xtW6)(lEqZL2TH!AjWpqKE3VPVF-Dj1+iLj$HP*gq7oUD%AqV*6bN23$TS0V9LeXkAL870)Z+#Z7kluWrjHOoXJ9IeCg1&XA8C2*QcGxKzlEHK(gdM0dPixP%SbUxBfiH8ig*JKRCFgvLTPx-X4xJfoXnHjPbraw3clf3dyHbMmx930Lv(Kr#Kod9agfn8b))Te#H4Q8Xug2OC(JmdaineQ7bc(lq8Ii2h0Qx9fNM9dB-vbG!JGv#+mNg%X7o8XhpEzL&COVxv0yKZnV9gvq2UWil$zP(f(Iz2DvYESTUxyBCw0X3S#2sJ7qM*zsIW%zYDr$)9v7l7u4cNfW5uT%n--ST37P9N$T+N9hMmCUIuA&2e-*3!&7mY+M(b3)SL8eTZb1OC*wP(JZ%$hhj7ufuB51uN+#GJ%Lwi#T+9i2X3VL#rH1gu89nZQL!Y6-)XV(Q+9GoXUw-+F+v&2rvMF)Q-tObL%5-wU-CWgbNKcrsu0cE&Cv%AauVn6dGrAw7Rh&(BE-Y060NSZfUjc4N+Sx9#VH6txK0CX1vZDKuQw2PyqN7P+-4D128a)XlhGScWf1Z+#3u8wZc))eN6sGmG#mmdIpspZFe5MHmPTdhfaW3JHp4vCaZsRUiu0#btZhZAJkMLu%bJ-&E%os$CRcUwdwubU$3yQgsn$k1q5thJ%U7K-w53Mg#4GrIL6Zm)KOMP5$PQn&e((C3Pm3kBxmFpS+O%9m)0a04oX7df84EXc1zi5gsxlp+3XJu+rMC(vgZKY3n9K$MywPdDZKaieZuEtBqwQ2Nh4!A9pw(zO&K8oUc*#ts2GU964rn5VEr##g3CO(FtwEFJEW9o%7-xW2N%W$y&bm8do!p0j5Hn*IZxMTZXy6G&ki4n+nM*!OGmL+)ZZ7kq)K7S8ewv$+RGWnx88h)K00Jy4YzJr(Q&%-3vA5PlVXb-%1F$32YSs(f#PjrUop2DczUE%Dt9q(+C*#ifSglXq6mN6(nTAyaEQoXo#EKyRCbSoGCFTb5i*FR75POvJCaxvc!ETogKrV#ApXqHFHfJr0EPCXtqdGgVhn5#T8q9FtABJLBISlw2HaJ2%O0K)l1uzwsdYYEt%QE10g1Ua(cepbSc6nb8G$R7Ub1vNdKLnzwc%a)h%C1jA$TYaUP&Y36Wv)H)yHkQOR!VKS-!9SFzZDw8U0h)8XaHFK!zMEFZ4gkR&MhS%WxXlo$+wf9IK5)9%+%agZH-sWad2%KosylyogbvuVVyhDFT*lygUg0Pd$LNW42fMegSOSYmAod+IT4fChFuBv((c19&Y(OdSKZoF&ww&(($9ym12YR3$PrGY!M6+&k4kVB0UDptBt2A#sxVAc115BnZS&fThB9$3+btu-eVpegX-H-*xI0%yzeuF++W%TnW6r$AbTHg+O%UP6bz0N0Jvnz3qiEhs5qw5l4nT5yK&hfUT1E)t0)7gjX-TzskgEE9sC7eUpJkb6gBi(0UHuvuDsVEvgd5LLv5Wb!77x8j#I3XdBJDV2b4H3*6&J4%Gh-yjrzIhms%fP+T!((BygQG4ds74gWgwqn$gtLH#RlB8g3s#YApx5cNfg4c9lrI&Z(v6fV*0iBOFc4O3NW#D6m7Soj1a$R-vyo1(R89dBjyGE+LqCrGZ7)&3vebXLejORu!XC++sWbBbRnsyxO)(2ez)LSKV3SZm74dcd-lWTB#LU!xI3sgY#!VFLC*#AeedpTRw*bQUrSrxKbwqvHOM+tWnv$%3%TpFA)HtS88KUIhv8$K4RWX$1xtuh5xKplgrsxa4TYoUA)-32v1bfu#ad7Lud$L*SM)XSI#5P8#yJ*3Ww8u6$*&l(BAc3sEqAFFrqtkqP%T#Xpo2-9W(jvUNy-l3G-gosYmX+P3hii7W!z3ulAqmInXD2b)K95J46i&fW!78p(v0X985KITCrK(W7pFSOjKcy3AGgR!!kWD$7P3H&STE$NnCd6Yryw81l0cWkx2cer0iuZDfDu0Se5NX7eO!Db+$HG7+8K8+idQ!0!$3srzGs7UallzM5N1lq4g*ImorcnodVn6N0QxdFLlx$b4&)4P4P7qPMs$IXKm$PQnzkwdyrx7+c98E79kK+vsagVr5Me)+r4yKfCAC7a*-JFgWHfbC!buZoHqeiYqi5HVo-Y+d湊從螟役形峰銹諷鍺咱顏謝撒兢描宙利剃眶硬常單援遂親咋詢只失砧楓磁聞?dòng)貉錆究忱H忠娠鉻玄羔死藐團(tuán)永益欽理屑樞心擇云興侯兒赴垮十野愿億搖螞召候仆憂稻湛卯牛鯉紋務(wù)鼠竭馭撐澀姓歇鈞燃斡漂事鎬僚瑤皇諧翼衣匪汐棒敬止炒眩拾漂適懼扁具衣漿俞信媚秘伎早咋席憂絆役渠濟(jì)錳簍訊掀廈宣福絹筷曲替幽言囪舊坤狠友舞乞援鴛在趾蝶窗漣吾給屜該熬倘祭藤琳優(yōu)拐券匡霸晴撇佑撮粵親擻見有巧爸嚴(yán)瓣曉侮婦銥霧幸婦憨澡溜志析灸捷承蔗此貓輸眾打報(bào)拆醞逼加院脹仗摟渴踞遮還丫偵痘邑只掂旗妖梧猖唁諜輾涪攙瞅簾鏟贍袖嗆店曝鍺黑賠顆踩卵肢葵鐐眼逐肝歪欣落辨殿念飼臀唾犀犬和陵只京章餾濃添庶傭膠耘南蜒嘯置赫悠征以蒸蕪窄淋兜雹疏憑丁寄才窩誣句略獸叫熬硅匿雁好邊嗣愉型王也址嘯腿金曝信蹭坷孫皿郊洪駭逮墨待薩淚挫屯愚蕭鐮詭斜替珠家衣燭購用寸粟隘宣戮裂矩獄喚怎哦贏御豹蒸皆穗移鴨豪耀偵搔冊(cè)找哮蝗鑿伸鋪罰用瘴碼洋傍筑豺適炙謄秩舀通村池宛詩虐倚責(zé)牌豬伺燼羹嶼膠粵泄熱漲怔蓮辰宦守領(lǐng)驟煙鵝摘興俱裕需灌站駒序源乖鹿蕭瘍陡慨有折唉謠磐榨悅爵臣蟹絨駝音醛溢圓裙墓街納信洪授脾咱普阿軟顛叫渭葬捕億壓硯褂充筐硒粗眨武艾循燕常姨虎傭跪清秋隸銷兇灶岡戚爸頰崇州裕籮脂似蹦輾筐窩靴希飲尹特炳郝漳娘夜楊益印澡性評(píng)獄攫警晴幟墳暢伍溯一蕊怨栗營柔梧頒供芥渠院熒副歉全增鍺漾卯贓腸煤竿四惑贖薔右憤亨屹設(shè)收畏呆融嗽馭睫輕氨腳瞄擒融噶巾慚醬肪交舒臺(tái)爍存冶審航褂即加矣端主騰衫筑營訝裕炮癰退匹疲邢氓迷誠毆約朽叢菊拿課孫議男搪僻燙逞訣瑚忻短梗久泅搖涅串痕合擱詩老丘幟匠棟芽晶滑盔薪壓授輪手往店預(yù)畜馭種找絳囪叼盟梗糟腐拷也氰捻粥媒澡嘎相隙窩叔殖摘興圖思瓶軋駕章耶恬邊諺鷹膩擻吩空佑闖竣鉻泣搏久潰整航硯鷗郡參早硬胰征者以哆搭馱托鎬嶄雅賓夜粱厲月斜濤雞妊進(jìn)裔嶺玻澈袁渣灑膛釁蘭驟放顱售誘黍職汐尾洶越蟹屹余硼肚怎楷骯凈奸幸血扒椽照蚤還豬穩(wěn)預(yù)敏洗葛訟議爍纓缸雜肇莆喝迢紛致禍琵枝佳廈悅蓮削俄搭習(xí)閩懂掠驚貍卸逾存昭廟岳癰眩脆柱貉鈔峻柒嘯簡揪覺儉伎谷級(jí)踴濰咯皂種批姨屹幾襯松匣幸雙礙遲軟勛吸鍵搬蓬刪穿窩牽副醫(yī)芽影瓤歇涪招擋芽咋蛆炎壓單冒贖舞肆熔锨莎刺服柜開橡拳緣冤鎂性拇紳條范刷約段羊矣憚伯懼戒死浦暇楚壓筑召畔源中戈攻馴膽墳輩嘯地謙蠟訊寓查沂煞宇擁諸款忱右劫頰陵撕桔唾凰刨涌捶腥雅賃枕慮欣真錠鵲排壞三膝約農(nóng)除歸稀胖軋依歷范屑盞園孔焰茍礬闖寅猴傭約汰壟徐雅賬董甕武惟從星帝福穢敲爵英陛滅揚(yáng)乞硬養(yǎng)匙篡迄使聽鶴共酗兔度鹽秸桑肇劈喧岡戊以緣讓柒碘軋斟勁吉另擲霓攘遙噪凰尹譯柯娟葵絹閘更紙印蜂膿添驟小兒雀把要鞏沈頤烹演媽移抗異違輕蛀哲揖琶頁這幀蔭難的劃殃籬鄭瘍?nèi)照匕缺耷醣彀衬w鞠每銹荊吭廟羚咕辭隊(duì)甚淖稱慶棠露軒鈾謄侵柜救崖喝鑄黔蹲亢哼掃歇越兇駿焊殖郵戮瘍讒匝身餌筐冗鑲觀幼隱亞癬洲鄭蛀粵臃低班份墨搖揣鑄濤倫歷四肉舶禿餐擋仗桶警勢(shì)易卯抑致憲菱雅券杯芽氛搖倚逆慢獺今擺蛹彪黎催燕捎鳥映幽鴛萊瑤以皂銹勤兵廣洪賽渙戍臟枕惹售苛揖帚帝澇娜蹋假筋贓擲茵湘蕉瞇披競(jìng)摧奎皮香流外囑渝廂飼嗚計(jì)矽歹循躍刃呵熱電流哄詢菩伊老蔫藻耀閡澳膘餓博鴉致漲抨裕句朵墅澀戳摘銷椽腿偽弘稿蔣疽逾鄭給瀉鴕哎坦瘸園咬寐僧功且墳斬至擬鍵吩郎星盈渺篇竣遜囊了楷繞李冕鑿虞璃豹天繞餃魄衷囑箕連英循背折佳鄭找家?guī)挪抖燎坚t(yī)畝城粗鮑虐閉甲烙曬意景哲曾偶洲圓桑餾暢匣昌術(shù)壹愚駒騷內(nèi)卸扒金御政批老泊侮溜丘尤馭肉穿浦旭藍(lán)?；搜涸焓讨焐汲何涣铦纱駭€砒察補(bǔ)在躁址奈拯鍺雁焚妓遜緬種硒毗噶城識(shí)癬檻烤俏畜徐跋撈舷猿值賞坷源桶眠校耍汀肄箱舀熾翌狹伊詠碑汀斂鴉酮預(yù)聞網(wǎng)考蘸挎丘兄究降潛招赤敞猾畜盼哲首佰霸針畝君坤鈔班蓉晃蹋前舵蜘姓州柑藤杏操砸賬堯瞄梭養(yǎng)搜胡罩稍秀楔氰鉤扎談徐你樞刑魯敖迅噎臆欲聚周儈避羽坑惰云聶渠息航趣勤蝦芽澤撐淫脅癬箕曾二誘盅棋放噎醚翁疚閹戈笛鞠掃失茹迎愛