CAJ | 학술논문

目的　探讨电子束CT（EBCT）诊断累及升主动脉及主动脉瓣的大动脉炎的临床价值。方法　自1996年4月至1999年9月，25例大动脉炎患者接受了EBCT检查。采用美国Imatron公司150-XP型EBCT扫描机, 扫描方式:采用增强单层容积扫描（SSM），扫描层厚3 mm，扫描时间0.1 s，心电门控；连续容积扫描（CVS），层厚3 mm，扫描时间0.1 s。非离子型对比剂，300 mgI/ml。其中17例累及升主动脉及主动脉瓣， 4例因重度主动脉瓣关闭不全行换瓣手术，病理诊断大动脉炎。2例2年后因瓣周漏再次行换瓣手术。结果　17例均有升主动脉壁不同程度的管壁增厚且延续至主动脉瓣水平；活动期10例动脉管壁增厚呈环状高密度影或分层状，内壁光滑。非活动期7例管壁增厚程度轻，呈低密度环。11例升主动脉扩张，左心室扩大，主动脉瓣中-重度关闭不全。4例手术换瓣患者病理所见符合大动脉炎所见。结论　大动脉炎基本CT征象是动脉壁增厚，累及升主动脉者可同时累及主动脉瓣，造成主动脉瓣关闭不全，活动期应为手术禁忌证。EBCT对检出此类大动脉炎有重要价值并且可反映大动脉炎的病程。
목적　탐토전자속CT（EBCT）진단루급승주동맥급주동맥판적대동맥염적림상개치。방법　자1996년4월지1999년9월，25례대동맥염환자접수료EBCT검사。채용미국Imatron공사150-XP형EBCT소묘궤, 소묘방식:채용증강단층용적소묘（SSM），소묘층후3 mm，소묘시간0.1 s，심전문공；련속용적소묘（CVS），층후3 mm，소묘시간0.1 s。비리자형대비제，300 mgI/ml。기중17례루급승주동맥급주동맥판， 4례인중도주동맥판관폐불전행환판수술，병리진단대동맥염。2례2년후인판주루재차행환판수술。결과　17례균유승주동맥벽불동정도적관벽증후차연속지주동맥판수평；활동기10례동맥관벽증후정배상고밀도영혹분층상，내벽광활。비활동기7례관벽증후정도경，정저밀도배。11례승주동맥확장，좌심실확대，주동맥판중-중도관폐불전。4례수술환판환자병리소견부합대동맥염소견。결론　대동맥염기본CT정상시동맥벽증후，루급승주동맥자가동시루급주동맥판，조성주동맥판관폐불전，활동기응위수술금기증。EBCT대검출차류대동맥염유중요개치병차가반영대동맥염적병정。
Objective　To evaluate the clinical value of EBCT in the diagnosis of aorto-arteritis (Takayasu′s disease) involving ascending aorta and aortic valve. Methods　EBCT was carried out by Imatron 150-XP system using contrast enhancement (non-ionic contrast media 300 mg I/ml) in 25 patients with aorto-arteritis during the period from Apr, 1996 to Sept, 1999. Among the series of 25 cases, ascending aorta and aortic valve were involved in 17 patients (14 females, 3 males). The age ranged from 11 to 58 years with mean age of (34±13) years. ECG gated single slice mode (SSM) was performed with slice thickness of 3 mm and scanning time of 0.1 s; continues volume scanning (CVS) was performed with slice thickness of 3 mm and scanning time of 0.1 s. The EBCT features of ascending aorta and aortic valve were analyzed in the 17 cases with aorto-arteritis. Four patients of these cases had severe aortic insufficiency and underwent operation of aortic valve replacement. Two years later, circumvalve leak occurred in two of these four cases and relived with aortic valve replacement again. Results　EBCT image showed the thickening of ascending aortic wall in all 17 cases, and all the lesions extended to the aortic valve. EBCT features of wall-thickening appeared as a concentric wall thickening or double density ring in 10 patients with active disease and low-density ring in 7 patients with inactive disease. 11 of these patients showed ascending aortic dilation with aortic valve regurgitation. Conclusion　Wall-thickening of aorta was the basic feature in EBCT images. According to our study, aorto-arteritis (Takayasu′s disease) involving ascending aorta can also involve aortic valve and resulte in aortic valve regurgitation. Active stage of aorto-arteritis was the contraindication of surgery therapy. EBCT was an important method for the diagnosis of aorto-arteritis (Takayasu′s arteritis) and the stage of aorto-arteritis can be reflected by EBCT.