目的主要探讨主动脉夹层动脉 瘤的CT平扫诊断方案及理论依据，提高CT 平扫筛查正确率，降低误诊、漏诊率。方 法 2名有经验的放射科医生对58例疑似主 动脉夹层动脉瘤患者的CT平扫影像进行分 析，并对一致认为与主动脉夹层动脉瘤相 关的CT预期征象进行记录。其中7种CT征 象被纳入本研究中，其中包括：管腔密度 不均、内膜瓣钙化内移、主动脉管径增 宽、纵膈积血、心包积液、胸腔积液、双 肺炎症，最终58例患者中有39例被CTA确 诊为主动脉夹层动脉瘤；本研究采用?2检 验或Fisher检验探讨CT平扫征象与主动脉 夹层动脉瘤的相关性，并通过ROC曲线分 析探索了主动脉夹层动脉瘤的诊断方案。 结果 单因素分析显示，管腔密度不均 (P<0.001)、内膜瓣钙化内移(P=0.002)、 胸腔积液(P=0.001)与主动脉夹层动脉瘤 存在明显的相关性。通过联合的ROC曲线 分析构建了三个模型：模型一以“管腔密 度不均”作为诊断依据；模型二以“管腔 密度不均”和“内膜瓣钙化内移”作为诊 断依据；模型三以“管腔密度不均”、 “内膜瓣钙化内移”及“胸腔积液”三个 征象作为诊断依据。结论 综合利用CT平 扫的“管腔密度不均”和“内膜瓣钙化内 移”及“胸腔积液”三个征象同时存在对 前期筛查主动脉夹层动脉瘤中具有重要意 义。

Objective Mainly discusses CT scan in the diagnosis of aortic dissecting aneurysm scheme and theoretical basis for improving CT scan screening accuracy, reduce misdiagnosis and missed diagnosis. Methods Two experienced radiologists have analyzed 58 CT scan images of suspected aortic dissecting aneurysm patient, and recording the expected to CT sign which is associated with aortic dissecting aneurysm. Seven kinds of CT manifestations were included in this study, including: lumen uneven density, endometrium valve calcification of aortic diameter broadening, mediastinal hemorrhage, pericardial effusion, pleural effusion, double pneumonia disease,Finally 58 patients of 39 cases were confirmed as the main artery dissection aneurysm;This research adopts the 2 test or Fisher's Exact Test to investigate the CT signs and the correlation of aortic dissecting aneurysm, and through the ROC curve analysis to explore the diagnosis of aortic dissecting aneurysm. Results the single factor analysis showed that the lumen Uneven density(P<0.001), Move in endometrium valve calcification(P=0.002), pleural effusion(P=0.001), and there are significant correlation between aortic dissecting aneurysm.Through joint of ROC curve analysis to build the three models: the model of an "lumen uneven density" as a diagnostic basis;Model 2 with "lumen uneven density" and "membrane valve calcification within shift" as a diagnostic basis;Model 3 "lumen uneven density", "inside lining valve calcification shift" and "pleural effusion" three signs as a diagnostic basis. Conclusions Comprehensive utilization of CT scan of the seven signs is of great significance in the early diagnosis of aortic dissecting aneurysm.