MSCT血管成像对孤立性肠系膜上动脉夹层的诊断价值  

Spontaneous isolated dissection of the superior mesenteric artery:multi-slice computed tomographic angiography findings in seven cases

作　　者：陈则君[1] 谢旭纲[1] 孟宪平[1] 朱建新[1] 王伯元[1] 

机构地区：[1]东南大学医学院附属江阴医院放射科,江苏214400

出　　处：《放射学实践》2011年第8期857-860,共4页Radiologic Practice

摘　　要：目的:探讨MSCT血管成像诊断孤立性肠系膜上动脉夹层(SISAMD)的临床应用价值。方法:对7例急性肠缺血患者行MSCT血管成像,采用容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)重组图像,由两位经验丰富的心血管影像医师评估夹层的部位和范围。结果:SISAMD与主动脉夹层CT血管成像(CTA)表现相同,CTA清晰显示撕裂内膜5例,破裂口均位于肠系膜上动脉(SMA)近心端。根据Yun分型:Ⅰ型1例,Ⅱa型3例,Ⅱb型2例,Ⅲ型1例。SMA直径增粗2例,SMA周围脂肪间隙模糊2例,局部回肠壁增厚、水肿2例,升结肠扩张、积液1例,腹腔及盆腔内少量积液2例。结论:MSCTA能清晰显示病变特征和累及范围,是孤立性肠系膜上动脉夹层首选的检查方法。Objective：To assess the value of multi-slice computed tomographic angiography（MSCTA） in the diagnosis of spontaneous isolated dissection of superior mesenteric artery（SMA）.Methods：7 patients with clinically suspected acute mesenteric ischemia underwent MSCTA.Multiplanar and three-dimensional images were obtained by imaging postprocessing techniques including volume rendering technique（VRT）,multiplanar reconstruction（MPR）,curved planar reformation（CPR） and maximum intensity projection（MIP） on a workstation.Image reading was performed in consensus by two experienced cardiovascular radiologists.Results：According to Yun＇s classification,there were one case of typeⅠ,three type Ⅱa,two type Ⅱb and one type Ⅲ.Spontaneous isolated dissection of SMA displays the same MSCTA features as aortic dissection.Intimal flaps were seen in five patients,with intimal tears at the proximal SMA.Other MSCTA findings associated with spontaneous isolated dissection of SMA were enlarged diameter of the SMA（n=2）,increased attenuation of the fat around the SMA（n=2）,local ileum wall thickening due to edema（n=2）,dilated ascending colon（n=1） and hemorrhagic ascites（n=2）.Conclusion：MSCTA allows the comprehensive evaluation of spontaneous isolated dissection of the SMA in terms of morphologic features and extent,making it the first-line imaging modality for the evaluation of spontaneous isolated dissection of the SMA.

关 键 词：肠系膜上动脉 夹层 体层摄影术 X线计算机 CT血管成像 

分 类 号：R657.2[医药卫生—外科学]