自发性孤立性肠系膜上动脉夹层MSCT血管成像研究  

MSCT angiography for spontaneous isolated superior mesenteric artery dissection

作　　者：王礼同[1] 李澄[1] 蔡玉建[1] 

机构地区：[1]扬州市第一人民医院影像科,扬州225001

出　　处：《放射学实践》2013年第7期779-783,共5页Radiologic Practice

摘　　要：目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的CTA征象及其对SISMAD的临床诊断价值。方法:回顾性分析20例SISMAD患者横轴面及后处理CT图像,观察破裂口、真假双腔、剥离内膜片、累及范围、分支是否受累、假腔内有无血栓形成、夹层动脉是否瘤样扩张或真腔狭窄、肠管有无缺血、有无肠系膜水肿等,并根据Sakamoto分型方法对SISMAD进行分型。结果:所有病例的CTA图像清晰,能清楚地显示SISMAD破裂口、真假双腔、剥离内膜片及累及范围等。SakamotoⅠ型12例,假腔近端及远端各有1处破裂口,假腔内充盈对比剂,3例假腔内部分血栓形成,真假腔之间为线样剥离内膜片;SakamotoⅡ型2例,假腔仅有一处近端破裂口,1例假腔内血栓形成,对比剂仅在破裂口处呈杵状充盈;SakamotoⅢ型3例,内膜溃疡样破裂口,对比剂呈结节状充盈,由真腔突入假腔,假腔内血栓形成,真腔偏心性狭窄;SakamotoⅣ型3例,假腔内完全由血栓占据,真腔狭窄。MPR、CPR显示真假双腔及剥离内膜片各16例、夹层动脉瘤样扩张13例、假腔内血栓形成10例;MIP、VR显示真假双腔及剥离内膜片各12例,夹层动脉瘤样扩张11例,真腔狭窄9例。结论:CTA能直观地显示SISMAD,可作为诊断及随访本病的无创、快速、准确的检查方法。Objective：To investigate the CT imaging features of spontaneous isolated superior mesenteric artery dis section （SISMAD） and to assess the value of multislice spiral CT angiography （CTA） in the diagnosis of SISMAD. Methods：The axial CT and post processing images of 20 patients with SISMAD were retrospectively analyzed, the ture and false lumen,intimal flap,extent,branch involved or not,false lumen thrombosis,with or without sandwich artery tumorlike ectasia,true lumen stenosis, intestine ischemia and mesenteric edema were observed. SISMAD was classified according to Sakamoto classification. Results：CTA could clearly show the intimal tear,intimal flap and extent of the dissection. Sakamoto type I （n= 12）：each one intimal tear at proximal and distal end of the false lumen,linear intimal flap between true and false lumen,false lumen was filled with conprast agent, thrombosis in part of the false lumen （n=3）;Sakamoto type Ⅱ （n： 2） ：only proximal tear of false lumen was shown, thrombosis in the false lumen （n=1 ）, club-shaped filling of contrast agent at tear site; Sakamoto type Ⅲ （n 3） ：ulcer like intomal tear, nodular filling of the contrast agent with protruding from the true lumen into the false lumen,thrombus formation in the false lumen,eccentric stenosis of the ture lumen; Saka moto type Ⅳ （n =3）：false lumen conpletely occupied by thrombosis, stenosis of the true lumen. MPR and CPR displayed true lumen,false lumen and intomal flap in 16 cases each,aneurysmal ectasia of the disseaction in 13 cases, thrombosis in false lumen in 10 cases. MIP and VR displayed the true lumen,false lumen and intimal flap in 12 cases each,aneurysmal ec tasia of dissection in 11 cases and stenosis of true lumen in 9 cases. Conelusion：CTA can clearly display SISMAD,it can be used as a non-invasive,rapid and accurate method for diagnosis and follow up of the disease.

关 键 词：动脉瘤 夹层 肠系膜上动脉 血管成像 体层摄影术 X线计算机 

分 类 号：R816.2[医药卫生—放射医学]