CT平扫征象诊断自发孤立性肠系膜上动脉夹层的价值  

The Value of Non-Enhanced Computed Tomography Signs in the Diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection

作　　者：刘国清[1] 陈维翠[1] 欧爱华[2] 吕霞[1] 毛礼厅 马泽兰 万芸[1] LIU Guoqing;CHEN Weicui;OU Aihua(Department of Radiology,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou,Guangdong Province 510120,P.R.China)

机构地区：[1]广东省中医院放射科,广州510120 [2]广东省中医院统计教研室,广州510120

出　　处：《临床放射学杂志》2022年第6期1070-1076,共7页Journal of Clinical Radiology

摘　　要：目的探索CT平扫征象在诊断自发孤立性肠系膜上动脉夹层(SISMAD)的临床应用价值。方法采用回顾性研究方法,搜集2012年2月至2021年5月SISMAD和与其症状类似的非SISMAD的患者CT平扫征象。对两组CT平扫征象采用两独立样本t检验、秩和检验以及Pearsonχ^(2)检验和非条件逐步Logistic回归分析出诊断SISMAD特征性CT征象,并应用诊断受试者工作特征(ROC)曲线分析其敏感性、特异性。结果54例(男45例、女9例)SISMAD患者,90例(男55例、女35例)非SISMAD患者,包括38例(男24例、女14例)肠系膜上动脉(SMA)栓塞患者和52例(男31例、女21例)SMA正常的其他腹痛患者。两组间差异有统计学意义的CT平扫征象:SMA主干扩张(P<0.001)、SMA周边脂肪浑浊(P<0.001),SMA管壁高密度征(P<0.001)、SMA主干管腔CT值(P<0.001)。Logistics回顾分析结果表明:扩张的SMA主干是诊断SISMAD最具有意义的CT平扫征象(P<0.001),曲线下面积(AUC)为0.962(P<0.001),且当扩张的SMA主干达10.3 mm时,其诊断敏感度为90.7%,特异度为92.2%。结论CT平扫征象中SMA主干扩张对诊断SISMAD具有重要的诊断价值,能提高初始诊断率。当SMA主干直径超过10.0 mm时,应及时行增强CT,以免漏诊SISMAD。Objective To investigate the value of plain CT findings in the diagnosis of spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods We retrospectively analyzed the plain CT findings of SISMAD and none SISMAD with similar clinical symptoms.Two independent sample t test,rank sum test,Pearsonχ^(2) test and unconditional stepwise logistic regression were used to diagnose the characteristic CT signs of SISMAD in the two groups.The sensitivity and specificity of diagnosed SISMAD were analyzed by ROC.Results 54 patients with SISMAD,90 patients with none SISMAD,include 38 patients with super mesenteric artery(SMA)embolism and 52 patients of other abdominal diseases with normal SMA.These CT signs were significant between two groups,dilated superior mesenteric artery(SMA)trunk,fuzzy fat around artery,high density of vessel wall and CT value of lumen(P<0.001).Regression statistical results suggested that the dilated SMA trunk was the most significant CT sign for the diagnosis of SISMAD(P<0.001).The AUC area of SISMAD diagnosed by the dilated SMA trunk was 0.962.When the diameter of SMA trunk reached 10.3 mm,the diagnostic sensitivity and specificity was 90.7%and 92.2%.Conclusion The CT sign of the dilated SMA trunk has good diagnostic sensitivity and specificity for the diagnosis of SISMAD,it can improve the initial diagnosis rate.When the main trunk diameter of SMA exceeds 10.0mm,enhanced CT should be performed in time to avoid missed diagnosis of SISMAD.

关 键 词：肠系膜上动脉夹层动脉瘤CT 平扫征象 

分 类 号：R572.3[医药卫生—消化系统] R816.5[医药卫生—内科学]