胡桃夹综合征的增强磁共振血管成像(CE-MRA)诊断

Diagnosis for Nutcracker Syndrome with Contrast-enhanced Magnetic Resonance Angiography

目的探讨增强磁共振血管成像(CE-MRA)对胡桃夹现象的诊断价值。方法MRI测量6例患者及10例正常对照肠系膜上动脉从主动脉发出的夹角,肠系膜上动脉从腹主动脉发出后转折下行前的长度,横断面过左肾静脉层面肠系膜上动脉与主动脉之间的距离,冠状位上主动脉左侧左肾静脉的上下径,以及左肾的最长径,使用t检验分析。结果肠系膜上动脉与主动脉的夹角、距离、以及左肾静脉上下径病例组分别为,33.7±7.7°,4.2±1.2mm,15.7±2.4mm;而对照组为84.5±11.5°,15.5±7.5,11.4±3.0mm,两组间具有显著性差异(P<0.05)。左肾静脉上下径两组之间有较大的重叠。而肠系膜上动脉从腹主动脉发出后转折下行前的长度与左肾的最长径两组之间无显著性差异。结论对于有血尿蛋白尿的患者在排除其它肾脏疾病的基础上应怀疑胡桃夹综合征的可能,MRA可以清楚显示肾静脉及其与周围血管的立体关系。肠系膜上动脉从主动脉发出的夹角及两者之间的距离对诊断有较大的价值,左肾静脉上下径对诊断有参考意义。

Objective To assess the diagnosis for nutcracker syndrome with contrast-enhanced magnetic resonance angiography. Methods 6 patients of nutcracker syndrome and 10 normal subjects as control was tested by contract-enhanced 3D magnetic resonanee anglography （CE-MRA）. The angle （a） of the origin of the superior mesenteric artery （SMA） from the abdominal aorta （AO）, the distance （a） of the origin of the SMA before it began a caudal descent in the sagittal plane that the AO and SMA, the distance （b） between the SMA and aorta in the axial plane crossing the left renal vein （LRV） were measured, and the supero-infefior diameter （e） of LRV left lateral to the aorta and the maeroaxls （d） of the left renal were also measured. Results The angle of the SMA and the AO, the distance of the SMA and the AO and the supero-inferior diameter （c） of LRV were 33.7±7.70, 4.2± 1.2mm and 15.7 ± 2.4mm in patient group, respectively and 84.5± 11.50, 15.5 ± 7.5mm and 11.4 ± 3.0mm in control group, respectively. There were significantly statistical difference between two groups. Conclusions To the patients who have bloody urine and albuminuria after excluding other renal diseases, we should consider nutcracker syndrome. MIRA can show the dimensional relationship between renal vein and peripheral vessels. The angle and the distance of the SMA and the AO have great value for the diagnosis of nutcracker syndrome, and the superoinferior diameter of LRV is reference significant to the diagnosis.