多层螺旋CT肠系膜动脉造影的三维解剖学研究

Three-dimensional anatomic evaluation of mesenteric arteries with multi-slice spiral CT angiography

目的:评价多层螺旋CT血管造影(MSCTA)对肠系膜动脉的显示能力,研究肠系膜动脉的三维影像学解剖。方法:54例患者行腹部MSCT薄层增强扫描获得原始图像,用容积再现(VR)、最大密度投影(MIP)、薄层最大密度投影(TSMIP)、多平面重组(MPR)进行血管三维重建,分析肠系膜动脉的空间解剖特征,比较不同重建方法对肠系膜动脉、特别是交通支的显示。结果:54例肠系膜动脉均清晰显示。VR及MIP图像可显示4～5级分支,TSMIP可显示6～7级分支至肠壁周围血管网。MSCTA可清晰显示肠系膜动脉位置、起源、管径、走向、分布及变异情况。腹腔干(CA)和肠系膜上动脉(SMA)间、SMA内部分支间均可见吻合支,仅59.2%病例显示肠系膜上下动脉间吻合。在显示吻合支的能力方面,TSMIP优于MIP和VR。结论:MSCTA三维成像能很好的显示肠系膜动脉解剖学特征,为临床诊断和治疗提供依据。

Objective： To evaluate the ability of multi-slice spiral CT angiography （MSCTA） in demonstrating mesenteric arteries and investigate the imaging anatomy of mesenteric arteries. Methods： 54 volunteers without abnormal alimentary tract underwent thin-section enhanced MSCT scan of whole abdomen. CT angiograms of mesenteric arteries were reconstructed adopting different methods, including volume rendering （VR）, maximum intensity projection （MIP）, thin-slab maximum intensity projection （TSMIP） and multiplannar reconstruction （MPR）. The display effects of mesenteric arteries and its communicating branches on various reconstruction techniques were compared with each other, meanwhile three-dimensional architectures of the arteries were analyzed. Results： Mesenteric arteries were well displayed in all 54 cases. MSCTA clearly displayed the location, origin, diameter, direction, distribution and variation of mesenteric arteries. The collateral pathways were identified between celiac axis （CA） and superior mesenteric artery （SMA）, and among the branches of SMA in all cases and in only 59.2% of cases between SMA and inferior mesenteric artery （IMA）. TSMIP was superior to MIP and VR in displaying the collateral pathways. Conclusions： MSCT with 3D reconstruction can clearly visualize the anatomical features of mesenteric arteries, thus it is helpful for the early diagnosis and intervention of ischemic or inflammatory bowel diseases.