MSCTA肠系膜下动脉成像的临床应用

Clinical application of MSCTA for inferior mesenteric artery

目的探讨多层螺旋CT血管造影(MSCTA)在肠系膜下动脉(IMA)成像中的临床应用价值。方法选择因直肠或左半结肠癌和血管性病变行MSCTA检查的患者75例,采用容积再现(VR)血管生长技术(AV)进行血管重建,观察肿瘤供血动脉及IMA狭窄或闭塞后的侧支循环情况。结果35例直肠癌患者中,显示肿瘤供血动脉:直肠上动脉35、直肠下动脉29例、骶正中动脉6例、乙状结肠动脉4例;7例乙状结肠癌由乙状结肠动脉供血;3例直肠乙状结肠交界区癌中,1例乙状结肠动脉供血,2例乙状结肠动脉和直肠上动脉供血;2例降结肠癌由左结肠动脉供血;5例脾曲癌由左结肠动脉升支和中结肠动脉左支供血。23例IMA狭窄或闭塞患者均有Riolan动脉弓侧支循环形成。结论MSCTA能清楚显示IMA参与肿瘤供血及准确评价其狭窄或闭塞后侧支循环形成情况。

Objective To study the clinical application value of multi-slice spiral CT angiography （MSCTA） in depicting the inferior mesenteric artery （IMA）. Methods Seventy-five patients including 52 with rectum carcinoma or left hemicolon carcinoma and 23 with IMA stenosis or occlusion underwent MSCTA, in which reconstruction of vessels were performed with VR AV technique in order to observe the blood supply of tumors and the collateral vessels of IMA. Results In 35 patients with rectum carcinoma, blood supply from superior rectal arteries was observed in all, from inferior rectal arteries in 29, median sacral arteries in 6, while from sigmoid arteries in 4 patients. In 7 patients with sigmoid carcinoma, blood supply vessels all came from sigmoid arteries. In 3 patients with carcinoma of the junctional zone between rectal and sigmoid, one blood-supply artery came from sigmoid artery, 2 from sigmoid arteries and superior rectal arteries. In 2 cases of descending colon carcinoma, the tumors were supplied by left colon arteries, whereas 5 carcinomas of the colon splenic flexure supplied by left colon arteries ascending branches and middle colon arteries left branches. Collateral vessels of the Riolan arterial arcades formed in all the 23 patients with IMA stenosis or occlusion. Conclusion MSCTA can depict the blood-supply vessels from IMA to the tumors, and evaluate accurately the collateral vessels when stenosis or occlusion of IMA occurred.