自发孤立性肠系膜上动脉夹层的MSCTA诊断与鉴别诊断

Diagnosis and Differential Diagnosis of Spontaneous Isolated Dissection of Superior Mesenteric Artery by MSCTA

目的:探讨多层螺旋CT血管成像(MSCTA)对自发孤立性肠系膜上动脉夹层(SIDSMA)的诊断价值。方法:回顾性分析24例SIDSMA患者的MSCTA资料,应用多种重组方法对图像进行重建,并对患者影像资料进行综合分析。结果:24例SIDSMA患者均显示破口,夹层破口距离肠系膜起始部距离0.4-4.3cm不等;17例显示内膜片,20例病变肠系膜上动脉(SMA)管径有不同程度增粗,其中2例伴SMA动脉瘤形成;4例患者清楚显示SMA分支受累,3例患者SMA远端分支闭塞,2例患者局部肠道可见缺血性改变。结论:MSCTA有助于SIDSMA的诊断,并能准确地对夹层进行评估,给临床提供有治疗价值的信息。

Purpose： To evaluate multi-slice spiral CT angiography （MSCTA） features of spontaneous isolated dissection of superior mesenteric artery（SIDSMA）. Methods： MSCTA findings of SIDSMA in 24 cases were reviewed retrospectively. Different reconstruction methods were used to analyze the image data. Results： Intimal tears were shown in all 24 cases. The distance from the origin of the superior mesenteric artery （SMA） to the tear was about 0.4cm-4.3cm. Intimal flaps were shown in 17 cases. Dilation of the SMA lumen in different degrees were shown in 20 cases. Aneurysm of SMA was seen in 2 cases. SMA branches involvement were seen clearly in 4 cases, 3 cases showed abrupt termination of SMA. Acute small bowel ischemia was shown in 2 cases. Conclusion： MSCTA is useful for the diagnosis of the SIDSMA, it may not only provide comprehensive evaluation of the disease, but also provide the valuable information for the clinical treatment.