MSCT血管成像在自发性内脏动脉夹层的临床应用价值

Multislice spiral CT angiography of spontaneous splanchnic dissection

目的探讨MSCT血管成像(MSCTA)评价自发性内脏动脉夹层(SSD)的临床应用价值。方法回顾分析13例自发性内脏动脉夹层临床资料,采用容积再现(VRT),多平面重组(MPR),曲面重组(CPR)及最大密度投影(MIP)重组图像。由两名经验丰富的心血管影像医师评估夹层的部位和范围及夹层继发改变。结果 13例SSD中,腹腔动脉夹层累及脾动脉1例,腹腔动脉夹层累及脾动脉合并肠系膜上动脉(SMA)夹层1例,孤立性SMA夹层11例;CTA清晰显示撕裂内膜11例,破裂口均位于受累血管近心端,假腔内血栓7例。SMA夹层分型:Ⅰ型4例,Ⅱa型3例,Ⅱb型3例,Ⅲ型1例。SMA直径增粗、SMA周围脂肪间隙模糊各2例,SMA瘤样扩张1例。局部回肠壁增厚、水肿2例,升结肠扩张、积液1例,腹腔及盆腔内少量积液3例。9例SSD行保守治疗,近期疗效良好,2例SSD行手术治疗。结论 MSCTA能清晰显示自发性内脏动脉夹层的特征和累及范围,结合患者症状、体征提供个性化治疗方案。

Objective To investigate the clinical value of muhislice CT angiography （MSCTA） for diagnosing spontaneous splanehnic dissection （SSD）. Methods Axial and post-processed CT images of 13 patients with SSD were retrospectively analyzed. Post-processing included volume rendering technique, multiplanar reconstruction, curved planar reformation and maximum intensity projection. The images were reviewed in consensus by two experienced cardiovascular radiologists. Results Dissection was detected in the superior mesenteric artery （SMA） in 11 patients, in the celiac artery extending to splenic artery in 1 patient and additionally to the SMA in 1 patient. MSCTA showed the intimal flap （11）, intimal tear at the proximal vessels and thrombi within false lumina （7）. The dissection was categorized using Yun＇ s classification of SMA dissection as types I （4）, IIa （3）, IIb （3） and lII （1）. The other associated findings on MSCTA were dilated SMA （2）, indistinct fat plane surrounding the SMA （2）, aneurysmal dilatation of SMA （1）, focal ileum mural edema （2）, distended ascending colon （1） and ascites （3）. Nine patients responded to conservative treatment and two patients required open surgery. Conclusions MSCTA is useful for detection and treatment planning of symptomatic SSD.