急性肠系膜上动脉血栓栓塞的MSCT诊断

Multislice CT diagnosis of acute superior mesenteric arterial thromboembolism

目的探讨急性肠系膜上动脉(SMA)血栓栓塞(SMAT)的MSCT表现。方法回顾分析28例急性SMAT患者临床资料及MSCT表现,所有患者均行MSCT平扫、动脉期和静脉期增强扫描,所得图像进行三维重组。结果 28例患者中单纯SMAT 20例,孤立性肠系膜上动脉夹层继发血栓栓塞5例,主动脉夹层累及肠系膜上动脉假腔继发血栓栓塞3例。MSCT平扫SMA内密度增高22例,等密度6例。增强扫描及CTA显示SMA中度狭窄6例、重度狭窄4例、闭塞18例。14例肠壁增厚伴强化异常,8例肠管扩张、肠壁变薄且不强化,6例肠壁厚度及强化程度无变化。另外,肠系膜缆绳征(5例),肠壁积气、门静脉-肠系膜上静脉积气(2例),麻痹性肠梗阻(5例),腹腔各液(5例),Riolan动脉弓扩张(5例)。结论 MSCT增强扫描及图像后处理技术能快速准确诊断SMAT并判断肠缺血程度,对临床治疗具有重要意义。

Objective To explore the muhislice computed tomography （MSCT） findings of acute superior mesenteric artery （SMA） thromboembolism. Methods The MSCT of 28 patients with acute SMA thromboembolism was analyzed retrospectively. All studies were performed without and with intravenous contrast injection in the arterial and venous phases with 3-D reconstruction. Results Of 28 patients, there was primary SMA thromboembolism in 20, SMA dissection and secondary thromboembolism in 5, aortic dissection involving the SMA with secondary thromboembolism in 3. The SMA was hyperdense （22） or isodense （6） on non- enhanced MSCT with moderate stenosis （6）, severe stenosis （4）, or occlusion （18） on enhanced MSCT and CT angiography. Bowel wall thickening with abnormal contrast enhancement was seen in 14, bowel dilatation with mural thinning and no contrast enhancement in 8, normal intestinal wall thickness and enhancement in 6. Other MSCT findings included mesenteric cable signs （5）, intestinal wall pneumatosis, portal vein and superior mesenteric venous gas （2）, paralytic intestinal obstruction （5）, ascites（5）, Riolan arterial arch expansion （5）. Conclusions MSCT can aid the diagnosis of SMA thromboembolism and determine the dczree of intestinal ischemia.