MSCTA与CT平扫在急性肠系膜血管栓塞中的应用对比

The Application Comparison of MSCTA and CT Plain Scan in Acute Mesenteric Vascular Embolization1112

目的比较MSCTA与CT平扫技术在急性肠系膜血管栓塞中的应用价值。方法回顾分析17例经手术或DSA证实的肠系膜上动静脉栓塞急诊CT平扫、CTA及三维重建资料,均行全腹64排螺旋平扫及CTA检查,并对平扫及CTA进行独立阅片分析,计算两种方法血栓的显示率,结合MPR图测量血栓最大层面直径及血栓的累及长度。结果 17例中急性肠系膜上动脉栓塞(SMAE)7例,急性肠系膜上静脉栓塞(SMVE)10例。SMAE平扫2例见血栓,敏感度28.6%,CTA均见充盈缺损,敏感度100%,两者比较存在统计学差异(X2=7.22 P<0.05)。SMVE平扫5例见血栓,敏感度50%;CTA均见充盈缺损,敏感度100%;两者比较存在统计学差异(X2=4.76 P<0.05)。7例CT平扫及CTA均显示的肠系膜血管血栓病例中,CT平扫显示血栓平均直径为6.8±2.3mm,CTA为9.1±3.8mm,两者均数比较存在统计学差异(t=3.51,P<0.05);CT平扫显示血栓的平均累及长度为24.6±8.9mm,CTA为41.7±15.5mm,两者均数比较存在统计学差异(t=4.84,P<0.05)。结论 MSCTA对急性肠系膜血管栓塞有较CT平扫更高的敏感性,CTA能更准确地评价血栓的部位、形态及范围,CTA可作为肠系膜血管栓塞的首选急诊检查技术。

Objective To compare the application value of MSCTA and plain CT in the mesenteric vascular embolization.Methods To retrospective analysis the images of non-enhanced CT、CTA and three-dimensional reconstruction of 17 cases with acute embolism of SMA and SMV proved by operation or DSA retrospectively. All patients underwent emergent full abdominal plain CT scan and CTA scan. Calculate the positive rate of thrombus in MSCTA and plain CT, measure the diameter and implicate length of thrombus on MPR images.Results 7 cases were SMAE and 10 cases were SMVE. 2 cases of 7 SMAE showed thrombosis on CT plain scan and the sensitivity was 28.8%,all cases showed filling defect on CTA and the sensitivity was 100%,there was statistical differences between plain CT scan and CTA on the sensitivity of thrombosis showed （X2=7.22 P〈0.05）. 5 cases of 10 SMVE showed thrombosis on CT plain scan and the sensitivity was 50%,all cases showed filling defect on CTA and the sensitivity was 100%,there was statistical differences between CT plain scan and CTA on the sensitivity of thrombosis showed （X2=4.76 P〈0.05）.In 7 cases plain both CT scan and CTA showed thrombosis, plain CT scan and CTA measured diameter of thrombosis were 6.8±2.3mm, 9.1±3.8mm and there was statistical differences on diameter of thrombosis（t=3.51,P〈0.05）. Plain CT scan and CTA measured length of thrombus implicated were 24.6±8.9mm, 41.7±15.5mm and there was statistical differences on diameter of thrombosis（t=4.84, P〈0.05）.Conclusion MSCTA was more sensitive than plain CT scan in the mesenteric vascular embolization, MSCTA can be able to show the location, form and scope more accurately,CTA can become the preferred emergency method of examination of mesenteric vascular embolization.