多层螺旋CT血管探针成像在孤立性肠系膜上动脉夹层的应用价值

Application value of MDCT with vessel probe for isolated superior mesenteric artery dissection

目的：探讨多层螺旋CT血管探针成像在孤立性肠系膜上动脉夹层（ISMAD）诊断和治疗中的应用价值。方法回顾性分析2008年6月至2013年5月间中山大学附属第一医院收治的15例ISMAD患者的临床和影像学资料。通过64层螺旋CT血管探针成像分析ISMAD的影像特征与临床症状和治疗选择的关系。结果15例夹层破口均位于动脉前壁，距离根部（24．3±9．7） mm；73．3％（11/15）的破口位于肠系膜上动脉近段弯曲近远端各1 cm区域内。无腹痛（8例）与腹痛（7例）患者夹层长度、真/假腔短径比及真/假腔长径比的差异均有统计学意义（均P＜0．01）。 Yun分型Ⅰ型5例，Ⅱa型3例，保守治疗均有效；Ⅱb型7例，其中3例保守治疗有效，4例行腔内介入治疗或手术治疗，症状均缓解。结论多层螺旋CT血管探针成像可清晰显示ISMAD的影像特征，可为ISMAD的诊断和治疗选择提供依据。

Objective To assess the value of MDCT with vessel probe （VP） in the diagnosis and treatment of isolated superior mesenteric artery dissection （ISMAD）. Methods Clinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP. Results The dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was （24.3 ±9.7） mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%（11/15） patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature . There were significant differences between patients without abdominal pain （8 cases） and those with abdominal pain （7 cases） in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen （all P＆lt;0.01）. According to classification of Yun, there were 5 patients of typeⅠand 3 typeⅡa, whose conservative treatment were successful. In other 7 patients of typeⅡb, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery. Conclusions 64-MDCT with VP can clearly depict the image manifestation of ISMAD , which provides evidence for the diagnosis and therapeutic options of ISMAD.