320排CT对自发性孤立性肠系膜上动脉夹层的诊断价值

Diagnostic value of 320-slile CT in spontaneous isolated superior mesenteric artery dissection

目的 探讨320排CT对自发性孤立性肠系膜上动脉夹层（SISAMD）的诊断价值.方法 回顾性分析9例自发性孤立性肠系膜上动脉夹层动脉瘤的320排CT表现及临床治疗措施,并根据影像表现进行Yun分型.结果 320排CT可直接显示肠系膜上动脉夹层的真、假腔,并清晰显示掀起的内膜瓣,破裂口均位于肠系膜上动脉（SMA）近心端（12～41mm）,夹层长度为21～128mm.后处理图像MPR、MIP、VR对于评估夹层的部位和范围有着更为直观的显示.SI-SAMD尚有一些间接征象,如肠系膜上动脉（SMA）管径增粗,SMA周围脂肪间隙模糊等.影像分型对于后续治疗有指导意义.依据Yun分型,本组病例：Ⅰ型4例,Ⅱa型4例,Ⅱb型1例,Ⅲ型0例.结论 320排CT能准确提供孤立性肠系膜上动脉夹层动脉瘤的信息,有助于临床治疗方法的选择.

Objective To assess the value of 320 slice CT in the diagnosis of spontaneous isolated dissection of superior mesenteric artery （SMA）. Methods 9 patients with SISMAD diagnosed by 320 slices CT were retrospectively reviewed. Yuffs classification was analyzed. Results Spontaneous isolated dissection of SMA displayed the same imaging appear anees as aortic dissection. 320-slice CT displayed all the true and false lumens and the intimal flap with intirnal tears at the proximal SMA （12-41） mm and dissection length was 21- 128mm. Construction imagings such as MPR MIP and VR can demonstrat directly but in one patient CRP displayed clearly. Other findings associated with spontaneous isolated dissection of SMA were enlarged diameter of the SMA and increased attenuation of the fat around the SMA. According to Yun＇s classification, there were 4 in type I , and 4 in type IIa. 1 in type IIb, none in type Ill. Conclusion MSCT is valuable for the diagnosis and the clinical therapy of isolated superior mesenteric artery dissection, and has important clinical diagnostic value.