肠系膜微小动脉瘤破裂伴肠腔内出血MDCT诊断

MDCT Diagnosis of Tiny Ruptured Aneurysms of the Superior Mesenteric Artery with Intestinal Hemorrhage

目的 探讨肠系膜微小动脉瘤破裂伴肠腔内出血的CT表现。方法 回顾性分析7例肠系膜微小动脉瘤破裂伴肠腔内出血患者64排螺旋CT的影像表现特点,采用动、静脉双期增强CT扫描及CTA重组对图像进行分析,重组方法采用容积再现（VR）、多平面重组（MPR）、曲面重组（CPR）、最大密度投影（MIP）等后处理技术。结果 7例患者动脉期增强扫描显示小肠肠管内小圆形高密度影,周围可见线样高密度影（4例位于空肠,2例位于回肠,1例位于结肠）,静脉期高密度影范围增大、密度减低。5例显示病变区肠管管壁增厚,2例病变区肠管周围可见少量渗出性改变。7例患者CTA检查显示肠系膜微小动脉瘤存在（直径0.4-0.8 cm）,其中1例显示多发微小动脉瘤。结论 MDCT双期增强扫描及CTA重组对肠系膜微小动脉瘤破裂合并肠腔内出血有极高的诊断价值,可以成为该病的首选检查方法。

Objective To explore CT manifestations of tiny ruptured aneurysms of the superior mesenteric artery with intestinal hemorrhage. Methods The 64 row spiral CT findings of 7 cases with tiny ruptured superior mesenteric aneu- rysms and consequent intraluminal hemorrhage were analyzed retrospectively. Dual-phase contrast-enhanced CT scannings in arterial phase and venous phase were performed. Image post-processing techniques like volume rendering （VR） , multi- planar reconstruction （MPR） , curved planar reconstruction （ CPR）, and maximum intensity projection （MIP） were used to reconstruct the abdominal vessels. Results 7 patients （4 cases in the jejunum, 1 in ileum,1 in colon） manifested circular high density in the small intestines accompanied with line-like high density shadow in the surrounding during the arte- rial phase. The high density lesions had enlarged range and reduced density in the venous phase. There were 5 cases of thickened intestines, 2 cases of slight exudates around the lesions. The CTA of 7 patients also confirmed the existence of ti- ny mesenteric artery aneurysms, about 0.4 - 0.8 cm in diameter. 1 case had multiple aneurysms. Conclusion Dual phase enhanced MDCT scanning and CTA reconstruction techniques have high diagnostic value of ruptured mesenteric arte- rial aneurysm with intestinal hemorrhage and can be used as the first choice for its clinical diagnosis.