64层螺旋CT血管重建诊断肠系膜上动脉及相关病变

64-slice spiral CT of revascularization in the diagnosis of superior mesenteric artery lesions

目的利用64层螺旋CT固定时间增强扫描采集的数据行血管重建,分析肠系膜上动脉及其相关病变的CT表现。方法 24例临床初步诊断为肠系膜上动脉病变及其相关病变的患者,采用Philips 64层螺旋CT行腹部增强扫描,以4.0ml/s的流率静脉注射碘海醇(300mg I/ml)90ml,在注射对比剂后27s开始采集动脉期图像,55s采集门脉期图像,利用动脉显示最佳期相的原始数据进行肠系膜上动脉重建,重建层厚1.5mm,重建间隔0.75mm,图像重建包括多平面重组(MPR)、最大投影密度(MIP)及容积再现(VR),以最佳角度显示SMA本身及其相关病变。结果 23例患者均于动脉期清晰显示肠系膜上动脉,1例房颤患者动脉期门脉期延迟,于门脉期清晰显示肠系膜上动脉。24例患者均经DSA或临床证实,其中肠系膜上动脉动脉粥样硬化斑块形成并管腔狭窄8例,肠系膜上动脉管腔血栓性栓塞并缺血性肠梗阻4例,孤立性肠系膜上动脉夹层动脉瘤2例,主动脉夹层动脉瘤累及肠系膜上动脉近中段5例;肠系膜上动脉压迫综合征2例,胡桃夹综合征3例。结论 MSCT固定时间延迟法行血管成像扫描并联合CT重建技术有助于肠系膜上动脉相关病变的诊断,具有广泛临床应用价值。

Objective To analyze CT performance of vascular imaging quality and superior mesenteric artery itself and its associated lesions by use of data of 64-slice spiral CT of fixed time delay method enhanced scan for revascularization. Methods 24 cases of initial diagnosis of superior mesenteric artery itself and its associated lesions patients were sellecte as research subjects.All patients underwent Philips 64-slice CT abdominal enhanced scan,with 4. 0 ml / s flow rate of intravenous iohexol（ 300 mg I /ml） 90 ml,after injecting contrast agent beginning to scan 27 s（ arterial phase）,55 s（ portal venous phase）. Scanning time was4 ~ 5 s,acquisition slice thickness was 3 mm,reconstruction interval was 1. 5 mm,pitch was 1. 172,tube voltage was 120 k V,tube current was 250 m As. Using the raw data of the best display of arterial phase to thinning reconstruct superior mesenteric artery,reconstruction thickness was 1. 5 mm,reconstruction interval was 0. 75 mm,the main image reconstructions were maximum intensity projection（ MIP）,muiti-planar reconstruction（ MRP）,volume reproduction（ VR）. The best angle to display superior mesenteric artery disease itself and its related lesions. Results 23 cases of arterial phase were clearly displayed superior mesenteric artery,1 patient with atrial fibrillation whose arterial phase fell portal venous phase,the use of portal venous phase images clearly showed the superior mesenteric artery,24 cases were confirmed by DSA or clinical,in which superior mesenteric artery atherosclerotic plaque formationed,stenosis were found in 8 cases,superior mesenteric artery lumen thromboembolic and ischemic bowel obstruction in 4 cases,the isolated SMA dissection in 2 cases aortic dissection involving the proximal and middle superior mesenteric artery lumen in 5 cases; superior mesenteric artery compression syndrome in 2 cases,and nutcracker syndrome in 3 cases. Conclusion The imaging quality of MSCT Fixed time delay method enhanced scan revascularization can diagnose superior mesenteric artery itself and associated lesions,with a wide clinical application.