CT平扫在自发性孤立性肠系膜上动脉夹层诊断中的意义

The significance of non-contrast-enhanced computed tomography scan in the diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection

目的探讨描述能提示自发性孤立性肠系膜上动脉夹层的CT平扫征象。方法回顾性分析22例自发性孤立性肠系膜上动脉夹层(4例DSA证实,8例随访证实,10例典型表现)病例,均于同一天行CT平扫和CTA检查。结果22例自发性孤立性肠系膜上动脉夹层中,SakamotoⅠ型3例,Ⅱ型6例,Ⅲ型5例,Ⅳ型8例。CT平扫征象包括:肠系膜上动脉管径增粗22例,密度增高17例,周围脂肪间隙模糊14例。结论自发性孤立性肠系膜上动脉夹层确诊仍需要CTA检查。对于急诊仅做平扫的患者,上述平扫异常征象能够提示自发性孤立性肠系膜上动脉夹层的存在,为进一步CTA检查提供依据。

Objective This study was to describe the ima-ng features of non-contrast-enhanced computed tomography （CT） as a potential indication of Spontaneous Isolated Superior Mesenteric Artery Dissection （SISMAD）. Methods We retrospectively analyzed clinical presentation and imaging appearances of the 22 patients who were diagnosed as having SISMAD, of whom 4 cases were confirmed by DAS, 8 cases were follow-up confirmed and 10 were typical cases. Both non-contrast-enhanced CT scan and CTA were conducted on the same day for all the patients. Results By sakamoto classification, we categorized SISMAD into the following four types based on imaging appearances ： type I, 3 patients, type II, 6 patients, type III, 5 patients and type IV, 8 pa- tients. In their non-contrast-enhanced CT scans, we found superior mesenteric artery diameter dilatation in all the 22 cases, in- creased density in 17 cases, and peripheral fat gap in 14 cases. Conclusion CTA examination is still required to confirm SIS- MAD. For the routine emergency patients with only non-contrast-enhanced CT scan, the above-mentioned abnormalities can sug- gest the presence of SISMAD and provide the basis for further CTA examination.