64排螺旋CT血管成像及图像后处理技术在胡桃夹综合征诊断中的价值

The value of 64-slice spiral CT angiography and image post-processing in the diagnosis of nutcracker syndrome

目的探讨64排螺旋CT血管成像及图像后处理技术在诊断胡桃夹综合征(NCS)中的意义和临床价值。方法收集我院2013—2018年收治的22例经临床明确诊断为胡桃夹综合征患者的临床及多层螺旋CT影像学资料,测量肠系膜上动脉(SMA)与腹主动脉(AA)间夹角(a)、左肾静脉狭窄段横径(b1)、截面积(c)1及左肾静脉近端扩张段横径(b2)、c2并计算其比值,探讨胡桃夹综合征的CT表现及参考范围。结果22例患者均为前胡桃夹综合征,SMA与AA间夹角(a)减小,左肾静脉通过肠系膜上动脉与腹主动脉间受压狭窄,左肾静脉近端扩张,呈“漏斗样”“鸟嘴样”改变。1例显示性腺静脉扩张,1例伴有十二指肠淤滞症,7例伴左肾不同程度增大。结论MSCT血管成像及图像后处理技术可以清晰、直观地显示左肾静脉、肠系膜上动脉及腹主动脉的形态、走行,并准确测量相关角度、面积等数据,对胡桃夹综合征的诊断、治疗方法的选择具有重要的指导作用。

Objective To investigate the significance and clinical value of 64-slice spiral CT angiography and image post-processing in the diagnosis of nutcracker syndrome(NCS).Methods Collection of 22 patients admitted in our hospital from 2013 to 2018 by the clinical diagnosis of nutcracker syndrome in patients with clinical and MSCT imaging data,measurement of the superior mesenteric artery(SMA)and abdominal aorta(AA)Angle between(a),the left renal vein stenosis diameter(b1),cross-sectional area(c1)and proximal expansion of left renal vein diameter(b2),cross-sectional area(c2),and calculate the ratio to explore CT manifestations and reference range of nutcracker syndrome.Results All the 22 patients had anterior nutcracker syndrome,the Angle between SMA and AA(a)decreased,the left renal vein was compressed and narrowed between the superior mesenteric artery and the abdominal aorta,and the proximal left renal vein was dilated,showing"funnel-like"and"beak like"changes.One case showed dilatation of the gonadal vein,one with duodenal stasis,and seven with varying degrees of enlargement of the left kidney.Conclusion MSCT angiography and image post-processing technology(MPR,VR,MIP,etc.)can clearly and intuitively display the morphology and course of the left renal vein,superior mesenteric artery and abdominal aorta,and accurately measure the relevant angle,area and other data,which plays an important role in guiding the diagnosis and treatment of nutcrac syndrome.