MSCT在自发性孤立性肠系膜上动脉夹层诊断中的应用

Application of multislice spiral CT in the diagnosis of spontaneous isolated superior mesenteric artery dissection

目的探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的多层螺旋CT平扫与CT血管成像(CTA)征象在诊断及分型中的价值。方法回顾性分析21例SISMAD病人的影像资料,观察CT平扫中肠系膜上动脉管径、密度、邻近结构及CTA中肠系膜上动脉的管腔影像,并根据Yoo分型法进行分型。结果SISMAD的CT平扫主要表现为肠系膜上动脉管腔内密度增高(20/21例,95%),可伴有管径增粗(19/21例,90.5%),大部分伴有周围脂肪密度增高(15/21例,71.4%),仅1例(4.8%)出现肠壁增厚及肠腔积液。根据Yoo分型法对CTA表现进行分型,Ⅰ型3例(均为Ⅰ-S亚型)、Ⅱ型6例(包括Ⅱ-S亚型3例)、Ⅲ型5例(包括Ⅲ-S亚型1例)、Ⅳ型7例(包括Ⅳ-S亚型2例)。11例显示真假两腔,10例假腔内为血栓充填,1例假腔呈瘤样扩张,7例可见溃疡,9例真腔狭窄率>80%,6例累及分支血管。1例受累空肠动脉供血肠管管壁增厚并呈高灌注表现。结论CT平扫对SISMAD的诊断具有重要提示意义,根据Yoo分型法对CTA表现进行分型更有利于临床治疗方案的选择。

Objective To investigate the value of multislice spiral CT plain scan and CTA in the diagnosis and classification of spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods The imaging data of 21 patients with SISMAD in our hospital were retrospectively analyzed.The diameter,density,adjacent structures of the superior mesenteric artery on plain CT scan and the lumen images of the superior mesenteric artery on CTA were observed and classified according to Yoo’s classification method.Results The main CT findings of SISMAD were increased intraluminal density of superior mesenteric artery(20/21 cases,95%),increased diameter(19/21 cases,90.5%),increased peripheral fat density(15/21 cases,71.4%),and only 1 case(4.8%)had intestinal wall thickening and effusion.According to Yoo’s classification,there were 3 cases of typeⅠ(all subtypesⅠ-S),6 cases of typeⅠ(including 3 cases of typeⅠ-S),5 cases of typeⅢ(including 1 case of typeⅢ-s)and 7 cases of typeⅣ(including 2 cases of typeⅣ-S).There were 11 cases showed true and false lumen,10 cases showed thrombus filling,1 case showed tumor like dilatation,7 cases showed ulcer,9 cases showed true lumen stenosis rate>80%,6 cases involved branch vessels.In one case,the wall of the jejunal artery was thickened and showed hyperperfusion.Conclusion CT plain scan is of great significance in the diagnosis of SISMAD.The classification of CTA manifestations according to Yoo’s classification is more conducive to the choice of clinical treatment.