症状性孤立性肠系膜上动脉夹层的CT血管成像及影像表现

CT Angiography and Imaging Findings of Symptomatic Isolated Superior Mesenteric Artery Dissection

目的:探讨症状性孤立性肠系膜上动脉夹层的CT血管成像及影像表现。方法:回顾性分析自2017年1月~2020年6月的19位肠系膜上动脉夹层动脉瘤的64层CT及双源CT血管成像(CTA)的影像表现,采用MPR(多平面重建)、CPR(曲面重建)、MIP(最大密度投影)、VR(容积再现)图像后处理技术重建病变图像。结果:19例患者SMA管径均不同程度增粗,9例患者显示撕裂内膜片,5例SMA周围脂肪间隙稍毛糙;根据Yoo分型标准:Ⅰ型3例,均累及分支及真腔狭窄>80%;Ⅱ型4例,均未累及分支,1例真腔狭窄>80%;Ⅲ型6例,均累及分支,1例真腔狭窄>80%;Ⅳ型6例,3例未累及分支,3例真腔狭窄>80%。结论:症状性孤立性肠系膜上动脉夹层以急腹症就诊,CT平扫不能诊断,只能提示SMA管径的变化、管腔密度及管周情况,而CTA可以清楚显示夹层撕裂内膜片,范围及真腔大小,对临床诊断及治疗有一定价值及参考意义。

Objective:,To investigate the CT angiography and imaging findings of symptomatic isolated superior mesenteric artery dissection.Methods:,Retrospective analysis was performed on the imgges of 19 superior mesenteric artery dissecting aneurysms from January 2017 to June 2020 using 64-slice CT and dual-source CT angiography(CTA).The lesion images were reconstructed using MPR(multiplane reconstruction),CPR(surface reconstruction),MIP(maximum density projection),VR(volume reconstruction)image post-processing techniques.Results:,The diameters of the SMA tubes were thickened too varying degrees in 19 patients,9 patients showed tearing of the internal membrane,and 5 patients showed slightly coarse fat gap around the SMA.According to Yoo classification criteria,there were 3 cases of typeⅠ,all of which involved branches and true lumen stenosis with>80%.There were 4 cases of typeⅡ,none of which involved branches,and 1 case of true lumen stenosis with>80%.There were 6 patients cases with typeⅢ,all of which involved branches,and 1 case with true lumen stenosis of>80%.There were 6 patients with typeⅣ,3 without branch involvement,and 3 with true lumen stenosis of>80%.Conclusion:,Symptomatic isolated superior mesenteric artery dissection was treated with acute abdominal disease,which could not be diagnosed by CT plain scan,but could only indicate the change of diameter,lumen density and perivascular condition of SMA,while CTA could clearly show the rupture of the internal membrane of the dissection,the range and the size of the true lumen,which was of certain value and referece significance for clinical diagnosis and treatment.