急性肠系膜缺血的多排螺旋CT诊断

Manifestations of acute mesenteric ischemia on multidetector computed tomography

目的总结急性肠系膜缺血(acute mesenteric ischemia,AMI)的多排螺旋计算机断层扫描(multidetector computed tomography,MDCT)表现以及MDCT对AMI预后的评估价值。方法检索近年来AMI病理生理学、CT特征以及与它预后相关的研究并进行综述。结果AMI的血管功能不全可由阻塞性(肠系膜动脉栓塞、动脉或静脉血栓形成)和非阻塞性病因引起。在AMI早期缺血阶段病变是可逆的,而晚期AMI的特点是发生不可逆的透壁性坏死,延迟诊断会导致病死的发生。AMI的MDCT表现可分为血管直接征象和缺血性肠损伤相关的影像学表现。气腹被视为AMI透壁性坏死的一个标志,然而由于诊断性试验的异质性,预测透壁性坏死的其他影像学特征存在争议。结论AMI是一种危及患者生命的腹部急症,早期诊断能改善患者预后。对于放射科医生来说,识别预后相关的影像特征对于区分早期和晚期AMI至关重要。

Objective To summarize the manifestations of acute mesenteric ischemia(AMI)on multidetector computed tomography(MDCT)and the diagnostic value of MDCT in the prognosis of AMI.Method Recent studies on pathophysiology,CT features,and prognosis of AMI were retrieved and reviewed.Results Vascular insufficiency of AMI could occur as a result of mesenteric arterial embolism,arterial thrombosis,venous thrombosis,or nonocclusive.Two stages of AMI,early and late,were associated with distinct prognosis.In early ischemia,the lesions were reversible.The late AMI was characterized by the development of irreversible transmural necrosis.A delayed diagnosis leaded to considerable mortality.MDCT findings in AMI could be divided into imaging findings related to vascular insufficiency and ischemic intestinal injury.Pneumoperitoneum could be considered a sign of transmural necrosis in the AMI.While,other imaging features predicting transmural necrosis were controversial because of the heterogeneity of diagnostic tests.Conclusions AMI is a life-threatening abdominal emergency.Early diagnosis can improve the prognosis of patient.It is important for radiologists to identify prognostic features for differentiating early from late forms of AMI.