MSCT血管造影在自发性孤立性肠系膜上动脉夹层中的应用价值

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摘要目的：探讨MSCT血管造影（MSCT angiography，MSCTA）及其后处理技术在自发性孤立性肠系膜上动脉夹层（Spontaneous isolated superior mesenteric artery dissection，SISMAD）诊断、治疗及随访中的应用价值。方法：回顾性分析2012年12月—2016年10月46例SISMAD患者的临床资料。分析其临床表现、MSCTA特点、临床结果和随访CT改变，并作Sakamoto分型。结果：MSCTA可以良好的显示夹层破口位置、内膜片、真假腔及假腔内血栓；其中SakamotoⅠ型11例，Ⅱ型4例，Ⅲ型26例，Ⅳ型5例；破口距离肠系膜上动脉（SMA）起始部（25.2±6.5）mm；夹层范围（75.4±4.3）mm。所有患者经积极治疗，取得良好疗效；其中保守治疗44例，腔内支架置入2例。随访MSCTA显示SMA完全重塑2例，部分重塑9例，没有变化33例。结论：MSCTA及其后处理技术可以清楚显示SISMAD，有助于临床诊断及治疗后随访评估。

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	严肃
	单海荣
	刘怡文
	闵志刚
	吉爱兵

关键词 ：肠系膜上动脉, 动脉瘤, 夹层, 体层摄影术, 螺旋计算机, 血管造影术

Abstract：Objective: To investigate the value of MSCT angiography and post-processing technique in the diagnosis, treatment and follow-up of spontaneous isolated superior mesenteric artery dissection(SISMAD). Methods: 46 patients with SISMAD admitted from December 2012 to October 2016 were included in this study. The clinical presentation, MSCTA characteristics, clinical outcome and follow-up CT changes were analyzed retrospectively. Sakamoto classification was made． Results: The tearing site, intimal-flap, true and false lumens, and thrombus of SISMAD were clearly displayed on MSCTA images. According to Sakamoto＇s classification, 11 patients were categorized into typeⅠ, 4 patients were type Ⅱ, 26 patients were type Ⅲ, and 5 patients were type Ⅳ. The location of intimal tear was (25.2±6.5)mm distal from the SMA origin on CT, the median length of dissection was (75.4±4.3)mm. 44 patients underwent conservative treatment, and 2 patients were performed in endovascular intervention, all patients presented good curative effect． The follow-up MSCTA showed complete remodeling in 2 patients, partial remodeling in 9 patients, and no changes in 33 patients. Conclusion: MSCTA and post-processing technique can clearly and fully display the characteristic features of SISMAD, which is very helpful for clinical diagnosis, treatment and follow-up management．

Key words： Mesenteric artery, superior Aneurysm, dissecting Tomography, spiral computed Angiography

收稿日期: 2017-03-20

PACS:	Ｒ543.5
	Ｒ814.42
	Ｒ814.43

通讯作者: 吉爱兵，江苏大学附属宜兴医院核医学科，214200。E-mail：staff245@yxch.com

作者简介: 严肃（1979-），男，江苏徐州人，主治医师。E-mail：wjf18927@sina.com

引用本文:

严肃，单海荣，刘怡文，闵志刚，吉爱兵. MSCT血管造影在自发性孤立性肠系膜上动脉夹层中的应用价值[J]. 中国临床医学影像杂志, 2018, 29(5): 341-344.
YAN Su, SHAN Hai-rong, LIU Yi-wen, MIN Zhi-gang, JI Ai-bing. Application value of MSCT angiography for spontaneous isolated superior mesenteric artery dissection. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(5): 341-344.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I5/341

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