多层螺旋CT与超声诊断胡桃夹现象的价值

 目的 探讨多层螺旋CT(multi-slice spiral CT,MSCT)和超声(ultrasonography,US)诊断胡桃夹现象(nutcracker phenomenon,NCP)的价值。方法 回顾性分析行腹部MSCT和US患者的影像资料,选取证实为NCP的患者30例为观察组,随机抽取因其他原因行腹部MSCT和US检查且无NCP的30例患者为对照组。对两组患者腹主动脉(AA)和肠系膜上动脉(SMA)的夹角(AMA)、左肾静脉(LRV)近肾门扩张处内径(DD)和峰值流速(PVd)、夹角段LRV最窄处内径(DN)和峰值流速(PVn)等,进行相关统计学分析。结果 MSCT和US均可对AMA、DD、DN进行准确测量,且独立检查方式下对比观察组与对照组,差异有统计学意义 (P<0.05),两种检查方式的单因素对比差异无统计学意义 (P>0.05)。US可测PVd、PVn,观察组和对照组数据具有明显差异(P<0.05)。观察组发现侧支循环扩张增粗12例,十二指肠受压7例,左肾体积增大5例,左肾皮质CT增强密度减低3例。结论 MSCT和US是诊断NCP的主要手段,但MSCT对NCP患者伴随征象诊断更具有优势。

The role of multi-slice spiral CT and ultrasonography in the diagnosis of nutcracker phenomenon

Objective To explore the value of multi-slice spiral CT(MSCT) and ultrasonography (US) in diagnosing nutcracker phenomenon (NCP). Methods The imaging data on 60 patients with abdominal MSCT and US was retrospectively analyzed. The 30 patients in the observation group were confirmed as cases of NCP.In the control group, 30 patients without NCP who underwent abdominal MSCT and US examination for other reasons were randomly selected.The aortomesenteric angle (AMA), the inner diameter (DD) and peak velocity (PVd) of the left renal vein near hilar dilatation, the inner diameter (DN) and peak velocity (PVn)of the narrowest part of the LRV in the AMA were obtained and analyzed statistically. Results Both MSCT and US could accurately measure AMA,DD and DN. An independent examination showed statistically significant difference in the data on the two groups(P<0.05), while the single-factor comparison between the two examination methods showed no significant difference (P>0.05). PVd and PVn could be measured in US, and there was significant difference between the two groups (P<0.05).However, MSCT had obvious advantages in the diagnosis of concomitant symptoms in patients with NCP.In the observation group using MSCT examination, there were 12 cases of dilatation and thickening of the left lumbar vein and reproductive vein, 7 cases of narrowing of horizontal parts of duodenum, 5 cases of enlargement of the left kidney volume compared to the right kidney, and 3 cases of decrease in CT enhancement density of the left renal cortex compared with the contralateral renal cortex. Conclusions MSCT and US are the main means of diagnosis of NCP, but MSCT is superior.