64层螺旋CT诊断血管性病变急腹症的临床价值分析

目的：探讨血管性病变导致急性腹痛的64层螺旋C T诊断价值。方法分析38例血管源性急腹症平扫及增强CT ,分析CT表现。结果内脏动脉瘤合并出血6例;腹主动脉及右侧髂总动脉瘤合并出血3例;腹主动脉分支夹层7例;肠系膜上动静脉扭转3例;肠系膜上动静脉栓塞及血栓形成14例;肾动脉栓塞5例。结论通过64层螺旋C T平扫及增强扫描,腹部血管性病变能清晰显示其病因、病变范围及其继发改变,达到诊断明确,所以腹痛疑诊为血管性病变时,CTA应作为影像学的首选检查方法。     

内膜下造影剂注射后延迟破裂

在选择性内脏血管造影术期间,动脉壁内膜下造影剂的注入不常发生,继发性迟发的主动脉夹层尤为罕见。作者报告了1例男性69岁患者,在做选择性肠系膜上动脉造影时,因大量造影剂注入到主动脉右侧壁内导致中止检查。后因进行性腹痛入院,CT平扫示腹主动脉内膜下有造影剂。几天后因腹痛加剧复查CT,示造影剂注入部有新的局灶性夹层,剖腹探查见腹腔内左上象限有新鲜血液及血凝块,出血来源于一个小的主动脉十二指肠瘘和肾动脉下方腹主动脉右侧壁的一个大的假性动脉瘤,作者指出,主动脉造影的潜在合并症很多,     

血管源性急腹症多层螺旋CT诊断价值

目的探讨以急性腹痛为主要表现的血管源性疾病的多层螺旋CT表现及诊断价值。方法回顾性分析经临床或手术确诊的35例血管源性急腹症的CT表现,包括平扫和增强扫描及利用多种图像后处理技术重建的图像,如多平面重建法（MPR）、曲面重建法（CPR）、最大密度投影法（MIP）、容积成像法（VR）、表面遮盖法（SSD）进行血管成像。结果肠系膜上静脉、门静脉及脾静脉血栓13例,夹层动脉瘤10例,肠系膜扭转伴肠梗阻3例,腹部动脉瘤3例,外伤致肠系膜血肿3例,腹部动脉血栓3例。结论多层螺旋CT平扫联合增强扫描,结合多种图像后处理技术能快速显示血管源性急腹症的病因、部位及范围,可作为首选的影像学检查方法。     

16排CT与DSA在肠系膜上动脉狭窄诊断中临床价值分析

目的探讨16排CT血管成像在肠系膜上动脉狭窄诊断中的应用价值。方法对我院因腹痛而拟诊断为肠系膜上动脉狭窄的21例患者进行16排CT血管成像和数字减影血管造影(DSA)检查。结果本文中的21例患者中DSA确诊为单纯肠系膜上动脉狭窄8例,单纯肠系膜上动脉夹层并管腔狭窄2例,主动脉夹层累及肠系膜上动脉引起管腔狭窄11例;21例患者共计检查了304条肠系膜上动脉主干及其Ⅰ级分支,其中CTA共计发现狭窄及闭塞血管124条,DSA发现狭窄及闭塞130条。经统计分析显示CTA诊断轻度狭窄的敏感度为86%,特异度为96%,阳性预测值为75%,阴性预测值为98%;CTA诊断中度狭窄的敏感度为82%,特异度为92%,阳性预测值为70%,阴性预测值为96%;CTA诊断重度狭窄及闭塞的敏感度为100%,特异度为96%,阳性预测值为89%,阴性预测值为100%。结论 16排CT血管成像能快速、准确地诊断肠系膜上动脉狭窄,值得临床推广使用。     

CT定位诊断腹腔内卵巢源性和小肠系膜源性囊性病变的价值

目的探讨螺旋CT对腹腔内卵巢源性和小肠系膜源性囊性病变的定位诊断价值。资料与方法回顾性分析18例临床资料和CT资料完整的卵巢源性和小肠系膜源性囊性病变,均经手术病理证实。着重观察肿块与十二指肠水平段的关系、肠系膜上血管有无移位、系膜血管有无包绕、生殖血管有无增粗、肿块有无卵巢血管蒂,以及肿块的后方有无空肠和回肠等。结果(1)5例小肠系膜囊性病变中,肿块上缘位于十二指肠上缘上方层面3例,肠系膜上血管移位4例,系膜血管包绕4例,肿块后方无空/回肠5例。(2)13例卵巢源性病变中,肿块上缘位于十二指肠上缘上方层面5例,肠系膜上血管移位4例,一侧生殖静脉增粗8例,卵巢血管蒂征显示8例,病变后方显示空/回肠11例。结论依据观察肿块上缘与十二指肠上缘的关系,肠系膜血管有无包绕,生殖血管有无增粗,卵巢血管蒂征的有无,肿块后方有无空肠和回肠显示等征象,以及肿块的CT特点,可对腹腔内卵巢源性和小肠系膜源性囊性病变作出定位诊断。     

多层螺旋CT血管成像在体部动脉病变中的应用

目的 评价多层螺旋CT血管成像(MSCTA)在体部动脉性病变诊治中的应用价值.方法 68例经手术病理证实的体部动脉病变患者行MSCTA检查,其中颈部35例,胸腹主动脉及其分支23例,双下肢动脉10例.应用多平面重建(MPR),曲面重建(CPR),最大密度投影(MIP),容积显示技术(VRT)以及血管分析(VA)软件进行图像重建及分析.结果 68例体部动脉病变中,CTA 显示颈动脉钙化斑块伴狭窄25例,颈内动脉闭塞1例,颈总动脉假性动脉瘤1例,颈动脉鞘内神经源性肿瘤伴血管推移2例,椎动脉钙化狭窄5例,椎动脉瘤1例.胸、腹主动脉瘤5例,假性动脉瘤8例,主动脉夹层10例,双下肢动脉硬化性闭塞症9例及下肢血管动静脉瘘1例.结论多层螺旋CT血管成像对体部动脉病变的临床诊治具有重要指导意义.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.     

肠系膜上动脉夹层的MSCT血管成像

目的:探讨多层螺旋CT血管成像(MSCTA)在诊断肠系膜上动脉夹层(SMAD)中的价值.方法:回顾性分析我院临床漏诊、经CTA诊断为SMAD后经手术或DSA证实的16例患者的临床及CT影像资料.所有患者均行MSC-TA检查,并采用MPR、CPR、MIP和VR技术进行图像后处理.总结SMAD的CTA特征表现,分析临床漏诊的原因.结果:SMAD主要CT表现:16例患者均可见SMA为双腔结构,可见内膜片,其中7例患者假腔内可见新月形充盈缺损.CT横轴面和三维重组图像能清楚显示11例患者肠系膜上动脉夹层的范围和程度.SMAD患者的主要临床表现是急性或慢性腹痛、以中上腹为主,无特异性,临床医师未认识到MSCTA诊断SMAD的价值是导致漏诊或误诊的原因.结论:MSCTA能提供评估肠系膜上动脉夹层的可靠信息,临床医师和影像医师应该认识其价值,重视对肠系膜上动脉夹层的观察.     

不典型主动脉夹层MSCT血管成像及临床应用(附8例报道)

目的：探讨MSCT对不典型主动脉夹层的诊断价值。方法：回顾性分析8例不典型主动脉夹层的MSCT血管成像及其重组影像资料。结果：VR、MPR重组图像均清晰显示出升主动脉、主动脉弓、降主动脉、腹主动脉、双侧髂总动脉、双侧髂内外动脉以及腹腔动脉干、肠系膜上动脉、双侧肾动脉主要分支的血管,图像清晰,血管对比明显,血管边缘无阶梯状改变;8例患者中有5例表现为壁内血肿,3例为无回腔性沟通。结论：MSCT血管成像技术可以在无创或微创的情况下清晰显示不典型主动脉夹层,为临床的诊断和治疗提供有价值的信息。     

自发性腹腔干夹层的MSCT血管成像表现

【摘要】目的：总结自发性腹腔干夹层的MSCT血管成像表现。方法：回顾性分析14例自发性腹腔干夹层患者的临床及MSCT血管成像表现。结果：14例患者中自发性腹腔干夹层10例（71.4%,10/14）,腹腔干和肠系膜上动脉夹层4例（28.6%,4/14）。14条腹腔干血管和4条肠系膜上动脉夹层均显示了内膜片、破口及真假腔,3条血管夹层合并血栓,2条夹层血管合并钙化,2例患者合并周围血肿,1例合并脾梗死。14条腹腔干夹层中6条血管夹层伴有动脉瘤样突起,4条肠系膜上动脉夹层均伴有动脉瘤样突起。2例患者行DSA检查,DSA表现与MSCT血管成像表现一致,1例行支架植入术后复查见支架内血栓形成。结论：MSCT血管成像能敏感地显示腹腔干夹层的病理改变,可作为其诊断和随访的首选检查方法。     

磁共振三维血流成像在小儿腹部疾病诊断中的价值

目的：探讨对比剂增强自动触发磁共振三维血流成像(3D CE MRA)技术在小儿腹部疾病诊断中的价值。方法：2001年3月～2003年6月对临床拟诊腹部实体肿瘤和腹腔大血管病变的46例患儿行常规MRI扫描和3D CEMRA检查，年龄生后1天～14岁，平均4．8岁。腹部实体肿瘤40例，腹腔大血管病变6例。全部患者检查前行肘静脉穿刺并保留静脉通道．镇静睡眠后注射2～3倍剂量非离子型对比剂。扫描采用Smart Prep Angio。对比剂智能捕捉技术。结果：本组检查成功率97．83％。40例实体肿瘤中,3D CEMRA显示肿瘤起源2例，肿瘤侵犯和包绕腹主动脉11例，下腔静脉闭塞3例，肾动静脉受侵蚀闭塞6例，肾蒂受肿瘤牵拉变细3例，腹腔动脉干、肠系膜上动静脉及睥静脉移位共12例，门静脉及其左右肝内分支受侵犯3例。腹部大血管病变6例。结论：3D CEMRA技术对巨大腹膜后肿瘤的起源定位具有诊断价值。结合多方位的断面图像不仅可以了解腹腔重要大血管被肿瘤浸润包裹和推挤移位情况，而且可对肾脏受浸润破坏情况进行术前评估，从而为临床制定恰当的治疗方案提供比较可靠的影像学依据。3D CEMRA是无创显示体腔大血管病变的有效方法。     

十二指肠血管压迹的影像学观察

目的探讨胃肠钡餐造影检查中十二指肠横部血管压迹的来源.材料和方法对比研究50例钡餐造影所见的十二指肠横部血管压迹与相应CT层面上十二指肠横部、腹主动脉、肠系膜上动、静脉及下腔静脉之间的关系;3例血管造影与钡餐造影联合检查,证实该压迹的来源.结果所有病例十二指肠横部血管压迹均与腹主动脉相吻合;肠系膜上动脉等血管与该压迹的位置及宽度不符;下腔静脉偶可导致另一压迹.结论十二指肠横部血管压迹,为腹主动脉压迫所致,称其为"十二指肠腹主动脉压迹”较为准确.     

CT features of abdominal manifestations of primary antiphospholipid syndrome.

PURPOSE: The purpose of this work was to evaluate the CT features of the abdominal manifestations of primary antiphospholipid syndrome (PAPS). METHOD: Of the 32 patients who were confirmed to have PAPS among 751 patients with elevated antiphospholipid antibodies during a 2 year period, we retrospectively reviewed the 14 patients who underwent abdominal CT. The clinical indications for abdominal CT included abdominal pain, abdominal distension, or lower leg swelling. CT findings were analyzed with regard to the abdominal vascular system and abdominal organ involvement patterns as well as ancillary findings. RESULTS: Of the 14 patients with PAPS, 10 had involvement of the venous system (72%), 2 of the arterial system (14%), and 2 of both systems (14%). Of the 12 patients who had venous system involvement, 4 had thrombosis in the inferior vena cava (IVC), 2 in both the IVC and the hepatic vein, 1 in the IVC and splenic and portal veins, 1 in the IVC and hepatic and adrenal veins, 1 in the hepatic, portal, and renal veins, and 3 in the portal and superior mesenteric veins. Budd-Chiari syndrome developed in five of the nine patients who had thrombosis of the IVC or hepatic vein. Arterial thrombosis was noted in four patients, hepatic artery in two, aorta in one, renal artery in one, pancreatic arcade in one, and splenic artery in one, with infarct of multiple organs including the liver, jejunum, colon, kidney, and adrenal gland. Seven of the 14 patients (50%) manifested thrombosis or infarct of multiple extra-abdominal organs. CONCLUSION: PAPS should be included in the differential diagnosis when CT demonstrates infarcts in multiple organs or patients have recurrent episodes of venous or arterial thrombosis.     

Pancreas: optimal scan delay for contrast-enhanced multi-detector row CT

PURPOSE: To prospectively determine optimal scan delays for multiphasic contrast medium-enhanced imaging of the pancreas with multi-detector row computed tomography (CT). MATERIALS AND METHODS: This study was approved by an institutional review committee, and patients gave written informed consent. One hundred ninety-one patients underwent three-phase CT of the pancreas after receiving intravenous contrast medium with a fixed duration injection of 30 seconds. Patients were prospectively assigned among four groups with scan delays of 25, 45, and 65 seconds (group 1); 30, 50, and 70 seconds (group 2); 35, 55, and 75 seconds (group 3); and 40, 60, and 80 seconds (group 4). Mean CT numbers of abdominal aorta, spleen, pancreatic parenchyma, superior mesenteric artery and vein, splenic vein, and hepatic parenchyma were measured, and increases in contrast enhancement on enhanced images were assessed. Qualitative analysis was performed with a four-point scale. RESULTS: Abdominal aorta and superior mesenteric artery enhanced at a mean of 35 seconds from the start of injection (both P < .001). Pancreatic parenchyma enhanced most intensely at 35-45 seconds (P < .001) with a peak enhancement at the mean of 40 seconds. Liver parenchyma enhanced most intensely at 55-65 seconds with a peak at 60 seconds (P < .001). The mean time to peak enhancement was 45 seconds for the splenic vein and 55 seconds for the superior mesenteric vein. Qualitative results were in good agreement with quantitative results (both P < .001). CONCLUSION: With the injection protocol used in this study, optimal scan delays for imaging the pancreas were 30-35 seconds for the abdominal aorta and the superior mesenteric artery, 35-45 seconds for the pancreas, 45 seconds for the splenic vein, and 55 seconds or later for the liver.     

Abdominal thrombotic and ischemic manifestations of the antiphospholipid antibody syndrome: CT findings in 42 patients

PURPOSE: To determine the abdominal computed tomographic (CT) findings in patients with antiphospholipid antibody syndrome (APS). MATERIALS AND METHODS: Retrospective review of medical records from two university medical centers from 1994 through 1997 revealed 215 patients who had a hypercoagulable state attributed to primary or secondary APS. Abdominal CT findings in these patients were reviewed for evidence of large-vessel occlusion or visceral ischemia. RESULTS: In 42 (19.5%) of 215 patients with APS (age range, 32-65 years; mean age, 42 years), abdominal thromboses or ischemic events were detected at CT. Twenty-two (52%) had major vascular thromboses, including those in the inferior vena cava (n = 10), portal and superior mesenteric veins (n = 7), splenic vein (n = 4), and aorta (n = 1). Thirty-six (86%) patients had abdominal visceral ischemia resulting in renal infarction (n = 22), bowel ischemia (n = 13), splenic infarction (n = 6), pancreatitis (n = 3), hepatic infarction (n = 1), and/or hepatic dysfunction with portal hypertension (n = 1). In some patients, more than one abdominal organ and/or vessel was involved. CONCLUSION: Patients who have circulating antiphospholipid antibodies are at risk for major abdominal vascular thromboses and organ infarction. Radiologists must be familiar with this syndrome; they may be the first physicians to suggest the diagnosis on the basis of findings of unusual or recurrent sites of thrombosis, especially in young patients.     

双排螺旋CT在前胡桃夹综合征诊断中的应用价值

目的:探讨双排螺旋CT在前胡桃夹综合征诊断中的应用价值。方法:回顾性分析6例经临床诊断为前胡桃夹综合征患者的双排螺旋CT影像学资料及临床资料。结果:6例前胡桃夹综合征均显示肠系膜上动脉压迫左肾静脉征象:腹主动脉与肠系膜上动脉之间夹角平均为18°;左肾静脉穿肠系膜上动脉夹角时明显受压,其前后径受压前后之比约4:1;其中2例显示左侧精索静脉扩张,1例显示左侧卵巢静脉扩张。结论:综合应用双排螺旋CT平扫、增强扫描及多种图像后处理技术能够清楚显示腹主动脉和肠系膜上动脉与受压的左肾静脉三者之间的解剖关系,并能发现增强扫描平衡期双肾实质密度差异及精索静脉或卵巢静脉曲张等表现,可作为前胡桃夹综合征确诊的一种重要手段。     

A case of acute abdominal aortic dissection caused by blunt trauma

We present the case of an 18-year-old man involved in a fall with blunt abdominal trauma. The patient had hypovolemic shock and findings of an acute abdomen. Initial computed tomography (CT) showed pulmonary contusion, pneumohemothorax, hemoperitoneum, hepatic contusion, right kidney laceration and vascular avulsion, rupture of the mesenteric vein, rupture of the right rectus muscle with bowel hernia, and infrarenal aortic dissection. There were no signs of limb or medullar ischemia. After hemodynamic stabilization and surgical repair of the associated lesions, the dissection was successfully treated with a self-expanding aortic Wallstent. Postprocedure CT showed a well-positioned patent stent and the patient was discharged asymptomatic. Percutaneous endovascular stent implantation is minimally invasive and seems to be a safe treatment for traumatic dissection of the abdominal aorta.     

Dissection of the abdominal aorta in a child with Takayasu's arteritis

Takayasu's arteritis is a chronic inflammatory disease that primarily involves the aorta and its main branches. Varying degrees of narrowing, occlusion, or dilatation develop in the involved vessel segments. However, dissection of the aorta is quite rare in this disease, and it may develop particularly after angioplasty. We report a very rare case of Takayasu's arteritis with dissection of the abdominal aorta just distal to the origin of the inferior mesenteric artery in a 9-year-old girl. She was treated conservatively with close follow-up. At the end of 1 year's follow-up, the dissection of the aorta did not show progression, and new lesions were not identified. To our knowledge, this patient is the youngest child presented with arterial dissection as the initial manifestation of the disease.     

多层螺旋CT血管仿真内窥镜在主--髂动脉病变中的应用

目的　探讨多层螺旋CT(MSCT)血管仿真内窥镜在主 -髂动脉病变中的临床应用价值。方法　对 3 6例临床疑诊主 -髂动脉疾病及 40例腹部检查患者行MSCT血管造影检查 ,之后在图像后处理工作站对可疑血管病变部位行CTVE并观察所获图像质量与扫描技术参数之间的关系。结果　 10例夹层动脉瘤均见撕裂内膜及双腔征 ,16例动脉瘤样病变见瘤腔扩大 ,48例见内膜钙化斑 ,血管内支架及血管置换术后各 1例可见支架形状及换血管部位狭窄 ,血管闭塞 1例见闭塞管腔。结论　CTVE图像质量的好坏与增强技术、扫描参数、运动伪影相关。CTVE是MIP、MPR及SSD的重要补充 ,在血管性疾病的诊断、治疗及疗效观察中有极高的参考价值。