多排螺旋CT平扫对肠系膜上动脉压迫综合征的诊断价值

目的 探讨多排螺旋CT(MDCT)平扫对肠系膜上动脉压迫综合征（SMAS）的诊断价值。方法 收集22例SMAS患者（观察组）和19例非SMAS患者（对照组）的多排螺旋CT平扫资料,采用Spearman等级相关分析法分析肠系膜上动脉（SMA）可见性与年龄的相关性。采用Fisher确切概率法检验两组SMA弯曲类型、十二指肠水平段近端扩张、充气所占比例差异。测量观察组、对照组的主动脉肠系膜上动脉夹角（AMA）、主动脉肠系膜上动脉距离（AMD）,采用t检验分析差异,采用受试者工作特征（ROC）曲线测定AMA、ASD诊断SMAS的阈值。结果 观察组SMA可见性与年龄呈正相关（r=0.592,P<0.01）。观察组十二指肠水平段近端扩张比例高于对照组,两组SMA弯曲类型占比差异无统计学意义（P>0.05）。观察组、对照组AMA分别为19.5°±11.4°、37.2°±25.2°,两组比较差异有统计学意义（P<0.05）。通过AMA诊断SMAS的最佳诊断阈值为17.9°,对应诊断灵敏度为94%、特异度为53%。观察组、对照组ASD分别为（7.4±3.1）、（13.1±7.6）mm,...     

自发性孤立性肠系膜上动脉夹层的诊断和非手术治疗

目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断和非手术治疗。方法:回顾性分析2008-02-2012-01收治的13例SISMAD患者的临床资料。结果:根据Sakamoto影像学分型,Ⅰ型夹层2例,Ⅱ型6例,Ⅲ型4例,Ⅳ型1例;11例保守治疗效果良好,已随访3～46个月(平均27.3个月),无明显腹部症状复发;CTA随访(8例)结果显示,SMA夹层稳定或不同程度改善,假腔内血栓减少,夹层远端动脉开放。2例保守治疗无效后改行腔内支架植入术,其中1例用弹簧圈栓塞假腔,已分别随访7个月和19个月,无腹部症状复发。结论:CT增强或CTA对于SISMAD的诊断具有重要帮助。保守治疗SISMAD有效,一旦无效或病情进展,根据病情改行腔内治疗或手术治疗。     

孤立性肠系膜上动脉夹层的诊断与治疗(附3例报告)

孤立性肠系膜上动脉夹层是一种临床罕见的疾病,自1947年Bauertield首次报道该病以来,国内外仅报道百余例。随着人民生活水平的提高,健康意识的加强及医疗技术的发展,近几年来诊断该病的患者数量有上升趋势。我院自2008年以来,共收治孤立性肠系膜上动脉夹层患者3例,现通过对患者临床症状,体征及影像学检查进行回顾性研究,旨在达到尽早明确诊断、减少误诊、对患者进行有效治疗的目的。     

主动脉夹层的早期临床与多层螺旋CT血管造影

目的观察应用多层螺旋CT血管造影（CTA）对复杂危重的主动脉夹层的临床早期诊断的准确性和实用性。方法对于13例临床疑诊为主动脉夹层的病例进行CTA检查（包括血管重建）。观察病变的起始范围和其他重要脏器的情况,进行临床总结和分析。结果13例主动脉夹层的病例经CTA检查均能清晰显示病变,甚至可以了解夹层中的血栓,夹层导致的心包填塞和破入胸腔。结论CTA检查是早期诊断主动脉夹层快捷．准确的方法。结合早期的临床表现使主动脉夹层的早期诊断率接近100％。     

CTA诊断自发性孤立性肠系膜上动脉夹层分型及评估临床症状的价值

背景 CT血管成像(CTangiography,CTA)技术无创、快速,能准确检查、评估病变血管和管腔狭窄程度、范围等,已常规应用于自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesenteric artery dissection,SISMAD)早期筛查.本研究进一步探究C TA诊断SISMAD分型及评估临床症状的价值.目的探究CTA诊断SISMAD分型及评估临床症状的价值.方法选取2019-10/2022-01我院95例疑似SISMAD患者,均行CTA检查,以临床结果[数字减影血管造影(digital subtraction angiography,DSA)或手术结果]作为“金标准”,分析CTA诊断SISMAD的价值,比较有临床症状、无临床症状SISMAD患者的CTA测量参数,分析CTA测量参数与SISMAD患者临床症状的相关性,采用Kappa检验CTA诊断SISMAD分型与临床结果的一致性.结果C TA诊断SISMAD的曲线下面积为0.953(95%C I:0.889-0.986),诊断敏感度、特异度分别为90.63%、100.00%...     

几种常见急性肠系膜上动脉事件的多层螺旋CT血管造影诊断

目的探讨几种常见急性肠系膜上动脉事件的多层螺旋CT血管造影(MSCTA)表现。方法对23例急性肠系膜上动脉事件的临床、影像资料进行回顾性归纳总结。结果 23例患者中,孤立性夹层9例(YUN分型Ⅰ型7例,Ⅱb型2例),均见真假腔和内膜瓣征;壁间血肿伴溃疡龛影3例;急性血栓栓塞11例,直接征象是血管腔内充盈缺损。结论虽然肠系膜上动脉夹层、壁间血肿和栓塞临床症状相似,但各有较典型影像表现,MSCTA是诊断急性肠系膜上动脉事件准确、快捷、有效的首选检查方法。     

孤立性腹腔干与肠系膜上动脉夹层二例并文献复习

目的 探讨孤立性腹腔干及肠系膜上动脉(SMA)夹层的诊断及治疗方法.方法 收集中山大学附属第三医院收治的2例孤立性腹腔干并SMA夹层的临床资料,并结合文献报道的119例病例,对孤立性内脏动脉夹层(IDVA)的诊断及治疗方法进行分析总结.结果 119例IDVA中69例存在相关症状,全部病例均由增强CT或MRI检查确诊.发现IDVA后,采取外科治疗8例,支架置入术5例,保守治疗106例,均取得满意疗效.本组2例患者亦由CT检查发现,并经血管造影证实,1例行降压、抗凝治疗,1例行支架置入术,随访中均无不适.结论 腹腔增强CT或MRI检查是诊断IDVA的主要方法.大部分IDVA可选择保守治疗,但需密切CT随访病变情况;对于动脉破裂、管腔阻塞及保守治疗中夹层进展者,需行腔内介入治疗或外科手术治疗.

Abstract：

Objective To investigate the diagnosis and treatment of isolated celiac artery (CA) dissection and superior mesenteric artery (SMA) dissection.MethodsIntegrating clinical data of 119 cases with isolated dissection of the visceral arteries ( IDVA ) reported in literature and 2 patients with spontaneous isolated dissections of both CA and SMA treated in the Third Affiliated Hospital of Sun Yat-sen University,the diagnosis and treatment of IDVA were analyzed retrospectively.Results Among 119 cases reported in the literature,69 cases were symptomatic.All of the cases were diagnosed by contrast-enhanced abdominal CT or MRI.After IDVA was discovered,surgical treatment and endovascular stent placement was performed in 8 and 5 patients respectively,although the remaining 106 patients were managed conservatively with good results.In our 2 cases,the diagnosis of CA and SMA dissection was established by contrastenhanced CT and confirmed by conventional angiograghy.One patient was treated with anticoagulation and antihypertension,and the other patient was treated with endovascular stenting.Both of the patients didn't have discomfort during the follow-up period of 12 and 3 months respectively.ConclusionsContrastenhanced abdominal CT is the main tool for detection of IDVA.Most of the patients with IDVA can be managed conservatively,but close surveillance with imaging studies is necessary for early recognition of dissection progression.Patients with persistent or relapsed symptoms,and dissection progression,should undergo surgical or endovascular treatment.     

孤立性肠系膜上动脉夹层MSCTA诊断及转归

目的分析孤立性肠系膜上动脉夹层(ISMAD)多层螺旋CT血管造影(MSCTA)表现及转归。方法采用熊江的新ISMAD影像学分型方法,回顾性总结14例孤立性肠系膜上动脉夹层的CT资料。结果 14例患者中,Ⅰ型5例,Ⅱ型1例,Ⅲa型6例,Ⅳ型1例,Ⅴ型1例。保守治疗后随访复查4例,1例Ⅰ型真腔变通畅,1例Ⅰ型无变化,1例Ⅲa型假腔溃疡囊袋状扩大,1例Ⅲa型假腔范围扩大伴真腔进一步受压变窄。结论熊江的新影像学分型法对MSCTA诊断孤立性肠系膜上动脉夹层准确快捷有效,有利于评估孤立性肠系膜上动脉夹层动态变化和转归。     

41例孤立性肠系膜上动脉夹层的治疗经验

目的:总结孤立性肠系膜上动脉夹层(ISMAD)的治疗经验。方法:回顾性分析2010年1月至2019年5月期间南京医科大学附属常州第二人民医院和南京市高淳人民医院收治的41例ISMAD患者的临床及随访资料,并对相关数据进行分析总结。结果:41例ISMAD患者中,32例(78.0%)患者成功进行内科保守治疗,6例患者予急诊支架置入治疗,2例患者内科保守治疗失败后给予支架置入治疗,1例患者内科保守治疗失败后给予球囊扩张治疗。随访(25.1±17.2)个月,32例内科保守治疗的患者中,25例(78.1%)患者的肠系膜上动脉(SMA)完全重塑形,另外7例患者SMA部分重塑形,25例(78.1%)患者完全重塑形的发生时间均在确诊后的12~24个月;8例支架置入治疗的患者中,7例夹层动脉瘤消失,1例夹层动脉瘤仍有残留;7例支架通畅,另外1例支架近端存在一定程度的再狭窄,但无支架闭塞。结论:绝大多数ISMAD可以经内科保守治疗,SMA完全重塑形发生于确诊后的2年内;部分内科保守治疗失败的患者可以置入自膨式裸支架治疗,但存在支架再狭窄的风险。     

多层螺旋CT血管造影诊断主动脉疾病临床分析

目的:研究分析采用多层螺旋CT血管造影对于主动脉疾病的临床诊断情况。方法:选择主动脉疾病患者34例作为研究对象,对所有患者采取多层螺旋CT血管造影诊断,所得容积数据传送到工作站后,进行多平面重建、最大密度投影以及容积再现成像。结果:所有患者诊断后,主动脉粥样硬化15例,主动脉瘤患者9例,主动脉夹层6例,穿透性主动脉溃疡2例,主动脉壁间血肿和大动脉炎患者各1例。结论:对于主动脉疾病患者采用多层螺旋CT血管造影具有显著临床诊断意义,是一种快速、无创、精确的诊断方法,值得临床推广运用。     

Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: Report of two cases and literature review

Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare and sporadically reported condition. Therapeutic options include medical treatment, surgery, and endovascular treatment. However, the optimal treatment strategy has still not been established. We herein present two patients with acute abdomen due to isolated spontaneous SMA dissection, in whom symptoms remained despite initial anticoagulation therapy. Percutaneous endovascular treatment with stenting of the dissected main trunk to achieve complete coverage of the entry site and balloon angioplasty for the distally involved side branches were performed successfully and resulted in complete resolution of the symptoms. According to our experience and previous case reports, early (within 1 week) elective percutaneous endovascular intervention with background anticoagulation therapy is a feasible and effective treatment strategy for symptomatic patients with isolated SMA dissection. © 2009 Wiley‐Liss, Inc.     

Management of isolated superior mesenteric artery dissection

AIM:To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection(ISMAD).METHODS:From January 2008 to July 2013,18 patients with ISMAD were retrospectively analyzed,including 7 patients who received conservative therapy,9patients who received reconstruction with bare stents,and 2 patients who underwent surgical treatment.The decision to intervene was based on anatomic suitability,patient comorbidities and symptoms.RESULTS:Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy.Stent placement was successful in 9patients.Of the 9 patients who received endovascular stenting,abdominal pain was alleviated after the procedure and gradually disappeared within 3 d.Followup computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure,which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion.In the 2 patients who underwent surgical treatment,good clinical efficacy was also observed.CONCLUSION:ISMAD may be managed successfully in a variety of ways based on the clinical symptoms.ISMAD should be treated by conservative management as the first-line option,however,in those with bowel necrosis or imminent arterial rupture during conservative therapy,endovascular or surgical therapy is indicated.     

Spontaneous coronary artery dissection and associated CT coronary angiographic findings: a case report and review

We report a case of an acute coronary syndrome in a 21-year-old male with invasive coronary angiography and computed tomography (CT) coronary angiography showing a spontaneous dissection of the left anterior descending artery. To our knowledge the CT coronary angiographic appearance of spontaneous coronary artery dissection has been reported only once before. We describe the role CT coronary angiography may have in the evaluation of coronary dissection as well as potential treatment options.     

64排螺旋CT血管成像诊断永存三叉动脉

目的观察64排螺旋CT血管成像（CTA）在诊断永存三叉动脉（PTA）中的价值,提高对该血管变异的认识。方法回顾性分析2734例行头颈64排螺旋CTA检查中的5例PTA患者的影像学资料,分析PrrA的发生率、起源、走行、后循环供血及合并其他血管畸形的情况。结果①PTA的发生率为0．18％（5／2734）,其中3例位于右侧,2例位于左侧。②三叉动脉均起自颈内动脉海绵窦段,血管走行外侧型4例,内侧型1例;按Saltzman分型显示PTA后循环供血情况：I型1例,Ⅱ型1例,Ⅲ型3例。③吻合点近端的基底动脉及双侧椎动脉发育不良3例,吻合点近端基底动脉完全萎缩1例;合并PTA的动脉瘤1例,合并对侧大脑中动脉成窗1例。结论64排CTA能清晰、快速、无创、准确地显示PTA及其走行。在鞍区或鞍上区手术及介入治疗前,了解这种异常血管的有助于制定合理的手术和介入治疗方案,避免因操作不当所致的危险。     

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a relatively rare and unexplored type of coronary disease. Although atherosclerosis, hormonal changes during pregnancy and connective tissue disorders might represent a sufficiently convincing explanation for some patients with SCAD, the many remaining cases display only a weak relationship with these causes. While on one side the clinical heterogeneity of SCAD masks a full understanding of their underlying pathophysiologic process, on the other side paucity of data and misleading presentations hamper the quick diagnosis and optimal management of this condition. A definite diagnosis of SCAD can be significantly facilitated by endovascular imaging techniques. In fact, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) overcome the limitations of coronary angiography providing detailed endovascular morphologic information. In contrast, optimal treatment strategies for SCAD still represent a burning controversial question. Herein, we review the published data examining possible causes and investigating the best therapy for SCAD in different clinical scenarios.     

多排螺旋CT冠脉成像与冠脉造影对冠心病诊断的对比研究

目的初步评价多排螺旋CT（MSCT）在冠状动脉成像中的临床应用价值。方法18例疑诊冠状动脉狭窄患者行MSCT扫描,利用影像曲面重建,3D重建,了解冠状动脉病变情况,并与冠状动脉造影（CAG）对比。结果18例76支血管同时经MSCT和CAG成像。CAG发现狭窄27支,其中左前降支（LAD）病变11支,回旋支（LCA）病变3支,左主干（LMA）2支,右冠（RCA）病变9支,桥支病变2支。MSCT发现狭窄24支,其中LAD病变11支,LCA病变3支,LMA病变1支,RCA病变7支,桥支病变2支。MSCT与CAG结果相符的病变血管22支,MSCT成像的敏感性为82%（22/27）,特异性96%（47/49）。结论在控制心率的情况下MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

Iatrogenic superior mesenteric arteriovenous fistula: Ultrasonographic, CT and angiographic features and histological findings of the liver biopsy

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.