Sonographic diagnosis of an aneurysm of the superior mesenteric artery

This is a report on a patient with a mycotic aneurysm of the superior mesenteric artery proved by histology. Because of a marked intolerance of contrast media we abstained from angiography. It is shown that real-time sonography gives a definite diagnosis, if the multiple vascular structures of the upper abdomen are precisely identified.     

Simultaneous thrombosis of superior mesenteric artery and superior mesenteric vein following chemotherapy: MDCT findings

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.     

MSCTA在肠系膜上动脉夹层中的应用

目的探讨多层螺旋CT血管成像(MSCTA)在肠系膜上动脉夹层(SMAD)中的应用价值。方法回顾性分析13例SMAD的MSCT、CTA表现,采用平面重组(MPR)、曲面重建(CPR)、最大密度投影(MIP)、容积再现(VR)重建图像,分析其影像特征。结果 MSCTA结合多种重建图像分辨真腔及假腔11例;清晰显示肠系膜上动脉(SMA)内膜片形成10例,破裂口均位于SMA近心端。Yun分型:Ⅰ型2例,Ⅱa型6例,Ⅱb型4例,Ⅲ型1例。结论 MSCTA能早期诊断SMAD,对及时采取临床治疗具有重要的意义。     

Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT

Objective

To investigate the diagnostic capability of multidetector computed tomography for detecting non-occlusive mesenteric ischemia (NOMI).

Methods

We studied 11 NOMI patients and 44 controls. Radiologists evaluated the CT images for the presence of bowel ischemia and measured the diameters of the superior mesenteric artery and the superior mesenteric vein (D _SMA and D _SMV). We also performed linear discriminant analysis (LDA) using D _SMA and D _SMV.

Results

All NOMI patients presented with more than 2 CT findings of bowel ischemia. D _SMA and D _SMV were significantly smaller in NOMI patients than in the controls (p < 0.01). At the optimal cut-off values for D _SMA (6.5 mm), D _SMV (9.0 mm), and the Z value in LDA (0.93), sensitivity and specificity were 81.8 and 81.8; 81.8 and 88.6; and 81.8 and 97.7 %, respectively.

Conclusions

D _SMA and D _SMV were significantly smaller in NOMI patients than in the controls and D _SMV is a more significant parameter than D _SMA.     

Sonographic diagnosis of volvulus in midgut malrotation

We report a case of midgut malrotation with volvulus in an adult diagnosed by ultrasonography, and we present the sonographic appearance of a specific sign of this uncommon anomaly: whirl-like encircling loops of bowel around the abnormal disposed mesenteric vessels.This case is part of an exhibition that will be presented at the European Congress of Radiology, Vienna, Austria, Sep 15–20, 1991 Offprint requests to: D. Casas     

多层螺旋CT血管成像在急性肠系膜动脉栓塞疾病诊断中的应用

随着螺旋CT和多层螺旋CT技术的发展,CT血管成像在腹部的应用范围由大血管扩展到中小血管,多层螺旋CT血管成像在诊断急性肠系膜动脉栓塞疾病方面,已经成为一种有效的手段.本文综述了急性肠系膜上动脉栓塞的临床特征及多层螺旋CT血管成像在诊断肠系膜上动脉栓塞中的应用价值.     

原发性肠系膜上动脉夹层的CT诊断

目的：探讨原发性肠系膜上动脉夹层（PDSMA）的CT表现。方法：回顾性分析资料完整的17例PDSMA患者的CT表现。10例行CTA,7例行全腹部CT平扫加双期增强扫描。由2位经验丰富的腹部专业医师单独阅片,分析病变部位及CT表现,并对瘤体的4个径线进行测量。结果：①17例增强扫描均见明显的真假双腔（17／17）。②15例显示内膜辫征（15／17）。③13例假腔内显示血栓征（13／17）,其中2例假腔完全血栓化。④14例显示内膜破口（14／17）;7例显示假腔出口（7／17）。⑤9例显示肠管缺血征（9／17）。⑥瘤体近端距腹主动脉距离0．5～5．5cm,平均2．1cm。破口距腹主动脉距离1．6～5．6cm,平均2．6cm。瘤腔长度1．5～5．4cm,平均3．5cm。瘤腔宽度0．4～1．2cm,平均0．7cm。结论：CT能准确诊断PDSMA及相应肠管的血供情况,为临床治疗和追踪随访提供有力依据。     

CT diagnosis of spontaneous dissection of the superior mesenteric artery

We report two cases of spontaneous superior mesenteric artery dissection diagnosed by CT. In both cases lamination of the arterial wall and enhancement of both true and false lumina were the key to the diagnosis.     

自发性肠系膜上动脉夹层MSCTA诊断

目的通过分析自发性肠系膜上动脉夹层病例资料,提高对该疾病的认识。方法应用MSCT对5例急症患者进行平扫描和增强扫描,结束后将图像传输至工作站后处理,应用容积再现(VR)、曲面重建(CPR)、最大密度投影(MIP)等方法观察血管情况。结果 5例患者在重建图像上均清晰显示出肠系膜上动脉及其分支。轴位示肠系膜上动脉内真假腔影,并能清晰显示低密度的内膜瓣,与主动脉夹层的真假腔相类似。CPR及MPR上可显示条形低密度充盈缺损影,亦可清楚显示内膜瓣。VR图像可以显示双腔改变。MIP图像与VR图像相似。5例均仅显示1处破裂口,而非像主动脉夹层显示两处或多处破裂口。其中1例病例远端肠系膜上动脉栓塞,并合并肝总动脉动脉瘤,1例病例近端、远端肠系膜上动脉栓塞,1例合并右肾动脉分支夹层。结论 MSCTA可早期诊断自发性肠系膜上动脉夹层。     

Aneurysm of the superior mesenteric vein

A superior mesenteric vein aneurysm was diagnosed by ultrasound, computed tomography, and angiography in a 55-year-old woman. It was successfully treated by partial resection and reconstruction of the confluent veins.     

门静脉和肠系膜上静脉血栓形成的MRI诊断

目的 分析门静脉（PV）和肠系膜上静脉（SMV）血栓形成的MRI特征及其诊断价值。方法 搜集经手术与病理证实的PV和SMV血栓形成患者12例，全部行MR T1WI、T2WI、抑脂T2、血管成像及钆喷替酸葡甲胺（Gd-DTPA）3期动态增强扫描。结果 直接征象为血管内血栓信号（12例），表现为T1WI和T2WI显示PV和SMV流空信号消失。3例急性期血栓T。WI为低或等信号，T2WI为高信号；8例亚急性期血栓T1WI及T2WI均为高信号；1例慢性期血栓T1WI为混杂信号，T2WI为低信号；增强扫描静脉期PV、SMV管腔内无对比剂充盈，PV周围呈轨道样增强，其内无强化的低信号血栓。间接征象包括肠腔扩张积液（10例）、肠管积血（6例）、肠壁增厚（12例）、肠黏膜水肿（11例）、薄纸样肠壁（1例）、缆绳征（11例）、肠系膜积液（2例）、肠壁积气（3例）、腹腔积液（12例）、PV海绵样变（3例）、肝脏异常灌注（6例）。结论 MRI是诊断PV和SMV血栓形成并肠道缺血敏感有效的方法，MR多序列、多轴面成像及增强扫描对病变的显示、定位、范围及血栓的分期等有重要作用。     

DSA诊断肠系膜上静脉局灶性曲张伴消化道出血一例

肠系膜静脉曲张很少见,但可引起持续或间歇性消化道出血.现报告一例肠系膜上静脉局灶性曲张1例.     

Aneurysm of the superior mesenteric vein: imaging findings

The authors report two uncommon cases of incidental superior mesenteric vein aneurysm in two asymptomatic women. Patients underwent ultrasonography, CT and MR angiography. The etiology, clinical features and treatment are discussed along with a review of to the literature.     

肠系膜上动脉病变 MSCTA 诊断价值

目的：探讨多层螺旋 CT 血管成像(MSCTA)诊断肠系膜上动脉(SMA)病变临床价值。方法回顾性分析40例 SMA病变患者 MSCTA 图像特点,运用容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)等多种后处理重建技术。结果SMA 缺血16例,包括 SMA 急性闭塞8例,其中并发小肠缺血性坏死1例并行坏死小肠切除术。SMA 慢性闭塞8例;孤立性 SMA 夹层10例;SMA 真性动脉瘤7例,感染性心内膜炎相关假性动脉瘤1例;SMA 溃疡3例,其中1例合并肠系膜下动脉(IMA)重度狭窄;腹腔干重度狭窄2例;IMA 闭塞1例。本组40例患者可见 SMA 疾病相关侧支循环13例,4例见于 SMA 慢性闭塞,3例见于 SMA 急性闭塞,1例见于孤立性 SMA 夹层,1例见于 SMA 假性动脉瘤,2例分别见于 IMA 狭窄和闭塞。2例见于腹腔干重度狭窄。其中包括胰十二指肠前、后动脉弓3例,胰背动脉侧支2例、Riolan 弓10例。结论MSCTA 可以清晰观察SMA 各类病变、侧支循环开通情况以及评估肠腔缺血状态。