MSCTA及图像后处理诊断自发孤立性肠系膜上动脉夹层

目的：探讨多层螺旋CT血管成像（MSCTA）及图像后处理技术对自发孤立性肠系膜上动脉夹层（SIDSMA）的诊断价值。方法回顾性分析21例SIDSMA患者MSCTA及后处理图像资料，观察评估夹层破裂口、真假腔、剥离内膜片、夹层范围、分支受累情况、肠管有无缺血等影像征象。结果21例患者明确显示破口者14例，破口距离肠系膜上动脉（SMA）起始部1.4-5.5 cm；夹层范围5.5-15.9 cm；清晰显示剥离内膜片14例；假腔血栓者18例；显示假性动脉瘤6例；动脉瘤样扩张3例，夹层动脉瘤破裂1例；真腔狭窄17例；真腔主干闭塞2例；SMA分支受累12例；2例患者局部肠道缺血性改变。结论MSCTA及图像后处理技术能对SIDSMA明确诊断及准确评估，有利于临床治疗方案的选择。

Diagnosis of Spontaneous Isolated Dissection of Superior Mesenteric Artery by MSCTA and Image post-processing Technique

Objective To evaluate the value of multi-slice spiral CT angiography （ MSCTA ） with post- processing image features in the diagnosis of spontaneous isolated dissection of superior mesenteric artery（SIDSMA）. Methods MSCTA and post-processing images of 21 SIDSMA patients were reviewed retrospectively. Multiple post-processing techniques were used to analyze the image data such as dissection rupture, true and false lumen, intimal flaps, extent of interbed, branches＇ affected situation and presence of ischemia. Results In these 21 patients, there were 14 patients had clear ruptures. The distance from the origin of the superior mesenteric artery （SMA） to the tear ranged from 1.4 cm to 5.5 cm. The length of dissection ranged from 5.5 em to 15.9 cm. There were 14 patients had clear intimal flaps, 18 patients had false lumen thrombosis, 6 patients had pseudoaneurysm of SMA, 3 patients had aneurysmal dilatation of the SMA. 1 patient had dissecting aneurysm ruptured. 17 patients had stenosis of the true lumen, 2 patients had SMA trunk occlusion, 12 patients had SMA branches involvement, and 2 patients had acute small intestinal ischemia. Conclusion MSCTA and image post-processing technique provide clear diagnosis and accurate evaluation of SIDSMA, which are helpful for the choice of clinical therapy.