多层CT血管成像诊断肠系膜上动脉病变

目的回顾性分析45例肠系膜上动脉（SMA）病变的多层CT血管影像,探讨肠系膜上动脉多层CT血管成像的临床应用和价值。方法怀疑SMA病变的45例患者,男30例,女15例,平均年龄50岁。使用GE16层CT机,探测器1.25mm×8,重建间隔1.0mm,重建层厚1.3mm。增强用对比剂优维显（300mgI/L）80～90ml,流速3.5ml/s。对SMA进行MPR、MIP、VR图像重组,最佳角度显示SMA的病变。结果SMA病变的类型：SMA动脉粥样硬化斑块形成、管腔狭窄16例;SMA近段管腔血栓性栓塞5例,3例有Riolan动脉弓形成,IMA近段管腔血栓性栓塞1例;＂胡桃夹＂征7例;SMA和腹腔动脉干共干2例;主动脉夹层动脉瘤累及SMA近中段管腔4例;多发性大动脉炎5例;SMA近段内支架术后1例;SMA管壁及管腔未见明显异常4例。多层CT图像后处理图像情况：MPR、MIP均清楚显示SMA管腔壁的增厚、斑块情况、管腔狭窄程度;MIP对SMA的显示范围较MPR大,随着MIP显示厚度及角度的变化,可以对SMA的部分管腔或整体管腔情况进行最佳角度显示;VR对SMA与周围血管结构的关系显示较MPR及MIP佳。结论16层CT肠系膜上动脉血管成像检查,可以明确观察SMA各类病变情况和周围血管结构的情况,有广泛的临床应用价值。

Imaging diagnosis of superior mesenteric artery lesion with MSCT angioimage

Objective To analyze retrospectively MSCT angioimage of superior mesenteric artery (SMA) lesion, study the clinical application and value of MSCT angioimage of SMA. Methods Forty-five cases patients, suspected SMA lesion, male 30 cases, female 15 cases, average 50 years. To use 16 slices CT, detector 1.25 mm×8, reconstruction interval 1.0 mm, reconstruction slice thickness 1.3 mm. Enhancement constrast medium was ultravist (300 mgI/L) 80-90 ml,flow rate was 3.5 ml/s. Reconstructed the SMA image of MPR, MIP, VR, showed pathological changes of SMA in best angle. Results The type of pathological changes of SMA: atherosclerotic plaque formation, lumens stenosis SMA in 16 cases; perisegment thromboembolism of SMA in 5 cases; formation of Riolan arterial arcades in 3 cases; perisegment thromboembolism of IMA in 1 case; "nutcracker sign" in 7 cases; SMA and celiac trunk together trunk in 2 cases; aortic dissecting aneurysm reach the mesisegment lumens of SMA in 4 cases; polyarteritis in 5 cases; perisegment of SMA after endoprosthesis technique in 1 case; the vessel wall and lumens of SMA were not obvious abnormality in 4 cases. Condition of reconstruction image: thickening plaque and stegnosisin in vessel wall of SMA were clearly displayed on MPR,MIP; range of SMA on MIP displayed were bigger than on MPR, by thick and angular variation on MIP, the condition of part lumens or whole lumens of SMA may be displayed in best angle; SMA together with relationship display of peripheral vessels constructed by VR were better than by MPR and MIP. Conclusion Angioimage of SMA by 16 slice CT may clearly display every pathological changes of SMA and peripheral vessels construction and has extensive clinical application value.