孤立性肠系膜上动脉夹层的MSCT临床诊断价值探讨

目的:探讨孤立性肠系膜上动脉夹层的MSCT表现及其诊断价值。方法:回顾性分析4例(5例次)CT原始横断位图像及经后处理VR、MPR、CPR图像,观察夹层的真假腔、内膜破口、夹层长度、是否累及分支动脉、真假腔大小、腔内是否存在血栓、夹层动脉是否扩张或狭窄以及内脏是否缺血或坏死。结果:MSCTA均显示肠系膜上动脉及分支内弧形充盈缺损影,与主动脉夹层的真假腔相类似,可清晰显示内膜片;后处理VR、MPR、CPR图像结合横断位图像清晰显示动脉夹层的真假双腔及剥离内膜片影,显示内膜破口4例,夹层长度2～4cm不等,累及分支动脉3例,假腔大于真腔3例,真腔大于假腔1例,假腔内血栓2例,所有动脉夹层真腔供血3例,假腔供血1例,1例为动脉夹层内支架术后,夹层消失,管腔通畅。1例合并小肠缺血。结论:孤立性肠系膜上动脉夹层的MSCT表现具有一定的特征性,目前MSCT是本病最有价值的诊断方法。

THE DIAGNOSTIC VALUE OF MSCT IN ISOLATED SUPERIOR MESENTERY ARTERY DISSECTION

Objective:To evaluate the features and diagnostic value of MSCT in isolated mesentery artery dissection.Methods:4 cases of isolated superior mesentery artery dissection with axial CT and post-processing (VR,MPR,CPR) images one patient examined twice were retrospectively analyzed to observe the true and false double lumen,and their size ruptured intimal orifice,and the length of dissection,whether the branch artery was involved,whether there was thrombus in false lumen,expansion or stenosis of dissection,and ischemia or infarction of viscera.Results:The MSCT could clearly demonstrate the arc filling damage shade in mesentery superior artery and its branch artery,which was similar to the real and false lumen of aortadissection,and clearly displayed the ruptured intimal orifice.Post-processing(VR,MPR,CPR) images with axial images could clearly display the true and false lumen in artery and the peeled diaphragm shade,including ruptured intimal orifice(n=4),the length of dissection ranging from 2 to 4cm,branch artery involvement(n=3),the false lumen cavity bigger than the true cavity(n=3),the true cavity bigger than the false cavity(n=1).Of the artery dissections,real lumen with blood supply(n=3),false lumen with blood supply(n=1),after inner support technique,band being vanished,and the lumen unobstructed(n=l),thrombus in false lumen(n=2),small intestine ischemia(n=l).Conclusion:MSCT can display the characteristics of isolated superior mesentery artery dissection,and it is the most valuable diagnostic method at present.