CT平扫在自发性孤立性肠系膜上动脉夹层诊断中的意义
|
摘要
目的探讨描述能提示自发性孤立性肠系膜上动脉夹层的CT平扫征象。方法回顾性分析22例自发性孤立性肠系膜上动脉夹层(4例DSA证实,8例随访证实,10例典型表现)病例,均于同一天行CT平扫和CTA检查。结果22例自发性孤立性肠系膜上动脉夹层中,SakamotoⅠ型3例,Ⅱ型6例,Ⅲ型5例,Ⅳ型8例。CT平扫征象包括:肠系膜上动脉管径增粗22例,密度增高17例,周围脂肪间隙模糊14例。结论自发性孤立性肠系膜上动脉夹层确诊仍需要CTA检查。对于急诊仅做平扫的患者,上述平扫异常征象能够提示自发性孤立性肠系膜上动脉夹层的存在,为进一步CTA检查提供依据。
Objective This study was to describe the imaging features of non-contrast-enhanced computed tomography( CT)as a potential indication of Spontaneous Isolated Superior Mesenteric Artery Dissection( SISMAD). Methods We retrospectively analyzed clinical presentation and imaging appearances of the 22 patients who were diagnosed as having SISMAD,of whom 4 cases were confirmed by DAS,8 cases were follow-up confirmed and 10 were typical cases. Both non-contrast-enhanced CT scan and CTA were conducted on the same day for all the patients. Results By sakamoto classification,we categorized SISMAD into the following four types based on imaging appearances: type I,3 patients,type II,6 patients,type III,5 patients and type IV,8 patients. In their non-contrast-enhanced CT scans,we found superior mesenteric artery diameter dilatation in all the 22 cases,increased density in 17 cases,and peripheral fat gap in 14 cases. Conclusion CTA examination is still required to confirm SISMAD. For the routine emergency patients with only non-contrast-enhanced CT scan,the above-mentioned abnormalities can suggest the presence of SISMAD and provide the basis for further CTA examination.
Objective This study was to describe the imaging features of non-contrast-enhanced computed tomography( CT)as a potential indication of Spontaneous Isolated Superior Mesenteric Artery Dissection( SISMAD). Methods We retrospectively analyzed clinical presentation and imaging appearances of the 22 patients who were diagnosed as having SISMAD,of whom 4 cases were confirmed by DAS,8 cases were follow-up confirmed and 10 were typical cases. Both non-contrast-enhanced CT scan and CTA were conducted on the same day for all the patients. Results By sakamoto classification,we categorized SISMAD into the following four types based on imaging appearances: type I,3 patients,type II,6 patients,type III,5 patients and type IV,8 patients. In their non-contrast-enhanced CT scans,we found superior mesenteric artery diameter dilatation in all the 22 cases,increased density in 17 cases,and peripheral fat gap in 14 cases. Conclusion CTA examination is still required to confirm SISMAD. For the routine emergency patients with only non-contrast-enhanced CT scan,the above-mentioned abnormalities can suggest the presence of SISMAD and provide the basis for further CTA examination.
引文
[1]Sakatomo I,Ogawa Y,Sueyoshi E,et al.Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery[J].Eur Radiol,2007,64(1):103-110.
[2]张敏宏,郭伟.孤立性肠系膜上动脉夹层的诊疗策略[J].中国血管外科杂志,2015,7(4):220-222.
[3]Luan JY,Guan X,Li X,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63(2):530-536.
[4]Casella I B,Bosch MA,Sousa WO.Isolated spontaneous dissection of the superior mesenteric artery by percutaneous stent placement:case report[J].J Vasc Surg,2008,47(1):197-200.
[5]Ko GJ,Han SG.A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous placement[J].Korean J Gastroenterol,2006,47:168.
[6]张会弟,邢震宇,刘丽英,等.孤立性肠系膜上动脉夹层的诊断与治疗(附3例报告)[J].中国心血管病研究杂志,2010,8(7):515-517.
[7]修文吉,邓星河.320排CT诊断孤立性肠系膜上动脉夹层动脉瘤1例[J].中国临床医学影像杂志,2010,21(4):303-304.
[8]Wu XM,Wang TD,Chen MF.Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection:report of two case and literature review[J].Cardiovasc Interv,2009,73:145-151.
[9]陈则君,孟宪平.自发性孤立性肠系膜上动脉夹层的影像学检查[J].中国医学影像学杂志,2011,23(10):798-800.
[10]陈吴兴,陈光平,纪建松,等.人肠系膜上动脉多层螺旋CT成像及其解剖对照[J].解剖学报,2010,41(1):147-152.
[11]殷瑞根,朱海涛,史新平,等.自发性孤立性肠系膜上动脉夹层影像分型与CT诊断[J].实用放射学杂志,2012,28(5):733-736.
[12]D Ambrosio N,Friedman B,Siegel D,et al.Spontaneous isolated dissection of the celiac artery:CT findings in adults[J].Am J Roentgenol,2007,188(6):506-511.
[13]李好鹏,叶贤旺,孙勤学,等.320排CT对自发性孤立性肠系膜上动脉夹层的诊断价值[J].医学影像学杂志,2015,25(1):88-91.
[14]Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR,2009,192(2):408-416.
[2]张敏宏,郭伟.孤立性肠系膜上动脉夹层的诊疗策略[J].中国血管外科杂志,2015,7(4):220-222.
[3]Luan JY,Guan X,Li X,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63(2):530-536.
[4]Casella I B,Bosch MA,Sousa WO.Isolated spontaneous dissection of the superior mesenteric artery by percutaneous stent placement:case report[J].J Vasc Surg,2008,47(1):197-200.
[5]Ko GJ,Han SG.A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous placement[J].Korean J Gastroenterol,2006,47:168.
[6]张会弟,邢震宇,刘丽英,等.孤立性肠系膜上动脉夹层的诊断与治疗(附3例报告)[J].中国心血管病研究杂志,2010,8(7):515-517.
[7]修文吉,邓星河.320排CT诊断孤立性肠系膜上动脉夹层动脉瘤1例[J].中国临床医学影像杂志,2010,21(4):303-304.
[8]Wu XM,Wang TD,Chen MF.Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection:report of two case and literature review[J].Cardiovasc Interv,2009,73:145-151.
[9]陈则君,孟宪平.自发性孤立性肠系膜上动脉夹层的影像学检查[J].中国医学影像学杂志,2011,23(10):798-800.
[10]陈吴兴,陈光平,纪建松,等.人肠系膜上动脉多层螺旋CT成像及其解剖对照[J].解剖学报,2010,41(1):147-152.
[11]殷瑞根,朱海涛,史新平,等.自发性孤立性肠系膜上动脉夹层影像分型与CT诊断[J].实用放射学杂志,2012,28(5):733-736.
[12]D Ambrosio N,Friedman B,Siegel D,et al.Spontaneous isolated dissection of the celiac artery:CT findings in adults[J].Am J Roentgenol,2007,188(6):506-511.
[13]李好鹏,叶贤旺,孙勤学,等.320排CT对自发性孤立性肠系膜上动脉夹层的诊断价值[J].医学影像学杂志,2015,25(1):88-91.
[14]Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR,2009,192(2):408-416.