目的：探讨自发孤立性肠系膜上动脉夹层（Spontaneous isolated superior mesenteric artery dissection，SISMAD）MSCTA的表现和分型。方法：收集我院确诊的21例SISMAD，利用CT平扫、增强薄层图像及后重建技术进行回顾性分析。结果：按Yun分型：Ⅰ型12例，Ⅱa型2例，Ⅱb型7例，Ⅲ型0例；21例SISMAD病变处近端瘤样扩张；破口内径平均值（3.5±0.2） mm，距肠系膜上动脉（Superior mesenteric artery，SMA）开口长度范围9～25 mm；13例破口位于真腔的腹侧，5例位于真腔的左侧，3例位于真腔的右侧；破口处假腔大于真腔，远端真腔大于假腔, 14例真假腔同步强化，7例假腔破口近端强化；7例血管壁见钙化斑，其中1例钙化斑内移。5例平扫见弧形高密度，血管周围间隙渗出、模糊。结论：MSCTA能够清晰显示SISMAD的征象并进行分型，综合CT平扫、增强薄层图像及后重建技术进行分析诊断和鉴别诊断，从而有效减少漏诊、误诊。
Abstract
Objective: To summarize the MSCTA features and imaging classification of spontaneous isolated superior mesenteric artery dissection(SISMAD). Methods: Twenty-one cases of SISMAD were retrospectively analyzed through thin-slice enhanced and reconstructed CT images. Results: Based on the Yun classification of SISMAD, there were 12, 2, 7 and 0 cases of type Ⅰ, Ⅱa, Ⅱb and Ⅲ. Which fasle lumen and ture lumen were enhanced meanwhile, entry and re-entry of fasle lumen were found in near-end and far-end. There were near-end entry without far-end entry in 9 cases of type Ⅱ, which 7 cases were enhanced with near-end entry of fasle lumen and thromarbus were filled with far-end fasle lumen. Twenty-one cases of SISMAD were enlarged diameter of superior mesenteric artery(SMA) like an aneurysms. Seven cases were found calcified plaque in SMA wall, 1 case of calcified plaque moved inside SMA lumen. Five cases showed curved high density and fuzzy fat around SMA by non-enhanced scanning. Thirteen cases of intimal crevasse were located in ventral vascular wall of SMA, 5 cases located in left wall of true lumen, 3 cases located in right. Distance between the proximal intimal crevasse and orgin of SMA was 9～25 mm. Conclusion: SISMAD can be clearly showed imaging features and classification by MSCTA.
关键词
动脉瘤 /
夹层 /
肠系膜上动脉 /
体层摄影术 /
X线计算机
Key words
Aneurysm, dissecting /
Mesenteric artery, superior /
Tomography, X-ray computed
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参考文献
[1]Chu SY, Chen CM, Hung CF. Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery[J]. Clin Radiol, 2012, 67(1): 32-37.
[2]陈跃鑫，刘昌伟，刘暴. 孤立性肠系膜上动脉夹层的病例荟萃分析[J]. 中华医学杂志，2008，88（47）：3345-3348.
[3]Solis MM, Ranval TJ, McFarland DR, et al. Surgical treatment of superior mesenteric artery compression[J]. Ann Vasc Surg, 1993, 7(5): 457-462.
[4]Park YJ, Park CW, Park KB, et al. Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric artery dissection[J]. J Vasc Surg, 2011, 53(1): 80-86.
[5]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.
[6]Sakamoto I, Ogawa Y, Sueyoshi E, et al. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery[J]. Eur J Radiol, 2007, 64(1): 103-110.
[7]Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection[J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
[8]Morita S, Ueno Eiko, Masukawa A, et al. Hyperattenuating signs at unhanced CT indicating acute vascular disease[J]. RadioGraphics, 2010, 30(1): 111-125.
[9]Furukawa A, Kanasaki S, Kono N, et al. CT diagnosis of acute mesenteric ischemia from various causes[J]. AJR, 2009, 192(2): 408-416.
