【摘要】 目的探讨成人腹腔干异常的MSCT诊断和后处理选择。方法收集2014年1月~2016年6月上腹部MSCT增强扫描及血管成像发现腹腔干变异和病变共65例,分析变异和病变的CT表现并比较三维重组的显示效果,结合临床表现、脏器灌注、疾病类型进行总结。结果 (1)腹腔干变异27例:腹腔干与肠系膜上动脉共干16例,表现为腹主动脉发出短粗的动脉干后直接分出腹腔干与肠系膜上动脉。腹腔干缺如2例,表现为肝总动脉与脾动脉分别单独起自腹主动脉前壁。腹腔干一级分支起源变异9例,表现为肝总动脉或脾动脉不从腹腔干发出,而由肠系膜上动脉发出。VR能立体直观显示腹腔干变异。(2)腹腔干管壁病变32例:腹腔干孤立性夹层5例,表现为血管壁内膜撕裂形成真假双腔,其中2例合并孤立性肠系膜上动脉夹层。腹腔干动脉瘤20例,表现为管腔局限性囊状或梭形扩张,其中14例合并其它内脏动脉的动脉瘤或夹层。腹腔干附壁血栓7例,表现为腹腔干管壁血栓形成,管腔变窄。MPR能清楚显示夹层的破裂口及内膜片,VR可直观显示动脉瘤的部位、大小、形态及与载瘤动脉的关系。(3)中弓韧带(压迫)综合征6例:表现为腹腔干近端受中弓韧带压迫呈"鱼钩状"或"U形"狭窄及狭窄后扩张。斜矢状位MPR有助于观察。结论 CT增强血管成像能有效诊断及区分腹腔干的变异及病变,辅以恰当的后处理技术,能清晰立体直观的显示腹腔干异常。更多还原

【Abstract】 Objective To investigate the diagnostic value of CT angiography(CTA) of celiac axis variation and lesions in adults.Methods From January 2014 through June 2016, CTA of 65 patients with celiac axis variation(27) and lesions(38) was retrospec-tively analyzed and the effect of three-dimensional reconstruction was compared. Results Among 27 celiac axis variations, 16 involved a short and thick celiac mesenteric trunk giving off the celiac trunk and superior mesenteric artery. Other variations included absence of the celiac trunk with separate origins of common hepatic artery and splenic artery from the anterior abdominal aortic(2),and origin of the common hepatic artery or splenic artery from the superior mesenteric artery(9). Volume rendering(VR) demonstrat-ed the celiac axis variation well. Of 32 lesions involving the celiac axis wall, 5 were dissections in the celiac axis alone(3) or com-bined with superior mesenteric artery dissection(2). There were 20 celiac axis aneurysms with 14 combined dissections or aneurysms of other visceral arteries. 7 celiac axis mural thrombi with lumen narrowing. Multiplanar reconstruction(MPR) showed the intimal flap whereas VR displayed the position, size, and shape of aneurysms as well as their relationships with parent arteries. There were 6cases of median arcuate ligament syndrome. The fishhook-or U-shaped stenosis and post-stenotic dilation of the proximal celiac axis because of compression by the median arcuate ligament was well seen on oblique sagittal MPR. Conclusion CTA with 3D reconstruction can distinguish the variation and abnormality of celiac axis.更多还原