【摘要】 目的 :探讨MSCT血管造影(MSCT angiography,MSCTA)及其后处理技术在自发性孤立性肠系膜上动脉夹层(Spontaneous isolated superior mesenteric artery dissection,SISMAD)诊断、治疗及随访中的应用价值。方法:回顾性分析2012年12月—2016年10月46例SISMAD患者的临床资料。分析其临床表现、MSCTA特点、临床结果和随访CT改变,并作Sakamoto分型。结果:MSCTA可以良好的显示夹层破口位置、内膜片、真假腔及假腔内血栓;其中SakamotoⅠ型11例,Ⅱ型4例,Ⅲ型26例,Ⅳ型5例;破口距离肠系膜上动脉(SMA)起始部(25.2±6.5)mm;夹层范围(75.4±4.3)mm。所有患者经积极治疗,取得良好疗效;其中保守治疗44例,腔内支架置入2例。随访MSCTA显示SMA完全重塑2例,部分重塑9例,没有变化33例。结论:MSCTA及其后处理技术可以清楚显示SISMAD,有助于临床诊断及治疗后随访评估。更多还原

【Abstract】 Objective: To investigate the value of MSCT angiography and post-processing technique in the diagnosis,treatment and follow-up of spontaneous isolated superior mesenteric artery dissection(SISMAD). Methods: 46 patients with SISMAD admitted from December 2012 to October 2016 were included in this study. The clinical presentation, MSCTA characteristics, clinical outcome and follow-up CT changes were analyzed retrospectively. Sakamoto classification was made. Results:The tearing site, intimal-flap, true and false lumens, and thrombus of SISMAD were clearly displayed on MSCTA images. According to Sakamoto’s classification, 11 patients were categorized into type Ⅰ, 4 patients were type Ⅱ, 26 patients were typeⅢ, and 5 patients were type Ⅳ. The location of intimal tear was(25.2±6.5)mm distal from the SMA origin on CT, the median length of dissection was(75.4±4.3)mm. 44 patients underwent conservative treatment, and 2 patients were performed in endovascular intervention, all patients presented good curative effect. The follow-up MSCTA showed complete remodeling in 2 patients, partial remodeling in 9 patients, and no changes in 33 patients. Conclusion: MSCTA and post-processing technique can clearly and fully display the characteristic features of SISMAD, which is very helpful for clinical diagnosis, treatment and follow-up management.更多还原