急性肠缺血MSCT诊断价值探析.docVIP

急性肠缺血MSCT诊断价值探析 　 作者：言伟强 刘晓杰 刘远健 江锦赵 方玲 王成林 刘鹏程 【摘要】 目的 评价MSCT对急性肠缺血(AMI)的诊断价值。方法 回顾性分析5例AMI患者的平扫、动脉期、门静脉期和MSCT肠系膜血管成像（MSCTA）图像，描述AMI的肠系膜血管及其相关病变MSCT的表现特点。结果 5个病例中，1例肠系膜血管显示正常。肠系膜上动脉（SMA）梗塞2例，其中1例断面图像表现为SMA起始端以远血管腔内无对比剂充盈，MSCTA示SMA起始端以远未显影；另1例断面图像SMA未见明显异常，MSCTA显示SMA近端局限性狭窄，血管壁明显增厚。肠系膜上静脉梗塞（SMV）2例，其中1例SMV完全闭塞，管腔内无对比剂充盈，MSCTA示SMV和门静脉均未显影；另1例SMV内见充盈缺损影，MSCTA示SMV内见条状低密度影。。5例均见小肠病变肠管壁明显增厚、肿胀，肠管积液扩张及腹水，2例见肠系膜水肿，2例并肠壁积气。结论 MSCT能准确显示AMI的肠系膜血管及相关病变情况，是AMI的理想检查方法。 【关键词】 肠缺血 　Evaluation of acute mesenteric ischemia with multi-slice CT Abstract: Objective To determine the diagnostic value of multi-slice CT (MSCT) in acute mesenteric ischemia (AMI). Methods To analyze of the images of the plain scan、arterial phase、portal venous phase and mesenteric MSCT angiography(MSCTA) in 5 cases of acute mesenteric ischemic, and to describe mesenteric the MSCT features of AMI. Results: The mesenteric vessels were showed normal in one case. superior mesenteric arterial (SMA) thrombosis were seen in 2 cases, one case showed there had no contrast medium in SMA in arterial phase, and SMA didn,t opacification in MSCTA，in the other case, SMA was confirmed normally in transverse scan, but the stenosis was showed in MSCTA, it accompany with arterial wall thickening. 2 cases of superior mesenteric venous (SMV) thrombosis were found, in one case, the SMV was occlusion completely. MSCTA showed the SMV and portal venous unopacification, in the other case, the filling defect was seen in SMV in portal venous, and the strip low density was seen in MSCTA.. The other signs of AMI included bowel wall edema and thickening、massive fluid in the bowel and ascites in all 5 cases, mesenteric edema and pneumatosis in 2 cases respectively. Conclusions: MSCT can accurately show the cause of AMI and its corresponding signs, it is very valuable tool in diagnosis of AMI. Key words: bowel ischemia; mesentery; thrombosis; tomography, X-ray computed. 　急性肠缺血（acute mesenteric ischemia, AMI）是一种严重威胁生命的血管急症，其病程凶险，死亡率高达50%—9