原发性孤立肠系膜上动脉夹层MSCT血管成像与临床表现相关分析张.doc

原发性孤立肠系膜上动脉夹层：MSCT血管成像与临床表现相关分析 张森，王屹，杜湘珂 （北京大学人民医院放射科，北京，100044） 摘要： 目的：对照分析原发性孤立肠系膜上动脉夹层(SISMAD)的形态学特点与腹痛程度的关系。 方法：回顾性分析10例（男性8例，年龄47-65岁，平均56岁）经 MSCT (Multislice Computed Tomography)诊断的SISMAD。根据视觉模拟疼痛评分系统就患者腹痛状况加以评分。根据MSCT血管造影影像，分析SISMAD形态特征，即夹层的开口位置和终止点、夹层的长度以及病变区域血管腔的狭窄程度，并根据Yun的标准进行分型。测量SISMAD夹层长度。Spearman法分析患者腹痛严重程度与肠系膜上动脉（SMA）夹层影像类型及夹层长度之间的相关性。 结果：本组SISMAD病例中，夹层开口位置在距肠系膜上动脉起始部约1.7-2.8cm的范围内。MSCT血管成像显示SISMAD I型为4例（40%），II型为5例（50%），III型为1例（10%）。夹层长度范围为22-117mm，平均长度64±34mm。疼痛的严重程度与 结论：MSCT血管成像技术能够明确诊断SISMAD并准确分型，可为临床治疗决策提供影像证据。 关键词：肠系膜上动脉; 夹层; 多层螺旋CT; 血管造影 Spontaneous isolated superior mesenteric artery dissection: Imaging Appearances and Abdominal Pain Zhang Sen,Wang Yi,Du Xiangke （Department of Radiology, Peking University People’ s Hospital , Beijing 100044, P. R. China） Abstract: Purpose: To analyze imaging features of spontaneous isolated superior mesenteric artery dissection (SISMAD) using multislice computed tomography (MSCT) angiography and discuss the associated clinical features. Methods: From 2006 to 2009, 10 patients (8 males and 2 females, mean age 56years, ranged 47-65) were diagnosed as SISMAD based on MSCT in our hospital. Imaging characteristics of SISMAD were retrospectively analyzed and the length of dissection was measured. SISMAD were subcategorized on the Yun’s grading classification into type I, patent false lumen with both entry and re-entry, type II, ‘cul-de-sac’ shaped false lumen without re-entry, type III, thrombosis appeared in false lumen and true lumen. Abdominal pain as one of major clinical features of SISMAD was graded on the basis of Visual Analogue Scale. The relationship between imaging features and abdominal pain were analyzed by Spearman’s correlation coefficient. Results: Based on Yun’s grading classification, 4 patients were identified as type I SISMAD, 5 patients had type II，and 1 patient had type III. Entry of SISMAD in 7 patients was located the transitional part of SMA. Mean length of dissection was 64±34mm r