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目的探讨多层螺旋CT血管造影(MSCTA)对自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断价值与影像特征。方法对2008年1月至2013年1月搜集的经手术证实的5例SISMAD患者的临床及MSCTA资料进行回顾性分析。结果每例患者均按腹主动脉、腹腔动脉干及主要分支(肝总动脉、胃左动脉、脾动脉)、肠系膜上动脉(SMA)主干近侧段、远侧段及主要分支(中结肠动脉、右结肠动脉、回结肠动脉、空肠动脉及回肠动脉)、肠系膜下动脉进行观察,共评价65支血管段,病变累及12支血管段,MSCTA诊断SISMAD的直接征象为内膜瓣、内膜破口和双腔征,间接征象主要有血管腔增粗、血管周围脂肪间隙密度增高、肠缺血及缺血性肠梗阻。以手术结果为标准,MSCTA诊断SISMAD的敏感度为91.7%,特异度为96.2%,阳性预测值为84.6%,阴性预测值为98.1%,准确性为95.4%。结论 MSCTA对SISMAD的诊断具有较高的准确性,可以作为评价SISMAD首选的无创检查手段。
Objective To investigate the diagnostic value and imaging features of multislice spiral CT angiography (MSCTA) in patients with spontaneous solitary superior mesenteric artery dissection (SISMAD). Methods The clinical and MSCTA data of 5 surgically-proven SISMAD patients collected from January 2008 to January 2013 were retrospectively analyzed. Results Each patient was divided into abdominal aorta, celiac trunk and main branches (hepatic artery, left gastric artery, splenic artery), proximal and distal segments of the superior mesenteric artery (SMA) , Right colonic artery, ileocolonic artery, jejunal artery and ileum artery), and inferior mesenteric artery were observed, a total of 65 vascular segments were evaluated, the lesions involving 12 vascular segments, MSCTA diagnosis of SISMAD direct signs of intimal flap, endometrial rupture Oral and double-lumen syndrome, indirect signs of the main lumen thickening, increased density of fat around the blood vessels, intestinal ischemia and ischemic ileus. According to the results of surgery, the sensitivity of MSCTA in diagnosing SISMAD was 91.7%, the specificity was 96.2%, the positive predictive value was 84.6%, the negative predictive value was 98.1%, and the accuracy was 95.4%. Conclusion The diagnosis of SISMAD by MSCTA is of high accuracy and can be used as the first choice of noninvasive detection for SISMAD.