急性肠系膜缺血性疾病的CT影像特征及诊断价值

目的:总结急性肠系膜缺血(AMI)的临床资料及CT影像特征并探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)对该病的诊断价值。方法:回顾性分析经临床或手术证实的54例AMI患者的CT和临床资料,包括其发病时间、主要症状、体征、相关实验室检查指标,评价并分析异常的MSCT表现。结果:54例均以非特异性腹痛为首发症状,其中肠系膜上静脉血栓形成(SMVT)38例,肠系膜上动脉栓塞(SMAE)12例,肠系膜上动脉血栓形成(SMAT)4例。MSCT诊断AMI的直接征象为血管内充盈缺损(43例),间接征象包括:肠壁增厚35例,"靶征"16例,肠管扩张20例,"缆绳征"22例,肠壁积气征13例,"薄壁样征"12例,腹腔积液34例。结论:AMI的临床表现缺乏特异性,MSCT检查可准确诊断AMI并明确缺血程度、范围,对指导治疗具有较高的应用价值。

Characteristics of CT Imaging in the Acute Mesenteric Ischemia and ItsDiagnostic Value

Objective： To sum up the clinical data and CT features of the acute mesenteric ischemia （AMI） and explore the value of multi-slice spiral computed tomography （MSCT） in diagnosis of AMI. Methods： CT features and clinical data of 54 cases with clinical or surgically proven AMI were retrospectively analysed,including the onset time, main symptoms, signs and the indexes of laboratory examination, and the abnormal MSCT findings were analyzed. Results： All 54 cases presented with initial symptom of non-specific abdominal pain, including superior mesenteric venous thrombosis （SMVT,n=38）, superior mesenteric artery embolization（SMAE,n= 12）, superior mesenteric artery thrombosis （SMAT,n=4）. The direct sign of AMI in MSCT images was filling defect in mesenteric vessels （n=43）. The indirect signs included thickening of bowel wall（n=35）, target sign（n=16）, bowel lumen dilatation（n=20）, strand sign（n=22）, pneumatosis of bowel wall（n=13）, thin bowel wall（n=12） and ascites（n=34）. Conclusion： AMI lacks specific clinical manifestations, the degree and extension of mesenteric ischemia can be accurately diagnosed by MSCT scan, which had an important clinical value for guiding the treatment of AMI.