CAJ | 학술논문

目的探讨64层螺旋CT血管成像(CTA)对肠系膜上动脉(SMA)活体形态的显示及临床应用价值.方法对80例临床疑有腹部、盆腔疾病的患者行64层螺旋CTA扫描,然后利用客积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)、反向MIP(I-MIP)和薄层MIP(TS-MIP)等技术进行后处理.80例忠者分为正常组(30例)和异常组(50倒)两组,对正常组采用多种重建技术显示SMA各级分支,并测量SMA的直径,观察SMA起始段的走行;在MPR像上测量SMA与腹主动脉(AA)的夹角(An),在左肾静脉(LRV)平面测量SMA至AA的距离(M),在左侧肾门旁测量LRV最大前后径(A),在SMA与AA间测量LRV最小前后径(B).对异常组采用多种重建技术显示SMA,分析SMA特点.结果 VR、MIP、I-MIP像均可显示正常组SMA整体解剖形态,TS-MIP对小分支显示优于其他重建技术.不同重建方式对SMA直径的测量无显著差异(F=0.71,P>0.05).SMA起始段走行方向为右下走行90%,前下走行占6.7%,左下走行占3.3%.An平均为(61.06±22.79)°.M平均为(14.62±4.00)mm,A平均为(9.16±1.91)mm,B平均为(6.00±2.01)mm,A与B比值>2者占20.0%,>3者占3.3%.异常组中有5例小肠先天性旋转不良及2例小肠扭转,SMA轴位像主要表现"回旋征",VR表现为"螺旋征";1例SMA分支栓塞;消化道肿瘤19例,其中8例供血动脉为SMA分支;回盲部动静脉畸形1例;余22例肝脏、泌尿生殖系统病变SMA无明显异常.结论 64层螺旋CTA能很好地显示SMA的活体形态特征,具有重要的临床应用价值.
목적 탐토64층라선CT혈관성상(CTA)대장계막상동맥(SMA)활체형태적현시급림상응용개치.방법 대80례림상의유복부、분강질병적환자행64층라선CTA소묘,연후이용객적재현(VR)、다평면중건(MPR)、최대밀도투영(MIP)、반향MIP(I-MIP)화박층MIP(TS-MIP)등기술진행후처리.80례충자분위정상조(30례)화이상조(50도)량조,대정상조채용다충중건기술현시SMA각급분지,병측량SMA적직경,관찰SMA기시단적주행;재MPR상상측량SMA여복주동맥(AA)적협각(An),재좌신정맥(LRV)평면측량SMA지AA적거리(M),재좌측신문방측량LRV최대전후경(A),재SMA여AA간측량LRV최소전후경(B).대이상조채용다충중건기술현시SMA,분석SMA특점.결과 VR、MIP、I-MIP상균가현시정상조SMA정체해부형태,TS-MIP대소분지현시우우기타중건기술.불동중건방식대SMA직경적측량무현저차이(F=0.71,P>0.05).SMA기시단주행방향위우하주행90%,전하주행점6.7%,좌하주행점3.3%.An평균위(61.06±22.79)°.M평균위(14.62±4.00)mm,A평균위(9.16±1.91)mm,B평균위(6.00±2.01)mm,A여B비치>2자점20.0%,>3자점3.3%.이상조중유5례소장선천성선전불량급2례소장뉴전,SMA축위상주요표현"회선정",VR표현위"라선정";1례SMA분지전새;소화도종류19례,기중8례공혈동맥위SMA분지;회맹부동정맥기형1례;여22례간장、비뇨생식계통병변SMA무명현이상.결론 64층라선CTA능흔호지현시SMA적활체형태특정,구유중요적림상응용개치.
Objective To investigate the values of 64-slice spiral CT angiography(CTA) on displaying the anatomical characteristics of Superi-or mesenteric artery(SMA) in vivo and its clinical application. Methods 80 patients with clinical suspected abdominal or pelvic disease were performed by 64-slice CT angiography, then the image data were processed with different reconstruction techniques,including volume render-ing(VR),multiplanar reconstruction(MPR), maximum intensity projection(MIP), invese maximum intensity projection(I-MIP) and thin slab maximum intensity projection(TS-MIP). 80 patients were divided into normal group (30 cases) and abnormal group (50 cases). In the nomal group,the SMA branches were shown at all levels by a variety of reconstruction techniques,Then,the diameters of SMA were meas-ured,the directions of the initial segment of SMA were displayed,tbe aortomesenteric angles(An) were measured,the distance(M) from SMA to abdominal aorta(AA) were measured at the level of left renal vein(LRV),the maximum anteroposterior diameters(A) of LRV were measured biside the left renal hilum,and the minimum anteropostefior diameter (B) were measured between SMA and AA. In the abnormal group ,SMA were shown by a variety of reconstruction techniques. Results in the normal group,the appearance of holo-SMA can be shown by VR,MIP and I-MIP. TS-MIP was superior to other reconstruction technique to exhibited small branches of SMA. There was no significant difference in different reconstruction methods by measuring diameter of SMA(F=0.71,P>0.05). 90% of the mitial segment of SMA were directed to rightinferior,6.7% were directed to anteroinferior and 3.3% were directed to leftinferior. The mean of AA was (61.06±22.79)°,the mean of M was (14.62±4.00) ram,the mean of A was (9.16±1.91) mm and the mean of B was (6.00±2.01) mm. The ratios of A and B were shown more than 2 in 20.0%and more than 3 in 3.3%. In the abnormal group,there were five cases with congenital intestinal malrotatio,and two cases with intestinal volvulus in which the SMA appeared a 'whirl sign' in the axial images and appeared 'spi-ral sign' in VR images. Branches of SMA were embolismed in one case. There were 19 cases with digestive tract tumors among them 8 cases had the feeding artery origining from the SMA branches. There was one case with ileocecal arterio-venous malformation. The SMA showed no obvious abnormalities in 22 cases with liver and(or) genitourinary system diseases. Conclusion 64-slice spiral CTA can perfectly show the anatomical characteristics of SMA in vivo and has important value to clinical application.