CAJ | 학술논문

目的探讨MSCT血管成像（MSCTA）评价自发性内脏动脉夹层（SSD）的临床应用价值。方法回顾分析13例自发性内脏动脉夹层临床资料，采用容积再现（VRT），多平面重组（MPR），曲面重组（CPR）及最大密度投影（MIP）重组图像。由两名经验丰富的心血管影像医师评估夹层的部位和范围及夹层继发改变。结果13例SSD中，腹腔动脉夹层累及脾动脉1例，腹腔动脉夹层累及脾动脉合并肠系膜上动脉（SMA）夹层1例，孤立性SMA夹层11例；CTA清晰显示撕裂内膜11例，破裂口均位于受累血管近心端，假腔内血栓7例。SMA夹层分型：I型4例，IIa型3例，IIb型3例，III型1例。SMA直径增粗、SMA周围脂肪间隙模糊各2例，SMA瘤样扩张1例。局部回肠壁增厚、水肿2例，升结肠扩张、积液1例，腹腔及盆腔内少量积液3例。9例SSD行保守治疗，近期疗效良好，2例SSD行手术治疗。结论MSCTA能清晰显示自发性内脏动脉夹层的特征和累及范围，结合患者症状、体征提供个性化治疗方案。
목적탐토MSCT혈관성상（MSCTA）평개자발성내장동맥협층（SSD）적림상응용개치。방법회고분석13례자발성내장동맥협층림상자료，채용용적재현（VRT），다평면중조（MPR），곡면중조（CPR）급최대밀도투영（MIP）중조도상。유량명경험봉부적심혈관영상의사평고협층적부위화범위급협층계발개변。결과13례SSD중，복강동맥협층루급비동맥1례，복강동맥협층루급비동맥합병장계막상동맥（SMA）협층1례，고립성SMA협층11례；CTA청석현시시렬내막11례，파렬구균위우수루혈관근심단，가강내혈전7례。SMA협층분형：I형4례，IIa형3례，IIb형3례，III형1례。SMA직경증조、SMA주위지방간극모호각2례，SMA류양확장1례。국부회장벽증후、수종2례，승결장확장、적액1례，복강급분강내소량적액3례。9례SSD행보수치료，근기료효량호，2례SSD행수술치료。결론MSCTA능청석현시자발성내장동맥협층적특정화루급범위，결합환자증상、체정제공개성화치료방안。
@@@@Objective To investigate the clinical value of multislice CT angiography(MSCTA)for diagnosing spontaneous splanchnic dissection(SSD).Methods Axial and post-processed CT images of 13 patients with SSD were retrospectively analyzed. Post-processing included volume rendering technique,multiplanar reconstruction,curved planar reformation and maximum intensity projection. The images were reviewed in consensus by two experienced cardiovascular radiologists.Results Dissection was detected in the superior mesenteric artery(SMA)in 11 patients,in the celiac artery extending to splenic artery in 1 patient and additionally to the SMA in 1 patient.MSCTA showed the intimal flap(11),intimal tear at the proximal vessels and thrombi within false lumina(7).The dissection was categorized using Yun’s classification of SMA dissection as types I(4),IIa(3),IIb(3)and III(1). The other associated findings on MSCTA were dilated SMA(2),indistinct fat plane surrounding the SMA(2),aneurysmal dilatation of SMA(1),focal ileum mural edema(2),distended ascending colon(1)and ascites(3). Nine patients responded to conservative treatment and two patients required open surgery.Conclusions MSCTA is useful for detection and treatment planning of symptomatic SSD.