孤立性肠系膜上动脉夹层的MDCTA诊断探讨

目的]探讨孤立性肠系膜上动脉夹层的MDCTA影像特点并进行分型，为临床治疗提供参考。方法]回顾性分析15例孤立性肠系膜上动脉夹层患者的MDCTA影像特点、临床表现、治疗策略和随访结果，归纳影像类型并探讨其临床价值。结果]根据影像表现分为四型：一型：假腔开放，可见出口入口（3例）；二型：夹层范围较小，只见入口不见出口（3例）；三型：夹层范围较大，只见入口不见出口，假腔内血栓形成，可见假腔入口处溃疡样改变（8例）；四型：假腔扩大并腔内血栓形成压迫真腔，致真腔闭塞（1例）。除四型需行腔内治疗或外科手术外，其它类型均可经保守治疗趋于稳定，长期随访情况良好。结论]MDCTA对孤立性肠系膜上动脉的诊断、分型及随访观察具有重要临床价值。

Diagnosis Study of MDCTA in Isolated Superior Mesenteric Artery Dissection

Objectives] To report the clinical and imaging features of isolated superior mesenteric artery dissection and describe our imaging classification of this disease entity. Methods] We retrospectively analyzed clinical presentation, therapeutic schedule, follow-up and MDCTA imaging appearances of 15 patients who were diagnosed as isolated superior mesenteric artery dissection in our hospital and categorized their image types and investigate their clinical significance. Results] We categorized isolated superior mesenteric artery dissection into the following four types based on imaging appearances： type Ⅰ, patent false lumen with both entry and re-entry （3 patients）; type Ⅱ, minor and thrombosed false lumen only without re-entry （3 patients）; type Ⅲ, ＇cul-de-sac＇ shaped false lumen without re-entry ,thrombosed false lumen with ulcer like projection （ULP）, which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen （8 patients）; type Ⅳ, completely thrombosed false lumen with occlusive true lumen （1 patients）. One patient with type IV underwent urgent surgery because of small bowel ischemia. The remaining 14 patients were conservatively managed without any event during the follow-up period of 3 - 12 months. Conclusions] MDCTA has clinical significance in the diagnosis, imaging classification and follow-up of isolated superior mesenteric artery dissection.