Clinical Application Of Mscta In Superior Mesenteric Artery

PartⅠThe evaluation of MSCTA performance in nomal SMA and SMA diseaseObjective: To investigate the imaging performance of superior mesenteric artery(SMA) MSCTA in normal adults and in patients who had SMA disease.Methods and materials: 504 cases were collected from January 2008 to December 2009 with dual-phase enhanced scan of whole abdomen. The dual-phase enhanced scan adopted arterial phase and venous phase. Source images of a thickness of 0.625mm were used for image reconstruction. The reconstruction techniques including MPR (Multiplanar Reconstruction), MIP (Maximal intensity projection) and VR (volume rendering) were used. The data was collected: the angle between SMA and abdominal aortic(AA), the number of jejunal and ileal artery, the angle between ileocolic artery branch, the frequency of right colic artery, transverse artery and inferior pancreaticoduodenal artery and on the left renal vein plane and the third part of dodecadactylon plane the distance between SMA and AA. SPSS13.0 software was used for statistical analysis.Results: In the 504 patients with dual-phase enhanced MSCT scan, a total 266 were found no lesion in the SMA and its distribution area and 44 were proved intestinal diseases by operation or pathology. In the 266 nomal cases of SMA and its distribution area, 259 cases had normal shape and distribution of SMA and 7 cases had normal variation. The angle between SMA and AA were 57.1°±14.0°. The frequency of right colic artery, transverse artery and inferior pancreaticoduodenal artery were 31.7%, 52.5%, and 68.4%. The angle between the two branches of ileocolic artery was 77.7°±28.7°. There are 3~8 jejunal arterys and 1~6 ileal arterys. The distance between SMA and AA were 16.2±7.2mm on left renal vein plane and 17.5±7.4mm on the third part of duodenum plane. The 44 cases of SMA lesions included: The etiological results included: superior mesenteric artery thrombosis (3 cases), superior mesenteric artery dissecting aneurysm (10 cases), arteriovenous malformation (5 cases), nutcracker syndrome(5 cases), superior mesenteric artery syndrome (6 cases), tumoral incasement of SMA(10 cases). In the patients of nutcracker syndrome the average angle between AA and SMA were 15°±2.4°, the distance between AA and SMA were: 5.8± 1.2mm on the plane of left renal vein.Both of the data were significantly different from nomal situation. In the patients of superior mesenteric artery syndrome the average angle between AA and SMA was 15.7°±2.6°, the distance between AA and SMA were: 5.7±1.6mm on the plane of left renal vein. compared with the normal situation, the data was significantly different.Conclusion:①MSCTA can visualize SMA course, distribution and the angle between SMA and AA.②MSCTA can clearly show the the endovascular lesion of SMA.③MSCTA can simultaneously observe the extravascular structure of SMA. PartⅡThe evaluation of MSCTA niveau diagnosis of small intestinal disease by reconstruction superior mesenteric arteryObjective To evaluate MSCT in niveau diagnosis by reconstruction superior mesenteric artery (SMA); and to observe the evaluation of qualitative diagnosis of small intestinal disease from the change of SMA and superior mesenteric vein (SMV).Methods 362 patients clinically suspected intestinal disease were collected from January 2008 to December 2009. Dual-phase MSCT scan was performed and source images of a thickness of 0.625mm were used for image reconstruction. The reconstruction technique of MPR (Multiplanar Reconstruction), MIP (Maximal intensity projection) and VR (volume rendering) were used. The diagnostic accuracy of reconstruction imaging was compared with the source images of a thickness of 0.625mm.Results A total 101 were proved intestinal disease by operation or pathology. The etiology resulted included: intestinal diverticulum (12 cases), intestinal tumor(29 cases), inflammatory process(25 cases) , arteriovenous malformation(AVM, 5 cases) , intestinal volvulu(7 cases), intestinal entocele(3 cases), enterolith intestinal obstruction (6 cases), adhesion intestinal obstruction (6 cases) , stomal stenosis after surgery(3 cases), intussusception(3 cases), oblique inguinal hernia(1 cases). In the 101 cases of intestinal disease proved by operation or pathology, 64 cases were diagnosed correctly with source image, and 94 cases were diagnosed correctly with reconstruction imaging. Reconstruction imaging significantly surpasses source image in niveau diagnosis of small intestinal disease. SMA reconstruction is valuable in qualitative diagnosis of the intestinal volvulus, the superior mesenteric artery syndrome, the mesenchymoma of small intestine and AVM .Conclusion MSCT with relative reconstruction techniques was helpful for evaluation of small intestinal disease, and was valuable for demonstrating the lesion site for surgical intervention, both of which are essential for make the suitable treatment planning.