The Study On Clinical Application Of Superior Mesenteric Artery Lesions And Associated Lesions With64Slice Spira CT Angiography

ObjectivesExplore the clinical value of64-slice spiral CT angiography of the superior mesenteric artery lesions and associated lesions. Summary common superior mesenteric artery lesions and associated lesions of the imaging features of the mainymptoms of acute and chronic abdominal pain. Understanding the normal anatomy of the superior mesenteric artery structure and variability.Materials and methodsCollected at our hospital from March2011to March2012, the clinical suspicion of mesenteric vascular disease in patients with acute and chronic abdominal pain. The whole abdominal enhanced CT and angiography. Collected69cases of superior mesenteric artery lesions in accordance with the inclusion criteria. Select patients with abdominal enhanced CT at the same time. Normal superior mesenteric artery were100cases collected in accordance with the inclusion criteria. All of the above cases the original data incoming the Toshiba Vitaea2workstation. Use of the maximum intensity projection (MIP), multiplanar reconstruction (MPR), volume rendering (VR), Thin slider MIP (TS-MIP), and surface reconst-ruction (CPR) a variety of post-processing reconstruction techniques. Observe and analyze the starting position of the normal superior mesenteric artery, and take the shape characteristics and branches, and other anatomical structures. Measuring the angle between the superior mesenteric artery (SMA) and abdominal aorta (AA)、distance of the left renal vein (LRV) level of SMA and AA、the minimum anteroposterior diameter of the left renal vein、 maximum anteroposterior diameter of the left renal vein of the left renal door、duodenum horizontal section (DHP) levels of SMA and AA distance. Evaluation of different post-processing reconst-ruction display capabilities and characteristics of the superior mesenteric artery and its branches. Classified summary of the superior mesenteric artery lesions.(Superior mesenteric artery syndrome and nutcracker syndrome) in patients with SMA and AA angle between the superior mesenteric artery lesions measured in accordance with the methods of measurement of the normal group, LRV levels of SMA and AA distance, minimum LRV of the anteroposterior diameter of the LRV’s maximum diameter, DHP level of SMA and AA around the distance. The superior mesenteric artery lesions and related intestinal lesions, summarized the imaging characteristics of the common lesions and MSCTA value. Use SPSS17.0statistical software for data analysis. Mean±standard deviation, on average, use the t-test and variance analysis were compared and the average difference. The chi-square test comparing different reconstruction methods using row X column shows the difference of the capacity and display rate. P<0.05for significant difference.Results100cases of the normal superior mesenteric artery. Male56cases,44cases of women, average age49.1years, less than30years old,12cases,aged30-60,65cases,23cases over the age of60. SMA starting position is lower than the average starting position of the celiac artery (CA)13.63±2.51mm. The starting point corresponds to the L1vertebral body in83cases (83%), corresponding between T12/L1vertebral body gap and L1/2vertebral body gap total of98cases (98%). SMA toward the longitudinal axis of straight34cases (34%), the bottom right toward the50cases (50%), the lower left toward the16cases (16%). Superior mesenteric artery and abdominal aorta angle average of56.62°±23.76°,stenosis (≤20°) in5cases,5%, normal type (20°～70°)66, accounting for66%, vertical (≥70°),29cases, accounting for29%. The LRV level SMA to AA distance12.6±6.05mm. LRV minimum inner diameter of5.88±2.04mm, LRV maximum internal diameter of8.75±2.54mm, The DHP level SMA to AA distance14.87±7.13mm. SMA in the process of out of shape, the separation of a blood vessel count is an average of12, between10-14support, accounting for89%. The left side of the average separation of8jejunal artery (JA), and ileal artery (IA),6-10-branch accounted for90%.The right side of the average issue4,4-5accounted for85%. Relatively fixed vascular branches of inferior pancreaticoduoden alarty(IPA), middle coliearty(MCA), rightcolicartery(RCA), ileocolicartery (ICA).SMA independently out of shape91(91%). The anatomic variations of eight cases. Celiac artery and superior mesenteric artery dry one cases. Hepatic artery from the SMA issued two cases. Right hepatic artery from the SMA issued four cases. Left hepatic artery from the SMA issued one cases.Between different gender, different age groups, SMA different go-shaped group, SMA and AA angle, LRV level of SMA to the AA distance, DHP level of SMA to the AA distance, by t-test and analysis of variance, p values>0.05, no significant difference. SMA different out of shape group the LRV level of LRV maximum internal diameter and the smallest inner diameter of variance analysis, p values>0.05, no significant difference. Different angle type A the LRV level of SMA to the AA distance,DHP level of SMA to the AA distance by analysis of variance, p value<0.05, significant difference. The LRV level of LRV maximum internal diameter and the smallest inside diameter of variance analysis, p values>0.05, no significant difference.Different angle between the Type B group, the LRV level of SMA to the AA distance, the’DHP level of SMA to the.AA distance by analysis of variance, p value<0.05, significant difference.The LRV level of LRV minimum inside diameter of variance analysis, p value<0.05, significant difference.The LRV level of LRV maximum internal diameter of variance analysis, p values>0.05, no significant difference.Three different reconstruction methods (VR, MIP, TS-MIP) can clearly show the superior mesenteric artery Ⅰ-Ⅲ-class vessel branch, the show was100%, displays and display rate of the chi-square test, p values>0.05, no significant difference. Vascular branch of the superior mesenteric artery IV-V level, regardless of the display capabilities or show, TS-MIP, MIP and VR, p value<0.05, significant difference. TS-MIP and MIP was significantly better than the VR. TS-MIP and MIP display and display rate, p<0.05, significant difference. TS-MIP better than MIP.The superior mesenteric artery lesions and associated lesions of69cases. Superior mesenteric artery lesions in13cases, including seven cases of nutcracker syndrome, the angle between the SMA and AA mean of13.78±5.31°the LRV level of SMA and AA distance was4.8±0.69mm, LRV minimum inner diameter of3.01±0.32, maximum inner diameter of7.99±1.27mm, respectively, compared with normal group by t test, p value<0.05, with a significant difference. Seven cases of nutcracker syndrome in patients with angle less than25°,the maximum diameter and the minimum inner diameter ratio greater than2.6cases of Superior mesenteric artery syndrome,SMA and AA angle average of20.88±5.95, the DHP level of SMA and AA distance was4.58±1.13mm, were significantly lower than the normal standard set of statistical significance.34cases of superior mesenteric artery disease itself. Including two cases of superior mesenteric artery embolism, laminated with thrombosis in two cases, four cases of sandwich. The performance of the direct signs of embolism and thrombosis in the MSCT, SMA lumen were seen in soft tissue density filling defect, stenosis, remote imaging interrupt or no imaging. Dissection were seen in the lumen in the arterial phase shift the intimal flap shadow and genuine dual-chamber. Aneurysm of the four cases, the performance of SMA initiation site was ectasia,9cases of atherosclerosis with stenosis, visible of MSCT on the SMA wall calcification and luminal stenosis and abdominal aortic prone to calcification. Bleeding in two cases, the performance of MSCT on the direct signs of bleeding tospill more obvious contrast agent overflow from the vessel lumen into the intestine, delayed scanning contrast agent. CTA reconstruction can clearly show abnormal thickening, strip or round the bleeding arteries.Tumor invasion of the the SMA10cases, to pancreatic violations of the most common, a total of seven cases, accounting for70%. Two cases of lymph node metastasis, embedded, one cases of lymphoma. Air embolism of the superior mesenteric artery in1case, the patient doors vein, aorta and superior mesenteric artery branches to see the wide range of gas. Intestinal lesions of22cases, including volvulus six cases, the CTA axial like to see a number of round or oval strengthen the blood vessel cross-section together, the typical signs of "whirl sign". Intussusception in four cases, the CTA reconstruction of direct signs of blood vessel involved in the levy, the involvement of mesenteric vessels in the intussusceptum.12cases of intestinal tumors, the CTA a variety of processing techniques reconstruction can be clearly showed SMA small branches and the relationship of the tumor, tumor location, nature provides an important basis of diagnosis.ConelusionSuperior mesenteric artery starting position, shape, SMA and AA angle anatomic structures such as large individual differences. The angle between the SMA and AA size, The LRV levels of SMA and AA distance, The DHP levels of SMA and AA distance are unrelated with different genders, different ages, Different shape of.SMA. The LRV levels of SMA and AA distance, The DHP levels of SMA and AA distance and the size of the angle between the SMA and AA are associated. The narrow angle type of LRV levels of SMA and AA distance and DHP levels of SMA to AA distance is significantly less than normal and the vertical angle type. The small angle between the SMA and AA is one of the causes of the nutcracker syndrome and superior mesenteric artery syndrome.64-slice spiral CT angiography (MSCTA) can be comprehensive, clearly show the superior mesenteric artery location, out of shape, angle and spatial anatomic characteristics, can be clearly shown that the cavity of the superior mesenteric arteries, extraluminal lesions form, location and scope. On superior mesenteric artery and their associated lesions in the diagnosis and differential diagnosis of great value, can effectively guide the clinical treatment and interventional operation, is currently the diagnosis of superior mesenteric artery lesions and associated lesions of the most effective, the most direct inspection method.