多层螺旋CT对左肾静脉走行规律的显示及对胡桃夹综合征诊断的启示

发布时间：2018-04-19 08:22

  本文选题：“胡桃夹”综合征 + 肠系膜上动脉　； 参考：《山东大学》2012年硕士论文

【摘要】：目的 应用多层螺旋CT(MSCT)及后处理技术研究正常左肾静脉(left renal vein, LRV)、肠系膜上动脉(superior mesenteric artery,SMA)与腹主动脉(abdominal aorta, AA)夹角的解剖形态学规律,探讨MSCT诊断“胡桃夹”综合征(nutcracker syndrome, NCS)的临床应用价值。 方法 采用64排MSCT,前瞻性观察220例正常者的SMA与AA的夹角大小,LRV最窄处、近肾门段最宽处的内径(前后径)及相应水平的截面积,以明确LRV的走行特征及正常人SMA与AA夹角的大小对LRV形态的影响,并计算出正常人SMA与AA夹角的范围LRV受压前后的内径、截面积的参考范围以及体重指数与夹角的关系。图像后处理技术包括多平面重组(multi-planar reformation, MPR)、最大强度投影(maximum intensity projection, MIP)。另有3例临床已证实NCS的病例作为分析参考。 结果 220例正常SMA与AA的夹角的大小为56.67±18.27。,肾门段LRV前后径(DD)为9.91±2.23mm,截面积(SAD)为119.81±43.03mm2；夹角段LRV前后径(DN)为6.50±2.31mm,截面积(SAN)为86.47±41.27mm2；并计算DD/DN,SAD/SAN。220例正常人中体重指数(body mass index, BMI,Kg/m2)与SMA与AA间的夹角不具有明显的相关性,但是有一定的正相关联系。 结论 正常人LRV于SMA夹角处呈所谓轻度受压征象(移行型或夹角小于50。)是一种普遍存在的正常现象。NCS是一个以临床症状为前提的综合诊断,不能单纯依靠CT表现确诊NCS,但CT表现可提示患NCS的可能性大小。当LRV呈未受压型或移行型,SMA夹角大于50。,截面积缩小在Ⅱ度以下,可排除NCS的可能；LRV呈漏斗型,夹角小于50。,截面积缩小达Ⅱ度以上者,高度可疑NCS,应结合临床症状进一步检查确诊。
[Abstract]:PurposeThe anatomical morphology of left renal vein (LRV), superior mesenteric mesenteric artery (SMA) and abdominal aorta (AAA) in normal left renal vein were studied by multislice spiral CT (MSCT) and postprocessing technique. The clinical application value of MSCT in the diagnosis of nutcracker syndrome (NCSs) was discussed.MethodThe angle between SMA and AA and the inner diameter (anteroposterior diameter) near the widest part of the hilar segment and the corresponding sectional area were observed prospectively by 64 row MSCT in 220 normal subjects.In order to clarify the characteristics of LRV and the influence of the angle between SMA and AA on the morphology of LRV, the inner diameter, the reference range of cross section and the relationship between the body mass index and the angle of LRV were calculated before and after the compression of the angle between SMA and AA in normal people.Image post-processing techniques include multi-planar recombination multi-planar reform, MPRA, maximum intensity projection maximum intensity project, MPRA.Another 3 cases of clinically confirmed NCS were used as a reference for analysis.ResultThe angle between normal SMA and AA was 56.67 卤18.27 mm, the anterior and posterior diameter of renal hilar LRV was 9.91 卤2.23 mm, the cross section area was 119.81 卤43.03 mm-2, the angle segment of LRV anterior and posterior diameter was 6.50 卤2.31 mm, and the cross section area was 86.47 卤41.27 mm, and the body mass index (BMI) between SMA and AA was calculated.There is no obvious correlation between the angles,But there is a positive correlation.ConclusionIn normal subjects, LRV showed so-called mild compression at the angle of SMA (transference or angle less than 50. 0).NCS is a common normal phenomenon. NCS is a comprehensive diagnosis based on clinical symptoms. It can not be diagnosed solely by CT findings, but CT findings can indicate the possibility of NCS.When the angle of LRV is greater than 50. The cross section area is smaller than 鈪，

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