目的 探讨多层螺旋CT(multi-slice spiral CT,MSCT)和超声(ultrasonography,US)诊断胡桃夹现象(nutcracker phenomenon,NCP)的价值。方法 回顾性分析行腹部MSCT和US患者的影像资料,选取证实为NCP的患者30例为观察组,随机抽取因其他原因行腹部MSCT和US检查且无NCP的30例患者为对照组。对两组患者腹主动脉(AA)和肠系膜上动脉(SMA)的夹角(AMA)、左肾静脉(LRV)近肾门扩张处内径(DD)和峰值流速(PVd)、夹角段LRV最窄处内径(DN)和峰值流速(PVn)等,进行相关统计学分析。结果 MSCT和US均可对AMA、DD、DN进行准确测量,且独立检查方式下对比观察组与对照组,差异有统计学意义 (P<0.05),两种检查方式的单因素对比差异无统计学意义 (P>0.05)。US可测PVd、PVn,观察组和对照组数据具有明显差异(P<0.05)。观察组发现侧支循环扩张增粗12例,十二指肠受压7例,左肾体积增大5例,左肾皮质CT增强密度减低3例。结论 MSCT和US是诊断NCP的主要手段,但MSCT对NCP患者伴随征象诊断更具有优势。
Abstract
Objective To explore the value of multi-slice spiral CT(MSCT) and ultrasonography (US) in diagnosing nutcracker phenomenon (NCP). Methods The imaging data on 60 patients with abdominal MSCT and US was retrospectively analyzed. The 30 patients in the observation group were confirmed as cases of NCP.In the control group, 30 patients without NCP who underwent abdominal MSCT and US examination for other reasons were randomly selected.The aortomesenteric angle (AMA), the inner diameter (DD) and peak velocity (PVd) of the left renal vein near hilar dilatation, the inner diameter (DN) and peak velocity (PVn)of the narrowest part of the LRV in the AMA were obtained and analyzed statistically. Results Both MSCT and US could accurately measure AMA,DD and DN. An independent examination showed statistically significant difference in the data on the two groups(P<0.05), while the single-factor comparison between the two examination methods showed no significant difference (P>0.05). PVd and PVn could be measured in US, and there was significant difference between the two groups (P<0.05).However, MSCT had obvious advantages in the diagnosis of concomitant symptoms in patients with NCP.In the observation group using MSCT examination, there were 12 cases of dilatation and thickening of the left lumbar vein and reproductive vein, 7 cases of narrowing of horizontal parts of duodenum, 5 cases of enlargement of the left kidney volume compared to the right kidney, and 3 cases of decrease in CT enhancement density of the left renal cortex compared with the contralateral renal cortex. Conclusions MSCT and US are the main means of diagnosis of NCP, but MSCT is superior.
关键词
体层射影术 /
X线计算机 /
超声 /
胡桃夹现象
Key words
tomography /
X-ray computed /
ultrasonography /
nutcracker phenomenon
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参考文献
[1] Kim S H. Doppler US and CT Diagnosis of nutcracker syndrome[J]. Korean J Radiol,2019,20(12):1627-1637.
[2] 闫呈新,李筱倩,杨可乐,等.MSCTA多平面重组及三维重建图像对胡桃夹综合征的诊断价值[J].中国CT和MRI杂志,2012,10(3):68-70.
[3] 刘玉霞,马 睿.MSCT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[J].医学影像学杂志,2012,22(4):611-615.
[4] Yun S J, Lee J M, Nam D H,et al. Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography[J].Abdom Radiol (NY),2016,41(8):1580-1588.
[5] Yun S J, Nam D H, Ryu J K, et al. The roles of the liver and pancreas in renal nutcracker syndrome[J]. Eur J Radiol,2014,83(10):1765-1770.
[6] Dunphy L, Penna M, Tam E, et al. Left renal vein entrapment syndrome: nutcracker syndrome![J],BMJ Case Rep,2019,12(9):e230877.
[7] 王永光,陈庆东,李 勐,等.多层螺旋CT在后胡桃夹综合征和后胡桃夹现象中诊断价值[J]. 临床放射学杂志,2019,38(7):1282-1285.
[8] Zerin J M, Hernandez R J, Sedman A B, et al. “Dilatation” of the left renal vein on computed tomography in children: a normal variant[J].Pediatr Radiol,1991,21(4):267-269.
[9] Yin H, Zhao J, Du L.Incidental finding of the nutcracker phenomenon detected by 18F-FDG PET/CT[J]. Clin Nucl Med,2013,38(3):212-214.
[10] Inal M, Karadeniz M Y, Sahin S. Nutcracker syndrome accompanying pelvic congestion syndrome; color doppler sonography and multislice CT findings: a case report[J]. Iran J Radiol,2014,11(2):e11075.
[11] Oh M J. Superior mesenteric artery syndrome combined with renal nutcracker syndrome in a young male: a case report[J]. Korean J Gastroenterol,2017,70(5):253-260.
[12] Özkan M B, Ceyhan B M, Hayalioglu E. Anterior and posterior nutcracker syndrome accompanying left circumaortic renal vein in an adolescent: case report[J]. Arch Argent Pediatr,2016,114(2):e114-e116.
[13] Moreno M C, Galván M D, Cortés Sañudo X,et al. An unusual association: median arcuate ligament syndrome and nutcracker syndrome[J]. Rev Esp Enferm Dig,2019,111(3):241-242.
[14] 张 鹏,都基权,许 韫,等.腹部CT低剂量扫描自动管电流调制技术的应用价值[J].武警医学,2020,31(4):287-290.
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