-
摘要:目的
探讨弓状韧带综合征（MALS）CT血管成像（CTA）检查的影像学特征。
方法采用回顾性描述性研究方法。收集2019年11月至2020年10月上海交通大学医学院附属瑞金医院收治的56例MALS病人的临床影像资料；男30例,女26例；中位年龄为54岁,年龄范围为19~78岁。病人均行CTA检查。观察指标：（1）CTA检查情况。（2）相关性分析。（3）手术情况。正态分布的计量资料以x±s表示。计数资料以绝对数表示。采用Spearman相关性分析统计腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部距离、腹腔干和肠系膜上动脉最近距离的相关性,检验水准为0.05。
结果（1）CTA检查情况。①腹腔干狭窄程度：CTA横断面检查结果示56例病人中,腹腔干闭塞2例,重度狭窄10例,中度狭窄9例,轻度狭窄35例。CTA矢状面检查结果示：56例病人中,腹腔干闭塞2例,重度狭窄21例,中度狭窄15例,轻度狭窄18例。②不同狭窄程度检查情况：以CTA矢状面检查结果为标准。2例腹腔干闭塞病人均未见动脉瘤、夹层及血管变异,均可见胰十二指肠前后弓代偿增粗迂曲。21例腹腔干重度狭窄病人中,2例可见动脉瘤,1例可见夹层,7例可见胰十二指肠前后弓代偿增粗迂曲,8例可见胰十二指肠前后弓吻合,8例可见血管变异。15例腹腔干中度狭窄病人中,2例可见动脉瘤,3例可见夹层,2例可见胰十二指肠前后弓代偿增粗迂曲,4例可见胰十二指肠前后弓吻合,7例可见血管变异。18例腹腔干轻度狭窄病人中,1例可见动脉瘤,2例可见夹层,7例可见胰十二指肠前后弓吻合,6例可见血管变异。56例病人均未见肝、脾、胃等脏器缺血。③腹腔干发出位置：56例病人中,43例自第12节胸椎（T12）椎体下缘水平发出,2例自T12椎体中部发出,1例自T12椎体上部发出,7例自第1节腰椎（L1）椎体上部发出,1例自L1椎体中部发出,2例闭塞。（2）相关性分析。CTA矢状面检查结果示：56例病人腹腔干起始部与肠系膜上动脉起始部的距离为（6.0±4.0）mm,腹腔干轻度、中度、重度狭窄病人的起始部距离分别为（6.2±2.8）mm、（8.1±4.4）mm、（5.3±3.2）mm。56例病人中,23例起始部距离<5 mm。相关性分析结果显示：腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部的距离无关（r=-0.205,P>0.05）。CTA矢状面检查结果示：56例病人腹腔干和肠系膜上动脉的最近距离为（3.8±2.4）mm,腹腔干轻度、中度、重度狭窄病人的最近距离分别为（4.2±2.0）mm、（4.4±3.3）mm、（3.0±1.9）mm。56例病人中,45例最近距离<5 mm。相关性分析结果显示：腹腔干狭窄程度与腹腔干和肠系膜上动脉的最近距离无关（r=-0.249,P>0.05）。（3）手术情况：56例病人中,2例有临床症状（腹部疼痛）,54例无临床症状；4例行手术治疗,52例未治疗。4例行手术治疗病人中,2例病人因腹部疼痛就诊,上腹部CTA检查结果示MALS,腹腔干呈重度狭窄,行腹腔动脉造影检查、腹腔动脉支架置入术。术后CTA检查结果示腹腔干未见明显狭窄。2例病人无明显临床症状,因胰头部肿瘤行胰十二指肠切除术。术前CTA检查结果示腹腔干重度狭窄,术中行动脉搭桥术,缓解术中、术后因胃十二指肠动脉结扎造成的肝脏缺血,避免MALS术后并发症发生。术后CTA检查虚拟三维图像显示搭桥血管通畅。
结论CTA矢状面检查结果可评估MALS病人腹腔干狭窄程度、与弓状韧带的关系以及发出位置。
Abstract:ObjectiveTo investigate the features of median arcuate ligament syndrome (MALS) in computed tomography angiography (CTA).
MethodsThe retrospective and descriptive study was conducted. The clinical and imaging data of 56 patients with MALS who were admitted to Ruijin Hospital, Shanghai JiaoTong University School of Medicine from November 2019 to October 2020 were collected. There were 30 males and 26 females, aged from 19 to 78 years, with a median age of 54 years. All 56 patients underwent CTA. Observation indicators: (1) CTA examination; (2) correlation analysis; (3) surgical situations. Measurement data with normal distribution were represented as Mean±SD. Count data were described as absolute numbers or percentages. Spearman correlation analysis with test level of 0.05 was used to analyze the correlation between celiac trunk stenosis and the distance between the original location of celiac trunk and original location of superior mesenteric artery and the minimum distance of celiac trunk and superior mesenteric artery.
Results(1) CTA examination. ① Celiac trunk stenosis: results of cross sectional examina-tion of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 10 cases of severe stenosis, 9 cases of moderate stenosis and 35 cases of mild stenosis. Results of sagittal examination of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 21 cases of severe stenosis, 15 cases of moderate stenosis and 18 cases of mild stenosis. ② Examination of patients with different degree of vascular stenosis: according to the results of sagittal examination of CTA, the 2 cases with celiac trunk occlusion were negative for aneurysms, aortic dissection or vascular variations but positive for compensated varix of the anterior and posterior pancreatico-duodenal arches. Of the 21 cases with celiac trunk severe stenosis, 2 cases were positive for aneurysms, 1 case was positive for aortic dissection, 7 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 8 cases were positive for collateral circula-tions of anterior and posterior pancreaticoduodenal archs and 8 cases were positive for vascular variation. Of the 15 cases with celiac trunk moderate stenosis, 2 cases were positive for aneurysms, 3 cases were positive for aortic dissection, 2 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 4 cases were positive for collateral circulations of anterior and posterior pancreaticoduodenal archs and 7 cases were positive for vascular variation. Of the 18 cases with celiac trunk mild stenosis, 1 case was positive for aneurysms, 2 cases were positive for aortic dissection, 7 cases were positive for collateral circulations of the anterior and posterior pancreaticoduodenal arches, 6 cases were positive for vascular variation. All 56 patients were negative for ischemia of liver, spleen and stomach. ③ Original location of celiac trunk: of 56 patients, there were 43 cases had celiac trunk originated horizontally from the lower edge of T12 vertebral body, 2 cases had celiac trunk originated from the middle of T12 vertebral body, 1 case had celiac trunk originated from the upper part of T12 vertebral body, 7 cases had celiac trunk originated from the upper part of L1 vertebral body, 1 case had celiac trunk originated from the middle of L1 vertebral body and 2 cases had occluding celiac trunk. (2) Correlation analysis: results of sagittal observation on CTA examination showed the distance between the original location of celiac trunk and original location of superior mesenteric artery of the 56 patients was (6.0±4.0) mm. The distance between the original location of celiac trunk and original location of superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (6.2±2.8)mm, (8.1±4.4)mm and (5.3±3.2)mm respectively. There were 23 cases of the 56 patients had the distance between the original location of celiac trunk and original location of superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the distance between the original location of celiac trunk and original location of superior mesenteric artery (r=‒0.205, P>0.05). Results of sagittal observation on CTA examination showed the shortest distance between celiac trunk and superior mesenteric artery of the 56 patients was (3.8±2.4)mm. The shortest distance between celiac trunk and superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (4.2±2.0)mm, (4.4±3.3)mm and (3.0±1.9)mm, respectively. There were 45 cases of the 56 patients had the shortest distance between celiac trunk and superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the shortest distance between celiac trunk and superior mesenteric artery (r=‒0.249, P>0.05). (3) Surgical situations: of 56 patients, 2 cases were positive for clinical symptoms of abdominal pain, 54 cases were negative for clinical symptoms, 4 cases under-went surgical treatment and 52 cases not underwent surgical treatment. Of the 4 cases undergoing surgical treatment, 2 cases with abdominal pain were diagnosed as MALS by upper abdominal CTA. Celiac trunk of the 2 cases were severe stenosis and stents implantation under celiac arteriography were performed. Results of postoperative CTA showed celiac trunk was negative for obvious stenosis. The other 2 cases who were negative for clinical symptoms of MALS were planed to pancreaticoduo-denectomy for pancreatic head tumor. Results of preoperative CTA showed severe stenosis of celiac trunk and arterial bypass grafting was performed for the 2 cases during pancreaticoduodenectomy to alleviate liver ischemia caused by gastroduodenal artery ligation which would avoid the incidence of postoperative MALS associated complications. Result of postoperative CTA three-dimensional reconstruction showed the bypass vessel was unobstructed.
ConclusionBased on sagittal result of CTA examination, the stenosis of celiac trunk, the anatomical relationship between celiac trunk and arcuate ligament and the original location of celiac trunk of MALS patients can be evaluated.
-
Keywords:
- Arteries /
- Diagnosis, differential /
- Arcuate ligament /
- Celiac trunk /
- Stenosis /
- Computed tomography angiography /
- Surgery
-
弓状韧带综合征（median arcuate ligament syndrome,MALS）又称膈肌中脚压迫综合征、腹腔动脉压迫综合征,是由主动脉裂孔前方横膈角形成的正中弓状韧带压迫腹腔干导致的疾病,严重时可引起临床症状和并发症,部分病人需要手术治疗[1‑4]。腹腔干狭窄及其侧支循环的准确诊断、MALS并发症的评估,对肝脏、胰胆管等手术有重要价值[5‑6]。CT血管成像（computed tomography angiography,CTA）是一种特殊的CT检查方式,在血管团注对比剂后,选取靶血管中对比剂浓度最佳时刻进行CT扫描,重建血管二维、三维影像,常用于血管性疾病的诊断[7]。本研究回顾性分析2019年11月至2020年10月我科收治的56例MALS病人的临床影像资料,探讨MALS CTA检查的影像学特征。
资料与方法
一、一般资料
采用回顾性描述性研究方法。收集56例MALS病人的临床影像资料；男30例,女26例；中位年龄为54岁,年龄范围为19~78岁。本研究通过我院医学伦理委员会审批,批号为（2021）临伦审第（135）号。病人及家属均签署知情同意书。
二、纳入标准和排除标准
纳入标准：（1）行上腹部CTA检查。（2）CTA检查结果示腹腔干起始部狭窄。（3）CTA检查确诊为MALS。
排除标准：（1）CTA检查结果示腹腔干动脉粥样硬化斑块、肿瘤侵犯腹腔干、腹腔干大动脉炎导致的腹腔干起始部狭窄。（2）有腹部手术史。
三、影像学检查
（一）仪器与方法
采用日本东芝公司CT仪（型号：Toshiba Aquilion ONE）、中国联影公司CT仪（型号：uCT760）或荷兰飞利浦公司CT仪（型号：Philips IQon‑Spectral）行上腹部CTA检查；管电压为120 kV,管电流为150~200 mA,矩阵为512×512,扫描层厚层距为5 mm,重建层厚层距为1 mm。对比剂为碘普罗胺1.5 mL/kg。
（二）图像分析
容积数据重建后使用多平面重组、最大密度投影处理技术显示血管。由2位放射科医师共同阅片,经商讨后达成影像意见一致作为判断结果。
四、观察指标
观察指标：（1）CTA检查情况包括腹腔干狭窄程度、不同狭窄程度检查情况、腹腔干发出位置。（2）相关性分析：腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部距离的相关性；腹腔干狭窄程度与腹腔干和肠系膜上动脉最近距离的相关性。（3）手术情况：手术类型、手术完成情况。
评价标准：参考文献[8]评价腹腔干狭窄程度,重度狭窄为血管腔狭窄程度>75%,中度狭窄为血管腔狭窄程度为50%~75%,轻度狭窄为血管腔狭窄程度<50%。
五、统计学分析
应用SPSS 19.0统计软件进行分析。正态分布的计量资料以x±s表示。计数资料以绝对数表示。采用Spearman相关性分析统计腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部距离、腹腔干和肠系膜上动脉最近距离的相关性,检验水准为0.05。
结果
一、CTA检查情况
（一）腹腔干狭窄程度
CTA横断面检查结果示：56例病人中,腹腔干闭塞2例（图1A）,重度狭窄10例（图1B）,中度狭窄9例（图1C）,轻度狭窄35例（图1D）。CTA矢状面检查结果示：56例病人中,腹腔干闭塞2例（图2A）,重度狭窄21例（图2B）,中度狭窄15例（图2C）,轻度狭窄18例（图2D）。
（二）不同狭窄程度检查情况
以CTA矢状面检查结果为标准。2例腹腔干闭塞病人均未见动脉瘤、夹层及血管变异,均可见胰十二指肠前后弓代偿增粗迂曲。21例腹腔干重度狭窄病人中,2例可见动脉瘤,1例可见夹层,7例可见胰十二指肠前后弓代偿增粗迂曲,8例可见胰十二指肠前后弓吻合,8例可见血管变异。15例腹腔干中度狭窄病人中,2例可见动脉瘤,3例可见夹层,2例可见胰十二指肠前后弓代偿增粗迂曲,4例可见胰十二指肠前后弓吻合,7例可见血管变异。18例腹腔干轻度狭窄病人中,1例可见动脉瘤,2例可见夹层,7例可见胰十二指肠前后弓吻合,6例可见血管变异。56例病人均未见肝、脾、胃等脏器缺血。
（三）腹腔干发出位置
56例病人中,43例自第12节胸椎（T12）椎体下缘水平发出,2例自T12椎体中部发出,1例自T12椎体上部发出,7例自第1节腰椎（L1）椎体上部发出,1例自L1椎体中部发出,2例闭塞。
二、相关性分析
CTA矢状面检查结果示：56例病人腹腔干起始部与肠系膜上动脉起始部的距离为（6.0±4.0）mm,腹腔干轻度、中度、重度狭窄病人的起始部距离分别为（6.2±2.8）mm、（8.1±4.4）mm、（5.3±3.2）mm。56例病人中,23例起始部距离<5 mm。相关性分析结果显示：腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部的距离无关（r=-0.205,P>0.05）。CTA矢状面检查结果示：56例病人腹腔干和肠系膜上动脉的最近距离为（3.8±2.4）mm,腹腔干轻度、中度、重度狭窄病人的最近距离分别为（4.2±2.0）mm、（4.4±3.3）mm、（3.0±1.9）mm。56例病人中,45例最近距离<5 mm。相关性分析结果显示：腹腔干狭窄程度与腹腔干和肠系膜上动脉的最近距离无关（r=-0.249,P>0.05）。
三、手术情况
56例病人中,2例有临床症状（腹部疼痛）,54例无临床症状；4例行手术治疗,52例未治疗。4例行手术治疗病人中,2例病人因腹部疼痛就诊,上腹部CTA检查结果示MALS,腹腔干呈重度狭窄,行腹腔动脉造影检查、腹腔动脉支架置入术。术后CTA检查结果示腹腔干未见明显狭窄。2例病人无明显临床症状,因胰头部肿瘤行胰十二指肠切除术。术前CTA检查结果示腹腔干重度狭窄,术中行动脉搭桥术,缓解术中、术后因胃十二指肠动脉结扎造成的肝脏缺血,避免MALS术后并发症发生。术后CTA检查虚拟三维图像显示搭桥血管畅通（图3）。
讨论
MALS病人多无明显症状,少数可发生腹部不适等非特异性症状,极少数可导致腹腔动脉压迫综合征[9‑11]。MALS是腹腔动脉狭窄或闭塞的常见原因之一[12]。其他导致腹腔动脉狭窄原因有动脉粥样硬化、大动脉炎综合征、肿瘤压迫侵犯等[13]。MALS主要并发症为动脉瘤,以胰十二指肠动脉瘤多见,而腹腔动脉瘤罕见[14‑15]。
一、腹腔干狭窄程度
CTA横断面检查有时不能发现MALS压迫表现,导致无法准确评估腹腔干的狭窄程度[16]。本研究56例病人中,横断面检查结果示腹腔干重度狭窄10例,矢状面检查结果示重度狭窄21例。本研究结果显示：56例MALS病人中,54例无临床症状,但CTA检查结果示38例腹腔干中、重度狭窄或闭塞；并且,在腹腔干轻度、中度、重度狭窄病人中均可见胰十二指肠动脉前后弓吻合,部分病人还可见胰十二指肠动脉吻合弓增粗。已有的研究结果显示：MALS的侧支交通分为胰十二指肠动脉弓型、胰背动脉型和肝内型,以第1种最常见[17]。这提示多数MALS病人无临床症状和较少发生MALS相关术后并发症可能是因为有侧支交通代偿供血,这可以减轻因腹腔干狭窄引起的腹痛或腹腔干供血脏器的缺血,通常是通过胃十二指肠动脉‑胰十二指肠动脉弓吻合‑肠系膜上动脉补偿供血。
二、弓状韧带与腹腔动脉的关系
CTA检查可直接显示弓状韧带与腹腔干的解剖位置关系,通过多平面重建,可显示腹腔干牵拉压迫程度,进而评估其狭窄程度、有无并发症等[18‑19]。从腹腔干在腹主动脉发出位置来看,已有的研究结果显示：85%的腹腔干开口于第11节胸椎椎体上1/3和T12椎体上1/3之间,而正中弓状韧带常位于L1椎体水平,因此,腹腔干在腹主动脉上发出位置过高或膈肌脚附着点过低可导致腹腔动脉受压,通常前者为最常见原因[1,20]。本研究结果显示：56例MALS病人中,43例腹腔干发出位置位于T12椎体下缘,与李晚君等[12]的研究结果相近,推测膈肌脚附着点过低是腹腔干狭窄的主要因素。本研究结果显示：MALS病人腹腔干与肠系膜上动脉起始位置接近,腹腔干狭窄程度与腹腔干起始部和肠系膜上动脉起始部的距离和最近距离均无关。这提示两者不能作为评估MALS严重程度的指标,亦不能成为是否需要手术的依据。
本研究结果显示：2例腹腔干闭塞病人均未见动脉瘤、夹层、血管变异；18例腹腔干轻度狭窄病人中,1例动脉瘤,2例夹层,6例血管变异。这说明动脉瘤和（或）夹层、血管变异的出现仅提示存在MALS可能性,对于评估腹腔干的狭窄程度作用有限。
三、MALS的治疗和诊断重点
单纯的MALS压迫腹腔干无临床意义,腹腔干狭窄在无症状人群中的发生率约为7.3%[21]。只有当MALS压迫腹腔干致狭窄并引起临床症状或手术并发症时,才需要进行临床干预[22‑23]。对于需行腹腔干手术的MALS病人,术前CTA检查有助于准确评估腹腔干狭窄程度、腹腔干供血脏器血供情况,可以预防术后脏器缺血。而术前CTA诊断的重点应为MALS的直接征象,即腹腔干自腹主动脉发出的位置,矢状面可见弓状韧带压迫腹腔干起始段以及腹腔干的狭窄程度。其他CTA征象,如动脉瘤及夹层的发生、血管变异情况、侧支交通代偿情况,仅作为辅助指标。
综上,CTA矢状面检查结果可评估MALS病人腹腔干狭窄程度、与弓状韧带的关系以及发出位置；对有临床症状的MALS病人行腹腔干手术时应在搭桥手术前做好充分准备,以有效避免发生脏器缺血。
所有作者均声明不存在利益冲突。朱乃懿, 杨琰昭, 王晴柔, 等. 弓状韧带综合征CT血管成像检查的影像学特征[J]. 中华消化外科杂志, 2021, 20(9): 1001-1006. DOI: 10.3760/cma.j.cn115610-20210903-00436.http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20210903-00436
-
[1] 房星宇,于淼,宋海洋,等.腹腔动脉重度狭窄的影像学表现及经肝动脉介入治疗中的应对策略[J].中国介入影像与治疗学,2013,10(3):133‑137. [2] GoodallR, LangridgeB, OnidaS, et al. Median arcuate ligament syndrome[J]. J Vasc Surg,2020,71(6):2170‑2176. DOI: 10.1016/j.jvs.2019.11.012.
[3] KimEN, LambK, RellesD, et al. Median arcuate ligament syndrome‑review of this rare disease[J]. JAMA Surg,2016,151(5):471‑477. DOI: 10.1001/jamasurg.2016.0002.
[4] SunZ, ZhangD, XuG, et al. Laparoscopic treatment of median arcuate ligament syndrome[J]. Intractable Rare Dis Res,2019,8(2):108‑112. DOI: 10.5582/irdr.2019.01031.
[5] NasrLA, FarajWG, Al‑KutoubiA, et al. Median arcuate ligament syndrome: a single‑center experience with 23 patients[J]. Cardiovasc Intervent Radiol,2017,40(5):664-670. DOI: 10.1007/s00270-016-1560-6.
[6] UstaS, KarabulutK, ArtaşH. Median arcuate ligament syn-drome during pancreaticoduodenectomy[J]. Turk J Surg,2018:1‑2. DOI: 10.5152/turkjsurg.2018.3989.
[7] 金征宇.医学影像学[M].3版.北京:人民卫生出版社,2015. [8] 戴汝平.心血管病CT诊断学[M].北京:人民卫生出版社,2000. [9] RawalaMS, AhmedAS, RizviS. An atypical presentation of median arcuate ligament syndrome[J]. Cureus,2020,12(3):e7289. DOI: 10.7759/cureus.7289.
[10] NgFH, WaiOK, WongAW, et al. Median arcuate ligament syndrome[J]. Hong Kong Med J,2016,22(2):184.e3‑e4. DOI: 10.12809/hkmj154821.
[11] Zambrano‑LaraM, Gonzalez‑UrquijoM, Lozano‑BalderasG, et al. Median arcuate ligament syndrome as a rare cause of chronic abdominal pain[J]. Rev Gastroenterol Mex (Engl Ed),2021,86(2):199‑201. DOI: 10.1016/j.rgmx.2020.05.004.
[12] 李晚君,徐海,林秀蓬,等.正中弓状韧带压迫腹腔动脉多层螺旋CT表现[J].中国医学影像学杂志,2016,24(1):40‑42. DOI: 10.3969/j.issn.1005-5185.2016.01.012. [13] SugaeT, FujiiT, KoderaY, et al. Classification of the celiac axis stenosis owing to median arcuate ligament compre-ssion, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenec-tomy[J]. Surgery,2012,151(4):543‑549. DOI:10.1016/j.surg. 2011.08.012.
[14] LambaR, TannerDT, SekhonS, et al. Multidetector CT of vascular compression syndromes in the abdomen and pelvis[J]. Radiographics,2014, 34(1):93‑115. DOI:10.1148/ rg.341125010.
[15] Núñez DelgadoY, GMÁValero, García‑Villanova RuizP. Aneurysm of the hepatic artery caused by median arcuate ligament syndrome (MALS)[J]. Rev Esp Enferm Dig,2020, 112(2):152‑153. DOI: 10.17235/reed.2020.6282/2019.
[16] OzbülbülNI. CT angiography of the celiac trunk: anatomy, variants and pathologic findings[J]. Diagn Interv Radiol,2011,17(2):150‑157. DOI:10.4261/1305-3825.DIR.3283- 10.1.
[17] SongSY, ChungJW, KwonJW, et al. Collateral pathways in patients with celiac axis stenosis: angiographic‑spiral CT correlation[J]. Radiographics,2002,22(4):881‑893. DOI: 10.1148/radiographics.22.4.g02jl13881.
[18] HanakiT, FukutaS, OkamotoM, et al. Median arcuate ligament syndrome and aneurysm in the pancreaticoduo-denal artery detected by retroperitoneal hemorrhage: a case report[J]. Clin Case Rep,2018,6(8):1496‑1500. DOI: 10.1002/ccr3.1643.
[19] HortonKM, TalaminiMA, FishmanEK. Median arcuate ligament syndrome: evaluation with CT angiography[J]. Radiographics,2005,25(5):1177‑1182. DOI:10.1148/rg. 255055001.
[20] IlicaAT, KocaogluM, BiliciA, et al. Median arcuate liga-ment syndrome: multidetector computed tomography findings[J]. J Comput Assist Tomogr,2007,31(5):728‑731. DOI: 10.1097/rct.0b013e318032e8c9.
[21] SomanS, SudhakarSV, KeshavaSN. Celiac axis compre-ssion by median arcuate ligament on computed tomography among asymptomatic persons[J]. Indian J Gastroenterol,2010,29(3):121‑123. DOI: 10.1007/s12664-010-0028-x.
[22] JohariHG, EskandariS, ParviziH, et al. Median arcuate ligament syndrome presenting as splenic infarction[J]. Am Surg,2020,86(5):544‑545. DOI:10.1177/0003134820 919743.
[23] MichellH, NezamiN, DewaldA, et al. Median arcuate liga-ment syndrome with celiac artery aneurysm and dissec-tion[J]. Vasc Endovascular Surg,2020,54(6):525‑527. DOI: 10.1177/1538574420927866.
下载:
计量
- 文章访问数: 905
- HTML全文浏览量: 2
- PDF下载量: 0
