CTA与DSA在自发性孤立性肠系膜上动脉夹层中诊断中的价值对比

目的:探讨CTA与DSA在自发性孤立性肠系膜上动脉夹层中的诊断价值对比。方法:回顾性分析2017年1月至2019年12月本院收治21例SISMAD的患者临床资料，所有入选患者均行CTA及DSA检查。计算CTA对SISMAD的敏感性、特异性、阳性预测值、阴性预测值及准确率。比较两者在诊断SISMAD的准确率差异是否存在统计学意义。以DSA为金标准，CTA对SISMAD的检查结果进行一致性Kappa检验。结果:21例患者中，经CTA诊断20例为SISMAD，1例为肠系膜上动脉栓塞，CTA诊断SISMAD的准确率为95.23%，两者诊断SISNAD的准确率差异不存在统计学意义（P>0.05）。采用Yun分型方法，其中Ⅰ型8例，Ⅱa型5例，Ⅱb型7例，按Yun分型，对Ⅰ型SISMAD的敏感性、特异性、阳性预测值、阴性预测值分别为75%、84.61%、75%和84.61%；Ⅱa型SIAMAD的敏感性、特异性、阳性预测值、阴形预测值分别为60%、87.5%、60%和87.5%；Ⅱb型SIAMAD的敏感性、特异性、阳性预测值、阴形预测值分别为71.43%、85.71%、71.43%和85.71%。CTA对SISMAD检查结果与DSA的检查结果一致性较好（Kappa=0.738）。结论:CTA可快速准确诊断自发性孤立性肠系膜上动脉夹层，并能够准确分型，对临床下一步治疗具有重要指导意义，值得临床推广使用。 

Comparison of Value of CTA and DSA in the Diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection

Objective:To investigate the diagnostic value of CTA and DSA in spontaneous isolated mesenteric artery dissection. Methods:The clinical data of 21 patients admitted to our hospital from January 2017 to December 2019 were retrospectively analyzed, and CTA and DSA were performed in all selected patients. Calculate the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA to SISMAD. To compare whether there are statistically significant differences in the accuracy of the two in the diagnosis of sismad. Using DSA as the gold standard, CTA performed a consistent Kappa test on the inspection results of SISMAD. Results:Of the 21 patients, 20 were diagnosed by CTA as SISMAD, one was superior mesenteric artery embolization, and the accuracy of CTA in the diagnosis of SISMAD was 95.23%. There was no significant difference in the accuracy of the two diagnoses(P>0.05). The sensitivity, specificity, positive predictive value and negative predictive value to type Ⅰ SISMAD were 75%, 84.61%, 75% and 84.61% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of type Ⅱa SISMAD were 60%, 87.5%, 60%, 87.5%; The sensitivity, specificity, positive predictive value and negative predictive value of type Ⅱb SISMAD were 71.43%, 85.71%, 71.43%, 85.71%, 85.71%, respectively. The results of CTA examination of SISMAD were consistent with those of DSA(Kappa=0.738). Conclusion:CTA can diagnose spontaneous solitary mesenteric artery dissection quickly and accurately, and it has important guidance for the next treatment significance, which is worthy of clinical promotion and use.