Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Radiographics. 2012 Sep-Oct;32(5):1503-22. doi: 10.1148/rg.325115100.
Mesenteric vein thrombosis (MVT) accounts for 5%-15% of all mesenteric ischemic events and is classified as either primary or secondary. Primary MVT is idiopathic, whereas secondary MVT can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer (most frequently of the pancreas or liver), diverse inflammatory conditions, recent surgery, portal hypertension, and miscellaneous causes such as oral contraceptives or pregnancy. Clinical symptoms of MVT are rather nonspecific and are mainly characterized by abdominal pain. The mortality rate for MVT remains high, since even now the diagnosis is often delayed. Multidetector computed tomography (CT) is the modality of choice in this context. Although venous bowel ischemia occurs only infrequently with MVT, radiologists should be familiar with its multidetector CT features. Familiarity with the possible causes of MVT, the underlying pathogenic mechanisms associated with MVT, and the correlation between multidetector CT features and these pathogenic mechanisms is necessary to optimize medical management and improve patient care.
肠系膜静脉血栓形成(MVT)占所有肠系膜缺血事件的 5%-15%,可分为原发性或继发性。原发性 MVT 是特发性的,而继发性 MVT 可由多种潜在疾病和危险因素引起,包括原发性高凝状态或血栓形成倾向、骨髓增殖性肿瘤、癌症(最常见于胰腺或肝脏)、各种炎症性疾病、近期手术、门静脉高压和其他原因,如口服避孕药或妊娠。MVT 的临床症状相当不特异,主要表现为腹痛。由于即使现在诊断也常常被延误,MVT 的死亡率仍然很高。多排螺旋 CT(CT)是这种情况下的首选检查方法。尽管肠系膜静脉血栓形成很少导致肠壁静脉缺血,但放射科医生应该熟悉其多排螺旋 CT 特征。熟悉 MVT 的可能病因、与 MVT 相关的潜在发病机制以及多排螺旋 CT 特征与这些发病机制之间的相关性,对于优化医疗管理和改善患者护理是必要的。