Shibasaki Yasushi, Sakaguchi Takanori, Kitajima Ryo, Furuhashi Satoru, Kiuchi Ryota, Takeda Makoto, Hiraide Takanori, Morita Yoshifumi, Unno Naoki, Takeuchi Hiroya
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Hamamatsu Medical Center, 328, Tomizuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan.
Clin J Gastroenterol. 2018 Aug;11(4):327-332. doi: 10.1007/s12328-018-0844-6. Epub 2018 Mar 5.
Pancreaticoduodenal artery (PDA) aneurysm associated with celiac axis compression by the median arcuate ligament (MAL) is a rare disorder, but may be lethal if ruptured. Therefore, prophylactic surgical treatments need to be considered when MAL compresses the celiac axis. We herein report the usefulness of an arterial flow analysis for objectively evaluating this pathophysiology under four-dimensional flow-sensitive magnetic resonance imaging (4D-flow MRI). Celiac artery stenosis was incidentally found under contrast-enhanced CT in a 50-year-old woman with symptomatic solitary pancreatic insulinoma. Under 4D-flow MRI, retrograde blood flow and aberrant wall shear stress were detected in the pancreaticoduodenal artery arcade. After obtaining informed consent, enucleation for insulinoma concomitant with MAL dissection was performed. Hypoglycemic attack completely resolved immediately after surgery. One month after surgery, 4D-flow MRI revealed normalized vectorial flow and wall shear stress in the PDA arcade without hypoglycemic attack. 4D-flow MRI is a very useful and non-invasive modality for objectively evaluating visceral artery hemodynamics.
与正中弓状韧带（MAL）压迫腹腔干相关的胰十二指肠动脉（PDA）动脉瘤是一种罕见疾病，但破裂时可能致命。因此，当MAL压迫腹腔干时，需要考虑进行预防性手术治疗。我们在此报告动脉血流分析在四维血流敏感磁共振成像（4D-flow MRI）下客观评估这种病理生理的实用性。一名50岁有症状的孤立性胰腺胰岛素瘤女性在增强CT检查时偶然发现腹腔动脉狭窄。在4D-flow MRI检查中，在胰十二指肠动脉弓中检测到逆行血流和异常的壁面切应力。在获得知情同意后，进行了胰岛素瘤摘除术并同时进行MAL松解。低血糖发作在手术后立即完全缓解。术后1个月，4D-flow MRI显示PDA弓中的矢量血流和壁面切应力恢复正常，且无低血糖发作。4D-flow MRI是客观评估内脏动脉血流动力学的一种非常有用且无创的检查方法。
