Chronic mesenteric ischemia (CMI) is rare and is often diagnosed late. Fatal malabsorption-related complications or acute ischemic events occur in the absence of treatment. Diagnosis depends on careful acquisition of a medical history and elimination of other conditions. No sensitive and specific tests are available for functional diagnosis of CMI. If other causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) suggests CMI. Until the 1990s, open surgery was considered the treatment of choice; percutaneous transluminal angioplasty (PTA) was reserved for patients for whom surgery carried a high risk. However, open surgery carries a nonnegligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of CMI. New treatments including administration of fibrinolytic agents before PTA of chronic occlusions, routine revascularization of one or more arteries, and stent placement will probably be validated in the near future. Similarly, new data on selection of the best approach will become available soon.
경우 Grade 0, 리피오돌 결절성반점이 1-3개있는 경우 Grade 1, 결절성반점 이 4개이상 또 는 반월성반점이 한 개있는 경우 Grade 2, 그리고 반월성반점이 둘이상 있는 경우 Grade 3 으로 분류하였다. CT 촬영후 신장을 적출하여 조직표본을 만들고 CT 영상소견과 비교하였 다. 조직절편에 나타난 병변의 크기 측정은 신우를 중심으로 횡절단한 슬라이 스를 1: 1 로 인화지 촬영한후 방안지를이용하여 측량한후백분율을내었다. 결 과 : 현미경학적으로 이상이 있는 조직의 육안적 이상 소견은 염증세포 침윤과 리피 오돌 소적 이 있는 부위는 미세한 까만점의 무리로, 이영양성 석회화가 있는 부위는 암갈색 반점의 무리로,그리고세포괴사가있는부위는균절한펑크색 바탕으로나타났다. Grade 0 인 5예의 조직학적 병변의 크기는 평균 2.2%, Grade 1 인 4예는 평균 4.5 %, Gr ade 2 인 7예 는 평균 21.9%, 그리고 Grade 3 인 4예는 평균 24%로 CT 영상에서 결절성 반점 (nodular fleck) 이 4개이상이던지 혹은 반월성 반정 (semi lunar fleck) 이 있었던 Grade 2 및 3과 결절 성 반점이 3개 이하였던 Grade 0 및 1 사이에는 통계적으로 유의성있는 조직학적 병변의 크 기를나타내였다.
Our objective was to describe the main aspects of MR imaging in Caroli's disease. Magnetic resonance cholangiography with a dynamic contrast-enhanced study was performed in nine patients with Caroli's disease. Bile duct abnormalities, lithiasis, dot signs, hepatic enhancement, renal abnormalities, and evidence of portal hypertension were evaluated. Three MR imaging patterns of Caroli's disease were found. In all but two patients, MR imaging findings were sufficient to confirm the diagnosis. Moreover, MR imag-ing provided information about the severity, location, and extent of liver involvement. This information was useful in planning the best therapeutic strategy. Magnetic resonance cholangiography with a dynamic contrast-enhanced study is a good screening tool for Caroli's disease. Direct cholangiography should be reserved for confirming doubtful cases.
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