多模态MR小肠口服造影法对小肠肿瘤疾病的诊断价值分析

目的探讨多模态MR小肠口服造影法用于小肠肿瘤疾病诊断的临床价值。方法对130例患者均采用多模态MR小肠口服造影法进行小肠部位疾病的诊断,最终均经过了手术或者是肠道内镜活检及MR所测得的结果与病理结果进行对比。结果 130例患者中共有72例被确诊为小肠肿瘤,且有1例病理存在十二指肠横部间质瘤与十二指肠升部神经内分泌肿瘤并发的情况。MR对空肠近段的诊断效果相对较差,其余各部位的诊断敏感性、他异性、PPV、NPV以及负荷率均可达到100%,具有较好的诊断效果。腺瘤在MR影像中表现为小肠附壁结节,强化,突入肠腔,边缘光滑锐利;淋巴管瘤的肿块突入肠腔,表面覆盖强化的黏膜,囊肿没有强化;脂肪瘤平扫可见肠腔内脂肪的密度阴影;间质瘤的肠腔外软组织有肿块,边缘显著强化,没有肠梗阻的现象。结论多模态MR小肠口服造影法用于小肠肿瘤疾病诊断具有较高的诊断准确性。     

原发性小肠肿瘤临床特点及其诊治探讨

目的分析原发性小肠肿瘤的临床特点,探讨其诊断与治疗方法。方法回顾性总结分析我院2007—2014年收治的80例原发性小肠肿瘤患者的临床特点、病理类型与诊治方法。结果 80例原发性小肠肿瘤患者以腹痛、消化道出血、贫血、肠梗阻、腹部包块、消瘦为主要临床表现。其中恶性肿瘤30例,病理类型以腺癌、恶性间质瘤、淋巴瘤、印戒细胞癌为主;良性肿瘤50例,病理类型依次为良性间质瘤、错构瘤、腺瘤、血管瘤、脂肪瘤。原发性小肠肿瘤多发生于空肠,其次为十二指肠、回肠、十二指肠与空肠交界处。气囊辅助内镜对小肠肿瘤的阳性检出率明显高于胶囊内镜、腹部CT和消化道钡剂造影检查(分别为97.5%、88.2%、68.8%、66.7%,P<0.01)。结论原发性小肠肿瘤临床表现无特异性。气囊辅助内镜在小肠肿瘤的诊断和治疗中具有重要的临床应用价值。联合应用气囊辅助内镜、胶囊内镜、腹部CT及消化道钡剂造影检查可明显提高小肠肿瘤确诊率。     

MSCT在小肠肿瘤诊断中的临床价值

目的 探讨多层螺旋CT在小肠肿瘤性疾病诊断中的临床应用价值.方法 回顾性分析经手术及病理证实的32例小肠肿瘤的多层螺旋CT表现.结果 本组发生于十二指肠12例,空肠7例,回肠13例.13例腺癌、10例间质瘤、6例非霍奇金淋巴瘤及3例转移癌.结论 多层螺旋CT在小肠肿瘤诊断中的价值较大,尤其是增强扫描,大大提高了病灶的检出率,对常见小肠肿瘤的诊断与鉴别诊断具有较高的临床应用价值.     

小肠出血的诊疗进展

近年来 ,随着检查手段的拓展 ,对消化道出血的诊断有了明显提高 ,但对于怀疑小肠病变者 ,尚缺乏切实有效的检查手段。对于小肠血管性病变及小肠憩室 ,血管造影及ECT阳性率高 ,而对肠腔内隆起型病变 ,双对比造影效果较好 ,空肠上段及回肠末端病变 ,首选内镜检查 ,治疗上对于小肠出血 ,目前仍以手术为主 ,根据病变不同 ,也可镜下或药物治疗     

小肠出血的影像学检查

目的：分析小肠出血性病变的X线、DSA、核素扫描和CT表现,探讨小肠出血的影像学检查方法。材料和方法：回顾分析45例经临床病理证实的小肠出血性病变的X线、DSA、核素扫描和CT表现。包括小肠平滑肌瘤10例、平滑肌肉瘤8例、小肠憩室5例、小肠血管畸形22例。结果：小肠平滑肌瘤（肉瘤）,小肠钡剂造影检出率为86％（12／14）,DSA为92％（11／12）,核素扫描为50％（5／10）,CT检查为100％（8／8）。小肠憩室,小肠钡剂造影检出率为80％（4／5）,DSA为75％（3／4）,核素扫描为60％（3／5）,CT检查为67％（2／3）。小肠血管畸形,小肠钡剂造影检出率0％（0／20）,DSA为73％（16／22）,核素扫描为44％（7／16）,CT检查为0％（0／4）。结论：小肠出血病人的检查应该以小肠钡剂造影和DSA作为常规,核素扫描是一种补充手段,若发现小肠肿瘤时应加作CT检查。     

小肠肿瘤的影像学诊断

目的探讨小肠肿瘤的影像学表现及其病理学基础。方法搜集经手术病理证实的小肠肿瘤患者17例进行回顾分析。17例均行全消化道造影和螺旋CT平扫和双期增强扫描,7例行内镜检查。结果低分化腺癌3例,鳞腺癌1例,恶性间质瘤13例。发生于十二指肠7例,空肠6例,回肠4例。钡餐造影主要表现为黏膜变平或破坏12例,管腔狭窄5例。CT表现为不规则肿块,瘤体较大,瘤体内有低密度坏死区和细小钙化灶,双期增强扫描,肿块均有明显的不均匀强化,周围组织和淋巴结受侵。结论对临床疑为原发性小肠肿瘤者应首选上消化道造影,CT是明确诊断的主要影像检查技术,并对指导临床治疗和估计预后有一定的价值。     

螺旋CT及重组技术对小肠Crohn病的诊断价值

目的：探讨小肠Crohn病的CT表现。方法：回顾性分析经病理证实的8例Crohn病的CT扫描及后处理图像,分析病变肠管的数量、部位、肠壁的厚度和增强后病变肠壁的强化及并发症（蜂窝组织炎、炎性肿块、脓肿和瘘管）。结果：CT及后处理图像均能显示小肠Crohn病的病变肠段,敏感度为100%,8例共显示27段炎症肠壁。小肠Crohn病的CT表现：增强后所有病变肠段肠壁均有强化,25个病变肠段（92%）肠壁增厚,病变累及第6组小肠（回肠远段）8例,累及第5组（回肠中段）、第4组（回肠近段）、第3组（空肠远段）和第2组小肠（空肠近段）者分别7例、3例、2例和2例,累及回盲部3例,广泛累及结肠2例,8例均同时累及2组及2组以上小肠并呈节段性分布。肠系膜血管改变5例（62%）,肠管周围蜂窝织炎3例,炎性肿块2例,腹腔脓肿形成1例,未见瘘管形成。结论：螺旋CT及后处理技术是诊断小肠Crohn病的一种敏感的检查方法,并可判断病变的活动性,对指导临床治疗具有重要意义。     

口服等渗甘露醇螺旋CT肠造影对小肠肿瘤的诊断应用

目的评价口服大剂量2.5%等渗甘露醇螺旋CT小肠造影(SCTE)在小肠肿瘤诊断中的价值。方法 36例经手术病理证实小肠肿瘤患者每人口服2.5%等渗甘露醇约1000～1500 mL后,肌注20 mg山莨菪碱注射液,10～15 min后行螺旋CT三维扫描,分析不同小肠肿瘤的表现,并比较42例常规CT扫描与SCTE的诊断结果。结果 36例患者除2例回盲部充盈欠佳外,其余34例十二指肠,空肠及回肠肠腔充盈良好,对肿瘤的显示、衬托满意。SCTE检查与临床诊断符合率为94.4%(34/36),高于常规扫描78.57%(33/42)。结论 SCTE是一种简便、安全、非侵袭性,有效评价小肠肿瘤的方法,能明显提高肿瘤的检出率。     

小肠原发性肿瘤的影像诊断(附30例分析)

目的:探讨小肠原发性肿瘤的影像学特征及检查方法。方法:30例均行口服法小肠气钡双对比造影检查,其中2例行CT扫描,1例行MRI检查,全部病例均经手术病理证实。结果:30例中,腺癌9例,平滑肌肉瘤5例,腺瘤或息肉7例,类癌、间质瘤、管状腺瘤、神经节细胞瘤各2例,血管瘤1例。发生于十二指肠15例,空肠13例、回肠2例。恶性肿瘤多表现为:肠黏膜破坏,腔内或腔外不规则龛影,肠管局限性狭窄,壁僵硬,蠕动消失。良性肿瘤多表现为:肠腔内圆形、卵圆形充盈缺损,边缘光滑,形态可变,黏膜平坦。肠壁软,蠕动正常。肿瘤向肠腔外生长者B超、CT、MRI检查占有优势。结论:对临床疑诊为原发性小肠肿瘤者应首选小肠气钡双对比造影检查,小肠双对比造影检查与CT扫描相结合可提高诊断准确率。     

小肠肿瘤：前瞻性评价MR小肠灌肠检查

目的前瞻性评价有症状的病人MR小肠灌肠检出小肠肿瘤的准确性。以传统的内镜、组织标本、胶囊内镜、常规小肠灌肠和随访结果作为参考标准。方法人类研究委员会批准了本项研究计划,病人签署知情同意书。150例（男性83例．女性67例;平均年龄42．6岁,年龄范围17～84岁）临床怀疑小肠肿瘤,且既往上、下胃肠道内镜检查结果正常的病人进行了MR小肠灌肠检查。MR小肠灌肠表现依下述内容进行前瞻性评价：局限性肠壁增厚、小肠肿块和小肠狭窄。     

Role of CT enterography in obscure gastrointestinal bleeding

Background

Obscure gastrointestinal bleeding is a radiological challenge where in almost half of the patients; the origin of the blood loss remains unexplained.

Aim

To highlight the use of dual phase CT enterography for the detection of obscured gastrointestinal bleed.

Patient and methods

Twenty consecutive patients (11 men and 9 women) with OGIB were included in this study; their age ranged from 28 to 67 years (mean age 45.6 years). CT enterography was performed first with a non-contrast scan, followed by biphasic contrast-enhanced CT at 35 and 70 s at a rate of 4 mL/s.

Results

On CT enterography, 12 patients (60%) were negative while 8 patients (40%) had positive findings as follows: one patient (5%) had celiac disease, 1 patient (5%) had active Crohn’s disease and another patient (5%) had ischemic bowel changes. Five patients (20%) had small bowel neoplasms as follows: (1 patient had ileal angiolipoma, 1 patient had ileal hypervascular GIST, 1 patient had duodenal GIST, 1 patient had duodenal carcinoid and 1 patient had jejunal villous adenoma).

Conclusion

MDCT enterography has a good diagnostic accuracy in the evaluation of patients with OGIB and can reliably indicate the source of GI bleeding and guide subsequent therapy.     

Normal small bowel wall characteristics on MR enterography

Purpose

To assess the normal small bowel parameters, namely bowel diameter, bowel wall thickness, number of folds (valvulae connivientes) per 2.5 cm (in.), fold thickness and interfold distance per small bowel segment (duodenum, jejunum, proximal ileum, distal ileum and terminal ileum) on MR enterography.

Materials and methods

Between September 2003 and January 2008, 280 MR enterography examinations were performed for investigation of known or suspected small bowel pathology. 120 of these examinations were normal. Sixty-five (m = 29, f = 36, mean age = 34 years, range = 17-73 years) of 120 examinations without a prior small bowel diagnosis, with no prior or subsequent abnormal radiology or endoscopy examinations, no prior small bowel surgery and with a minimum 3 years follow-up demonstrating normality were retrospectively evaluated for the described small bowel parameters.

Results

We found the mean diameter of the duodenum to be 24.8 mm (S.D. = 4.5 mm), jejunum to be 24.5 mm (S.D. = 4.2 mm), proximal ileum to be 19.5 mm (S.D. = 3.6 mm), distal ileum to be 18.9 mm (S.D. = 4.2 mm) and terminal ileum to be 18.7 mm (S.D. = 3.6 mm). The number of folds per 2.5 cm varied from 4.6 in the jejunum to 1.5 in the terminal ileum. The fold thickness varied from 2.1 mm in the duodenum to 1.8 mm in the terminal ileum. The small bowel parameters gradually decreased in size from the duodenum to the smallest measurements which were in the terminal ileum. The bowel wall is similar in size throughout the small bowel measuring 1.5 ± 0.5 mm.

Conclusion

These results provide the mean, range of normality and standard deviation of the small bowel parameters per segment on the current population on MR enterography. From our experience, knowledge of these parameters is extremely helpful and essential in the everyday assessment of MR enterography studies.     

How to perform and interpret cine MR enterography

Magnetic resonance (MR) enterography has become a fundamental tool for small bowel evaluation. Multiphasic cine imaging is a useful component of MR enterography evaluation because it provides functional information about bowel motility. Cine MR enterography can be used to evaluate for strictures and adhesions. Bowel motility evaluation has been shown to increase pathologic lesion detection in Crohn's disease and has been incorporated into disease activity scoring systems. Currently, cine MR enterography remains underutilized. The purpose of this article is to outline how to perform and interpret cine MR enterography. The authors describe how to perform a multiphasic balanced steady state free precession sequence using different MR systems and give practical advice on how to display and interpret the cine sequence. Sample cases illustrate how the cine sequence complements standard MR enterography evaluation with T₂‐weighted, contrast‐enhanced T₁‐weighted, and diffusion‐weighted imaging. J. Magn. Reson. Imaging 2015;42:1180–1189.     

CT enterography: review of technique and practical tips

CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation.     

Computed tomographic enterography and enteroclysis: pearls and pitfalls

Computed tomographic (CT) enterography and enteroclysis improve visualization of the small bowel mucosa and wall in comparison with traditional CT and fluoroscopic studies by distending the small bowel through enteric hyperhydration with a negative contrast agent. Although CT enterography is performed with oral hyperhydration, CT enteroclysis requires the placement of an enteroclysis tube, often in patients who are unable to orally consume the amount of liquid. When tolerated, CT enterography is often preferred due to its lack of invasiveness. Magnetic resonance enterography and enteroclysis are other modalities that are still being studied and show promise in the imaging of small bowel. Unlike small bowel follow-through, conventional enteroclysis, or capsule endoscopy, extraenteric findings are best assessed on CT enterography. These include findings in the surrounding mesentery, perienteric fat, and the adjacent solid organs that may be associated with the small bowel process and include fistulas or abscesses, mural hyperenhancement, prominent vasa recta, and other inflammatory changes. CT enterography has developed into the first-line modality in the imaging of Crohn's disease and is considered the most appropriate imaging modality in patients with suspected Crohn's disease. It is also increasingly being used in the assessment of small bowel infections, neoplasms, adhesions, and polyps.     

Peroral CT enterography with lactulose solution: preliminary observations

OBJECTIVE: The objective of our study was to evaluate lactulose solution as a new oral contrast agent with the use of peroral CT enterography to determine the adequacy of luminal distention and conspicuity of the bowel wall. CONCLUSION: Peroral CT enterography performed with lactulose solution is a simple and noninvasive method of evaluating the small bowel by obtaining good distention. It can also be used at routine abdominal examinations as a negative contrast agent instead of iodinated oral contrast medium, especially for CT angiography.     

MR enterography in the evaluation of small bowel dilation

Magnetic reasonance (MR) enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. Furthermore, because the patient is not exposed to ionizing radiation, sequential “dynamic” MR imaging can be performed repeatedly over time further facilitating depiction of the site and/or the cause of obstruction. With increasing availability of MR imaging and standardization of the oral contrast medium regimens, it is likely that this technique will assume an ever-increasing role in the evaluation of small bowel dilation in the coming years. We illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional (e.g., ileus), or related to infiltrative mural disease.