多层螺旋CT对不典型消化道穿孔诊断的价值

目的：探讨多层螺旋C T在诊断不典型消化道穿孔的价值。方法回顾性分析经手术、病理证实的50例不典型消化道穿孔患者的C T表现。结果多层螺旋C T检查50例中48例（96．0％）显示腹腔游离气体和间接征象而明确诊断消化道穿孔,未发现异常2例（4．0％）。提示病因诊断74．0％（37/50）,其中提示消化道溃疡性穿孔71．0％（15/21）,外伤性穿孔91．7％（11/12）,肿瘤性穿孔50．0％（5/10）,阑尾炎穿孔86．0％（6/7）。结论多层螺旋C T能较准确诊断不典型消化道穿孔,并对穿孔的病因以及穿孔的位置有提示诊断价值。     

螺旋CT在消化道穿孔中的诊断价值

目的：分析CT在消化道穿孔中的诊断价值。方法回顾性分析51例经手术证实的消化道穿孔病例,术前行立位腹部平片检查者41例,腹部CT扫描者51例,比较两种检查方法在消化道穿孔中的诊断价值。结果41例X线片检出游离气体26例,CT检出50例,CT检出率高于普通X线检查（P＜0．05）。CT显示腹内游离气体呈新月状或小气泡影（50例）,胃肠穿孔处周围局限性积液或蜂窝织炎（34例）,阑尾周围脓肿（3例）,肠梗阻（5例）,胃肠壁增厚（25例）,胃肠壁肿块（2例）,胃肠壁缺损（4例）,腹水（30例）。CT对穿孔病因的诊断符合率为68．6％（35/51）,对穿孔部位的诊断符合率为88．2％（45/51）。结论螺旋CT诊断胃肠道穿孔是一种有效的检查方法,且对穿孔部位和病因的诊断也具有重要价值。     

胆囊穿孔的CT诊断及鉴别诊断(附12例分析)

目的 探讨胆囊穿孔的CT诊断及鉴别诊断.方法 12例经临床手术病理证实的胆囊穿孔患者的CT表现征象进行回顾性分析.结果 胆囊穿孔CT表现包括胆囊壁的改变、胆囊周围和右上腹腔的异常、肝脏内的异常密度.胆囊壁的特征性改变表现为连续性中断或局限性缺损、膨出.胆囊周围和有上腹的异常包括胆囊窝积液及右上腹包裹性积液,肌囊周围脂肪间隙密度增高或条索状影,胆囊邻近器官的改变.肝脏内异常灶表现为肝脓肿形成,胆囊与肝脓肿之间有通道.结论 螺旋CT能显示穿孔的胆囊壁连续性中断或局限性缺损,以及胆囊穿孔周围病变特征,为临床诊断和治疗提供可靠的影像学依据.     

消化道异位胰腺CT表现(附6例报告及文献复习)

目的 分析消化道异位胰腺的CT特征.方法 回顾性分析经病理证实的6例消化道异位胰腺的CT表现,6例均行CT增强扫描,观察其CT表现特征.结果 6例异位胰腺均为单发病灶,其中发生在胃部2例,十二指肠2例,小肠2例(均位于空肠).CT平扫病灶多呈圆形或卵圆形,密度多均匀,边界清楚,与胃肠道壁呈广基底连接,向腔内生长者居多,2例可见小囊变区.CT增强扫描,6例均明显强化,强化方式类似于正常胰腺,其中4例均匀强化,2例可见小囊变区未强化.结论 消化道异位胰腺的CT表现具有一定特征性,对本病正确诊断有帮助.     

CT游离气体分布对鉴别上/下消化道穿孔的价值

目的：评价CT对上消化道与下消化道穿孔的鉴别诊断价值。方法：回顾性分析64例消化道穿孔患者的CT图像,评价游离气体的位置、门静脉周围游离气体征、镰状韧带征和肝圆韧带征与消化道穿孔位置的关系。结果：上消化道穿孔的游离气体位于结肠下区的概率（7／42,16．7％）显著低于下消化道穿孔（18／22,81．8％）,而上消化道与下消化道穿孔的游离气体出现在结肠上区的概率差异无统计学意义（P＝0．25）。门静脉周围游离气体征出现在上消化道穿孔的概率（27／42,64．3％）显著高于下消化道穿孔（8／22,36．4％,P＝0．03）,而镰状韧带征和肝圆韧带征出现在上消化道和下消化道穿孔患者中的概率差异无统计学意义（P＞0．05）。结论：CT 显示游离气体的位置对鉴别消化道穿孔位置有重要价值,门静脉周围游离气体征提示消化道穿孔位于上消化道,结肠下区游离气体提示穿孔位于下消化道。     

闭孔疝CT诊断(附9例报告)

目的探讨CT诊断闭孔疝的价值和临床意义,提高对闭孔疝的认识。方法回顾分析9例经CT术前检查、并为手术证实的闭孔疝CT表现。结果右侧闭孔疝7例,左侧闭孔疝2例。CT表现主要有小肠梗阻,空回肠肠管扩张、积液;在闭孔外肌和耻骨肌之间可见疝囊;闭孔疝绞窄时,可见肠壁增厚、水肿,增强扫描强化减弱;腹腔可见积液。结论CT检查是闭孔疝的有效检测手段,对老年患者,特别是老年女性患者的不明原因肠梗阻,腹部CT检查将有助于临床确诊。     

胃肠道穿孔的螺旋CT诊断价值

目的探讨螺旋CT在胃肠道损伤诊断中的作用。方法对28例经手术证实胃肠道损伤患者的CT资料进行回顾分析。结果CT发现腹腔游离气体24例,肠壁增厚9例,腹腔积液20例,系膜密度增高5例,反射性肠郁张3例。结论腹腔游离气体是诊断胃肠道穿孔最强有力的指征,而腹腔积液、肠壁增厚和系膜密度增高等征象高度提示胃肠道穿孔。     

不典型脑膜瘤的CT表现(附34例报告)

不典型脑膜瘤的发病率较低,约占成人脑膜瘤的5％～8％,由于该病的CT表现不典型,极易造成误诊。我们收集经病理证实为不典型脑膜瘤的34例患者的CT检查资料,对其进行回顾性分析,旨在探讨不典型脑膜瘤的CT影像学特点,以提高诊断符合率。     

螺旋CT对急性胃肠道穿孔的早期诊断价值

胃肠道穿孔是临床常见的急腹症之一,既往多依赖腹部X线平片检查,但仍有部分患者平片未能显示膈下游离气体,尤其是在穿孔早期更是无法诊断。随着螺旋CT的应     

胸骨肿瘤CT诊断(附22例报告)

目的探讨胸骨肿瘤临床CT诊断和检查意义。方法搜集分析经临床病理证实的22例胸骨肿瘤CT资料,其中转移瘤17例(肺癌转移15例;乳腺癌转移2例)、骨髓瘤2例、软骨肉瘤1例、骨肉瘤1例、骨化性纤维瘤1例。结果局部骨质破坏(囊状膨胀性、溶骨性和混合性骨破坏3种),其中囊状膨胀性骨破坏1例(骨化性纤维瘤),溶骨性骨破坏16例(肺癌转移15例、骨肉瘤1例),混合性骨破坏5例(软骨肉瘤1例、骨髓瘤2例、乳腺癌转移2例)。胸骨处软组织肿块18例,胸骨前胸壁肌、皮下脂肪和胸骨后脂肪间隙浸润13例。结论胸骨肿瘤以转移瘤多见,CT检查对胸骨肿瘤有较高的诊断价值。     

Two cases of alimentary tract perforation owing to ingested foreign bodies: diagnosis by CT

We report the CT diagnosis of two cases of alimentary tract perforation caused by the ingestion of foreign bodies. The first case was a common fish bone perforation of the ileum with postoperative scar. The second case was a rare perforation caused by the impact of an uncooked rice cake on sigmoid colon diverticula. Helical CT scan clearly revealed the fish bone as a linear high-density area in the soft tissue between the right abdominal oblique muscles and ileum, and demonstrated the rice cake as high-density material in the bowel.     

The value of CT in detecting bowel perforation in children after blunt abdominal trauma

In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population, we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of six patients (1%) with documented bowel perforation, four (67%) had free intraperitoneal air detected preoperatively by CT. The remaining two cases had secondary signs of bowel thickening and unexplained peritoneal fluid. Free intraperitoneal air was not a specific indicator for bowel perforation. Of nine patients in whom CT studies showed pneumoperitoneum, only four (44%) had a ruptured bowel. The remaining five patients had pneumoperitoneum from sources other than bowel perforation including pneumomediastinum, bladder perforation, and previous peritoneal lavage. This experience shows that the CT finding of pneumoperitoneum is useful, although not specific for the detection of bowel perforation in children with blunt abdominal trauma. When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.     

多层螺旋CT检查腹腔游离小气泡对消化道穿孔的定位诊断价值

目的 探讨胃肠壁外游离小气泡对消化道穿孔的定位诊断价值.方法 回顾分析30例消化道穿孔患者（X线检查阴性）的MSCT影像资料,观察腹腔游离气体的大小形态、分布与穿孔部位的相关性,并与手术病理结果对照.以十二指肠屈氏韧带为界,按上、下消化道进行对比观察.结果 30例患者仅表现为腹腔单个或多个游离小气泡积聚.其中上消化道穿孔 14例,下消化道穿孔16例.与手术病理结果对照,游离小气泡对下消化道穿孔脏器定位诊断符合率为93.8％（15/16）,上消化道符合率为57.1％（8/14）,两者差异有统计学意义（P=0.031,P＜0.05）.结论 多层螺旋CT检查腹腔游离小气泡在下消化道穿孔中的定位诊断具有重要价值.     

急性胆道穿孔的CT诊断(附15例分析)

目的：分析CT在急性胆道穿孔诊断中的价值及诊断要点。方法：对15例病例均采用CT平扫加增强，层厚10mm、层距10mm连续扫描，局部层厚、层距5mm薄层扫描。结果：15例中14例显示胆囊或胆总管张力明显减低。胆囊、胆总管壁皱缩；胆囊壁增厚12例、明显增厚2例；1例表现为胆囊增大；15例均可见胆囊窝周围蜂窝织炎2例。结论：急性胆道穿孔临床体征与症状不典型，术前诊断较难，CT可根据胆道外型缩小、张力明显减低、壁皱缩，腹腔积液于胆道周围为主等典型征象，作出明确诊断。     

CT evaluation of gastrointestinal tract perforation

The purpose of this study is to review the computed tomography (CT) appearance of gastrointestinal tract (GI) perforation. Forty-two patients with 10 cases of proximal GI perforation and 32 cases of distal GI perforation were evaluated based on the CT findings of extraluminal air (which was subdivided into the CT-falciform ligament sign crossing the midline and scattered pockets of air), bowel wall thickening (>8 mm in gastroduodenal wall, >3 mm in the small bowel wall, >6 mm in the caliber of the appendix and >5 mm in the colonic wall), associated abscess formation, ascites and adjacent fat stranding. The results were compared using Fisher's Exact Test. Detection of extraluminal air in the upright plain films and CT was analyzed by Z test. Our results showed that CT-falciform ligament sign was more frequent in the proximal GI perforation, while pockets of extraluminal air (excluding the cases accompanying CT-falciform ligament sign), bowel wall thickening and fat stranding were found in higher incidence in distal GI perforation (P<.05). CT detected extraluminal air in more cases than the upright plain films did (69% vs. 19%; Z=4.62>Z(0.01)=2.326). We concluded that CT is a good imaging tool to differentiate the various GI perforations.     

Two-dimensional and three-dimensional CT diagnosis of alimentary tract]

The recent development of multidetector-row CT(MDCT) has made it possible to obtain three-dimensional images of the alimentary tract that offer new diagnostic potential. In its two-dimensional diagnosis of the alimentary tract, MDCT has also changed the concept of the oral contrast agent. Before MDCT, we routinely used a positive contrast agent to distinguish the stomach and intestine from other organs and masses. The excellent slice profile acquired by MDCT can distinguish the alimentary tract and depict abnormal findings without the use of a positive contrast agent. With the use of an intravenous contrast medium, the alimentary tract itself, alimentary tumors, and inflammatory disease are well demarcated with water and air. Moreover, the combination of two-dimensional and three-dimensional diagnostic images makes it possible to detect and assess early gastric and colonic cancers as conventional gastroscopy and colonoscopy. Although the lack of texture information is one of the disadvantages of three-dimensional CT, three-dimensional CT diagnosis of the alimentary tract is less invasive and more objective than conventional studies. Advances in three-dimensional imaging with isotropic data sets will lead to the use of two-dimensional and three-dimensional CT diagnosis as one of the standard examinations of the alimentary tract.     

CT evaluation of wall thickening in the alimentary tract

Computed tomography (CT) of the alimentary tract, when performed with adequate distention of the organ being examined and in the true axial plane, provides valuable information about the intramural or extramural extent of pathologic conditions. Neoplastic, vascular, and inflammatory diseases can all result in wall thickening of the alimentary tract. Wall thicknesses greater than 5 mm in the esophagus, stomach, and colon and 4 mm or greater in the small bowel are considered abnormal. If the thickened wall has a target or double-ringed appearance, it is most likely caused by benign disease. In general, the CT findings of asymmetric or focal wall thickening, nodularity, and thickening greater than 1.5 cm suggest a malignant process. Although it is commonly associated with benign disease, diffuse thickening can also result from some infiltrating malignant diseases. Careful review of CT scans for evidence of metastatic disease and adenopathy and correlation with clinical information aid in the differential diagnosis.