多排螺旋CT血管造影（CTA）对肠系膜血管栓塞症的诊断价值

目的：探讨多排螺旋CT血管造影对肠系膜血管栓塞的诊断价值。方法：回顾性分析15例经手术或临床证实的肠系膜血管栓塞症的临床特点、CT表现。结果：肠系膜上动脉栓塞9例，肠系膜上静脉栓塞6例，表现为肠系膜上动、静脉主干及分支内低密度充盈缺损，病变显示达4级分支。供血区肠管积液、扩张，肠壁增厚，但可强化10例；肠壁增厚无强化5例（坏死）；腹水6例。肠壁和门静脉积气2例。结论：多排螺旋CT血管造影不仅可准确显示肠系膜血管栓塞症的直接征象，还可准确显示肠管的情况。可作为肠系膜血管栓塞症的金标准，取代传统的血管造影。     

多层螺旋CT及后处理技术对肠系膜上动脉栓塞的诊断价值

目的：探讨多层螺旋CT（MSCT）及其后处理技术对肠系膜上动脉栓塞（SMAT）的诊断价值。方法：经CTA诊断为肠系膜上动脉栓塞及继发性改变的11例患者,均经DSA或手术证实。所有病例均行螺旋CT增强扫描,并采用多平面重组（MPR）、曲面重组（CPR）、最大密度投影（MIP）、容积再现（VR）等方法进行后处理。对SMAT的CTA表现及肠系膜、肠管等的继发性表现进行观察分析。结果：11例CT增强扫描表现均为肠系膜上动脉增粗和血管腔内充盈缺损。可见肠腔扩张、积气、积液和／或液-气平面7例,肠壁变薄2例,肠壁增厚及强化程度减低或不强化8例;肠系膜水肿5例,肠系膜积液2例;气体集聚2例,分别位于肠壁、肠系膜内及腹腔。结论：MSCT能够对肠系膜上动脉栓塞及继发病变进行快速、及时、准确地诊断,并能判断肠管缺血的程度,与DSA及手术所见相符,是诊断肠系膜血管栓塞性病变的有价值的影像学方法。     

急性肠系膜血管栓塞的螺旋CT诊断价值

目的：探讨急性肠系膜血管栓塞的螺旋CT诊断价值。方法搜集急性肠系膜血管栓塞病例20例,男12例,女8例,平均年龄64.2岁,7例手术病理证实外,其余13例内科保守治疗后,血管内充盈缺损消失。所有病例均行CT平扫及增强检查。结果20例中肠系膜上动脉栓塞12例,肠系膜上静脉栓塞7例,肠系膜下静脉栓塞1例。直接征象为血管内充盈缺损（20例）。间接征象为肠壁增厚（12例）、肠壁薄纸样改变（5例）、缆绳征（4例）、肠壁积气（3例）、门脉积气（2例）、肠系膜密度混浊（6例）、肠腔扩张积液（8例）及腹腔积液（9例）。结论螺旋CT是诊断急性肠系膜血管栓塞的一种快速、准确、无创检查方法,螺旋CT血管造影可显示良好的肠系膜血管图像,螺旋CT能给临床提供有价值的信息。     

肠系膜动脉栓塞的临床与CT分析

目的:分析肠系膜动脉栓塞的临床及CT表现,探讨其CT诊断价值。方法:回顾分析2004年10月～2009年5月,我院诊治的肠系膜动脉栓塞22例的临床表现及CT征象。结果:CT直接显示肠系膜动脉栓塞6例,腹主动脉瘤伴附壁血栓累及肠系膜动脉开口处2例,肠系膜血管周围渗出5例,节段性肠壁肿胀、增厚,肠腔扩张,肠壁强化明显减弱或延迟强化20例。结论:CT能很好地显示肠系膜动脉栓塞的直接和间接征象。     

64层螺旋CT对急性肠系膜血管栓塞的诊断价值分析

目的 探讨64层螺旋CT血管造影对急性肠系膜血管栓塞(AMI)的诊断价值.方法 回顾性分析经64层螺旋CT全腹平扫加多期动态增强扫描诊断的15例AMI.其中,肠系膜上动脉栓塞3例(完全栓塞1例,不完全栓塞2例),肠系膜上静脉栓塞12例.结果 15例AMI直接征象:动脉期显示肠系膜上动脉完全或部分充盈缺损,可诊断为肠系膜上动脉完全或部分栓塞(3例).静脉期显示肠系膜上静脉完全或部分充盈缺损,可诊断为肠系膜上静脉完全或部分栓塞(12例);间接征象“缆绳征”12例,肠系膜水肿10例,肠管壁增厚12例,肠管扩张、积液8例,肠壁强化减弱7例,其中2例可见节段性未强化区,腹水6例,肾前筋膜增厚4例,肠壁积气2例.平扫肠系膜上动脉或上静脉高密度征7例(静脉栓塞6例,动脉栓塞1例),肠系膜上静脉栓塞累及门静脉、脾静脉6例,其中4例在增强扫描时,可见肝脏异常低灌注区.结论 64层螺旋CT平扫加多期动态增强扫描对急性肠系膜血管栓塞的诊断及时准确,应作为临床怀疑肠系膜血管疾病首选检查方法,值得推广应用.     

急性肠系膜上动脉梗塞的CT诊断

目的探讨肠系膜上动脉栓塞(SMAE)的CT表现。资料与方法回顾性分析7例急性SMAE患者资料,男4例,女3例,平均年龄62岁,7例均行腹部CT平扫加增强扫描,用最大密度投影(MIP)、容积再现技术(VRT)图像后处理重组。结果肠系膜上动脉内充盈缺损7例,肠壁增厚5例,肠系膜上动脉增粗5例,肠腔扩张、肠壁菲薄和增厚3例,肠系膜上静脉及门静脉弥漫栓塞并肝缺血1例;腹腔积液2例。结论MSCT是诊断SMAE的一种可靠且无创的影像检查方法,对不明原因腹痛或临床怀疑SMAE的患者,应尽快行螺旋CT检查。     

MSCTA对急性肠系膜上动静脉栓塞的诊断价值

目的:探讨MSCTA对急性肠系膜上动静脉栓塞的诊断价值。方法:回顾性分析13例经临床证实的肠系膜血管栓塞患者的急诊CT平扫、CTA及三维重建资料。结果:13例中肠系膜上动脉栓塞(superior mesenteric artery embolism,SMAE)7例、肠系膜上静脉栓塞(superior mesenteric vein embolism,SMVE)6例。直接征象:7例SMAE中,平扫见血栓密度影2例,CTA均见充盈缺损;6例SMVE中,平扫见血栓密度影4例,CTA均见充盈缺损。间接征象:13例中肠梗阻5例,腹水6例。SMAE:血管壁钙化5例,薄纸样肠壁改变2例,肠壁水肿增厚强化减弱3例;SMVE:增强扫描管壁环形强化、管径扩张5例,缆绳征4例;受累肠管、肠系膜广泛水肿增厚,增强扫描可呈明显减弱或未强化特点,肝脏门脉期强化减弱不均匀2例;合并门静脉、脾静脉血栓2例。结论:CTA对肠系膜上动静脉栓塞的诊断敏感性较CT平扫高,对于CT平扫阴性的患者行CTA检查很有价值。     

CT诊断肠系膜损伤的价值

目的评价CT诊断肠系膜损伤的价值.材料和方法回顾性分析98例因腹部钝伤进行手术患者的CT图像和临床资料.结果手术证实7例肠系膜损伤.术前CT诊断肠系膜损伤6例.CT表现包括肠系膜内血肿4例、肠壁增厚2例、肠系膜脂肪内渗出6例和对比剂从肠系膜血管漏出2例.结论CT对于肠系膜损伤的检测具有很好的敏感性.     

CT诊断肠系膜血管栓塞的价值

目的：探讨螺旋CT诊断急性肠系膜血管栓塞的价值。材料和方法：回顾性分析6例肠系膜血管栓塞患者的CT平扫和增强扫描的表现，并与手术病理结果对照评价其诊断价值。结果：手术结果与CT诊断相符5例，其中肠系膜上动脉栓塞2例和肠系膜上静脉栓塞4例。误诊为绞窄性肠梗阻1例。结论：螺旋CT能快速无创伤地诊断急性肠系膜血管栓塞。     

急性肠缺血的CT征象分析

目的:分析急性肠缺血的CT征象,提高CT对急性肠缺血诊断的准确性.材料和方法:2004～2005年间经急诊CT平扫及增强扫描,53例被诊断为急性肠缺血,分析其CT征象并与临床治疗和手术结果相对照.结果:CT平扫及增强图像显示:①肠腔扩张及积液53例次.②肠壁增厚伴密度改变39例次,其中平扫时肠壁内见散在点状高密度影7例次,肠壁密度降低22例次.增强扫描肠壁黏膜层异常强化15例次.③肠系膜血管走行异常并血管增粗(漩涡征)10例.④肠系膜脂肪水肿及渗出(缆绳征)26例.⑤肠系膜动脉钙化斑26例;其中有5例可见肠系膜动脉内等密度无强化的血栓影;另3例经手术证实肠系膜上动脉近肠小血管襻内血栓形成,但CT未能显示.⑥肠系膜静脉血栓形成4例.全部53例病人中,39例内科保守治疗后好转,14例症状未缓解者,经外科手术治疗,证实10例为肠系膜动脉血栓形成(其中3例CT未显示血栓),4例为门静脉血栓形成.结论:肠腔扩张和积液、肠壁增厚、肠系膜血管缆绳征及腹水是急性肠缺血的CT间接征象.CT平扫结合MDCT增强和CTA图像显示肠壁内密度改变、肠系膜血管内血栓形成或血管硬化导致管腔狭窄、漩涡征,即可确诊.     

急性肠系膜血管梗塞的CT表现

目的评价CT对急性肠系膜血管梗塞（AMI）的诊断价值。方法搜集AMI病例10例，男6例，女4例，平均年龄67．2岁。除1例在诊断次日死亡外，其余均经手术病理证实。其中肠系膜上动脉（SMA）梗塞4例，肠系膜上静脉梗塞（SMV）5例，肠系膜下静脉（IMV）梗塞1例。除1例行CT平扫外，其余9例均行CT平扫及增强扫描，详细分析其影像学表现。结果直接征象为血管内充盈缺损（8例）。间接征象包括肠腔扩张积液（4例）、肠壁增厚（6例）、薄纸样肠壁（4例）、缆绳征（5例）、肠系膜积液（3例）、肠壁积气（2例）、门静脉积气（1例）及腹腔积液（3例）。结论CT是诊断急性肠系膜血管梗塞的一种快速、敏感、可靠及无创伤的影像学方法。     

双源CT双期增强血管成像对急性肠缺血的诊断

目的:探讨双源CT(DSCT)双期增强扫描血管成像对急性肠缺血(acute mesenteric ischemia,AMI)患者的诊断价值。方法:回顾性分析经手术或介入治疗证实的26例AMI患者的DSCT资料。所有患者均行DSCT双期增强扫描即动脉期和门静脉期血管成像。结果:肠系膜上动脉栓塞8例,肠系膜上动脉血栓形成4例,肠系膜上静脉血栓形成14例。CT直接征象为肠系膜血管内低密度充盈缺损,受累血管腔闭塞(17例)或重度狭窄(9例)。间接征象:肠壁增厚(21例),肠管扩张、肠腔内积液积气(18例),肠壁强化程度降低(7例),肠壁积气(5例),肠系膜脂肪水肿及渗出(19例),"缆绳征"14例,腹腔积液12例。结论:DSCT增强扫描及双期血管成像可清楚显示AMI血管阻塞的部位、范围、程度及继发改变,对明确诊断和指导治疗具有较高的应用价值。     

CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease

PURPOSE: To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease. MATERIALS AND METHODS: The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat. RESULTS: Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory. CONCLUSION: The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.     

Computed tomographic findings in bowel infarction

Findings on computed tomography (CT) were considered diagnostic or highly suggestive in seven cases of bowel infarction. Important findings were portal or mesenteric venous gas, intramural gas, focal thickening of bowel wall, focal or diffusely dilated fluid-filled bowel, and clot in the superior mesenteric artery. Only one patient had unequivocal extraluminal gas on initial abdominal radiographs, although others had equivocal findings or later developed obvious extraluminal gas. Because CT may detect extraluminal gas and mesenteric arterial occlusion not apparent on plain films, and because CT is increasingly used early in the evaluation of abdominal pain, it can play an important role in the diagnosis and management of bowel infarction.     

绞窄性肠梗阻的螺旋CT增强扫描征象分析

目的:分析螺旋CT增强扫描图像上绞窄性肠梗阻的征象,提高对绞窄性肠梗阻术前诊断的准确性.方法:64例手术证实的绞窄性肠梗阻病例纳入研究,男43例,女21例,年龄23～72岁,平均42岁.采用单排螺旋CT进行全腹部扫描,对比剂以2～3ml/s速度注射,注射后60s扫描,层厚10mm.参照术中所见,回顾性分析上述CT资料,包括:①间接征象:肠腔扩张积液,肠壁增厚及肠壁密度改变(靶征),肠系膜脂肪水肿及渗出(缆绳征),肠系膜血管增粗并肠系膜扭曲(漩涡征),肠壁间、肠系膜间及门静脉积气,腹水;②直接征象:肠系膜上动脉或上静脉充盈缺损.结果:正确诊断54例,正确率82.8％.CT显示肠腔扩张积液47例(73％),其中6例积液呈高密度提示肠腔内积血(9.3％);肠壁水肿增厚19例(29.6％),其中11例增强后肠壁密度不匀,呈“靶征”(17％),8例肌壁未见强化(12.5％);肠系膜脂肪水肿及渗出(缆绳征)43例(67％),肠系膜血管增粗并肠系膜扭曲呈“漩涡”状9例(14％),肠壁间积气、肠系膜积气各1例,门静脉积气2例,腹水31例(48.4％).肠系膜上动脉或上静脉充盈缺损3例.结论:绞窄性肠梗阻CT表现有一定特征,可做出提示性诊断.     

Computerized tomography features of intestinal infarction: 56 surgically treated patients of which 5 with reversible mesenteric ischemia]

PURPOSE: Bowel infarction is a rare and typical condition of the elderly; despite improvements in diagnostic imaging and vascular surgery, bowel infarction remains a major cause of acute abdomen, with mortality rates ranging 70-80%. Diagnosis is often late because clinical signs, laboratory data and radiologic findings are aspecific. We investigated radiographic and particularly CT patterns of intestinal infarction in 56 patients submitted to surgery within 12 hours of admission. We also report the CT findings of 5 of these patients who had reversible mesenteric ischemia. MATERIAL AND METHODS: We retrospectively reviewed 56 cases of bowel infarction. The patients were 29 men and 27 women ranging in age 46-84 years (mean: 63). All the patients were submitted to plain radiography of the abdomen in different projections; emergency CT was carried out with i.v. contrast agent injection. We considered the following CT patterns: dilatation of intestinal loops > 2.5-3 mm, wall thickening > 3-4 mm, intraperitoneal effusion, stuffing of mesenteric vessels with diameter > 3 mm, air-fluid levels. RESULTS: Patients in the 7th decade of life were most frequently affected (38 cases), with an overall mortality rate of 59% (33 deaths). Plain radiography showed distention of bowel loops with air-fluid levels in 91% of cases. CT proved to be an accurate technique with higher sensitivity than radiography in detecting mesenteric edema and hemorrhage (68%), abdominal and pelvic effusion (88%), parietal pneumatosis (9%), wall thickening (29%), intraportal gas (7%), and thrombosis of superior mesenteric artery (3.5%). CT patterns in the 5 patients with reversible intestinal ischemia were wall thickening (80%), peritoneal effusion (80%), meteoric dilatatation (40%), a blurred appearance of mesenteric fat (40%). CONCLUSIONS: Angiography is a valuable imaging and treatment technique permitting the diagnosis of vascular occlusion and the intraarterial infusion of vasodilators, but it can be carried out in emergency in few centers only. This makes conventional radiology, and particularly CT, the only tool providing useful information for early diagnosis and treatment of bowel infarction. CT is more sensitive than radiography and does not exhibit the limitations of angiography--i.e., invasiveness, radiation exposure and complex organization. Therefore CT can presently be considered the method of choice in patients with suspected bowel infarction.     

Is it Crohn's disease or intestinal tuberculosis? CT analysis

A computed tomographic (CT) analysis of 36 patients with differential diagnosis of intestinal tuberculosis (IT) or Crohn's disease (CD) in barium gastrointestinal studies was undertaken to identify distinguishing bowel wall or mesenteric features which could provide a radiological definitive diagnosis. Final diagnoses obtained in 32 cases were tuberculosis (N=18), CD (N=9), carcinoid (N=2), chronic appendicitis (N=2) and bowel infarction (N=1). In IT, the bowel wall changes were varied: absence of wall thickening (N=6), minimal asymmetric wall thickening with and without mucosal tethering (N=8), minimal symmetric wall thickening often with mild peritonitis (N=3), exophytic mass encircling bowel lumen (N=4). Mural stratification (target sign) was not found. CD showed concentric or symmetrical wall thickening ranging from 0.6 to 1.5 mm and mural stratification occurred in about a half of the cases. Lymphadenopathy was the commonest associated feature in both but in IT, the nodes were larger and a third had necrotic centers. Displacement of bowel loops was more often due to enlarged lymphadenopathy in IT while in CD it was frequently due to fibrofatty change. CT was able to provide the correct diagnosis in 26 out of these 32 (81%) cases of indeterminate barium studies. CT is recommended when barium gastrointestinal studies are unable to differentiate between intestinal tuberculosis and Crohn's disease.     

Blunt abdominal trauma: performance of CT without oral contrast material

PURPOSE: To retrospectively evaluate multi-detector row computed tomography (CT) without oral contrast material for depiction of bowel and mesenteric injuries that require surgical repair in patients with blunt abdominal trauma. MATERIALS AND METHODS: The investigational review board approved the study. Informed consent was waived. CT reports for October 2001 to September 2003 were reviewed and 1082 patients were identified who had undergone abdominopelvic CT with a multi-detector row scanner and without oral contrast material. Findings were divided into four categories: negative, solid organ injury with or without hemoperitoneum, free fluid only, and suspected bowel or mesenteric injury. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated by comparing CT findings with laparotomy reports and hospital course. RESULTS: CT findings were no intraabdominal injury (n = 932), solid organ injury only (n = 102), free fluid only (n = 34), and suspected bowel or mesenteric injury (n = 14). CT findings in patients suspected of having bowel or mesenteric injury were pneumoperitoneum with other secondary findings (n = 4), mesenteric hematoma and bowel wall abnormality (n = 2), mesenteric hematoma only (n = 4), and bowel wall thickening only (n = 4). In 11 patients, bowel or mesenteric injury was proved surgically. Thus, the study included 1066 true-negative, nine true-positive, two false-negative, and five false-positive results. Based on these data, sensitivity was 82% (95% confidence interval [CI]: 52%, 95%), specificity was 99% (95% CI: 98%, 99%), positive predictive value was 64% (95% CI: 39%, 83%), and negative predictive value was 99% (95% CI: 98%, 99%) for depiction of bowel and mesenteric injuries. CONCLUSION: Multi-detector row CT without oral contrast material is adequate for depiction of bowel and mesenteric injuries that require surgical repair. Results are comparable with previously reported data for single-detector row helical CT with oral contrast material.