中空脏器穿孔的CT诊断

目的:评价CT对中空脏器穿孔的诊断价值。方法:经手术和/或临床随访证实的中空脏器穿孔61例,于发病后1h~7d内行CT扫描。常规采用腹窗(窗宽300HU,窗位20HU)及纵隔窗(窗宽600HU,窗位-30HU)观察腹腔内游离气体及相关病变。结果:CT检查可确认腹腔内游离气体的存在(100%)及分布,可清晰显示腹腔渗液、穿孔部位周围炎性改变、反射性肠郁张、脓肿、胸水等间接征象。CT对穿孔部位的诊断符合率为62.3%,对穿孔原因的诊断符合率为52.5%。结论:CT检查是中空脏器穿孔的有效诊断手段,对穿孔的确认、穿孔部位和病因的判断有价值。     

腹部空腔脏器破裂穿孔的螺旋CT诊断价值

目的：探讨螺旋CT在腹部空腔脏器穿孔中的诊断价值。方法：回顾性分析经手术证实的15例腹部空腔脏器穿孔病例的CT表现。结果：胃十二指肠溃疡穿孔7例,腹部外伤致空回肠穿孔4例,肠结核穿孔、异物（硬鱼骨）致乙状结肠穿孔、粪块性乙状结肠穿孔及子宫积脓自发穿孔各1例,15例腹部空腔脏器穿孔的主要CT征象为剑突下隐窝积气（13例）、肝下肝圆韧带间隙积气（9例）、网膜囊积气（4例）、穿孔脏器周围局限性积气（11例）、腹膜后间隙积气（1例）、腹腔积液（11例）以及肠壁增厚（3例）等。CT可直观地显示脏器穿孔破裂口、异物等,准确地判断腹腔游离气体的有无、部位和多少,并能为穿孔部位、病因、合并症的诊断提供较多有价值的信息。结论：螺旋CT可较准确地诊断腹部空腔脏器穿孔,可作为腹部X线平片的重要补充。     

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。     

螺旋CT对腹部空腔脏器穿孔的诊断价值

目的探讨螺旋CT在腹部空腔脏器穿孔中的诊断价值。方法回顾性分析18例腹部空腔脏器穿孔的CT表现,所有病例经临床及手术证实。结果胃、十二指肠穿孔6例,空回肠穿孔6例,结肠穿孔4例,子宫积脓自发穿孔1例,膀胱自发性破裂1例。主要CT征象有：肝上间隙积气（14例）、肝下间隙积气（8例）、肝圆韧带裂隙积气（4例）、穿孔脏器局部积气（17例）、腹腔积液（13例）、肠壁局限性增厚（9例）。结论 CT可直观地显示腹膜腔、腹膜后腔游离气体,为临床提供及时准确的诊断,并可为明确穿孔部位、病因、合并症提供较多有价值的诊断信息。     

腹腔中空脏器穿孔的CT诊断

目的:探讨腹腔中空脏器穿孔的各种CT征象及诊断价值。方法:分析32例腹腔中空脏器穿孔的 CT表现,29例作CT平扫,3例作增强扫描,全部病例经手术病理证实。结果:32例中发现腹腔游离气体 21 例(65%),腹腔游离积液27例(85%),大网膜及肠系膜改变14例(44%),脓肿2例,血肿3例,肠郁胀积气 3 例,胃扩张 1 例,胸水 2 例,左肾筋膜增厚1例,骨折1例。结论:腹腔游离气体,腹腔游离积液、大网膜及肠系膜改变是腹腔中空脏器穿孔的主要 CT表现。结合临床并综合分析各种CT征象能够及时、正确地作出定性诊断。     

CT窗宽技术对原发性大网膜梗死的诊断价值

目的探讨CT窗宽技术对腹部原发性大网膜梗死的诊断价值。方法选取并分析22例临床确诊为腹部原发性大网膜梗死患者的腹部CT资料,固定窗位为50 HU,分别使用窗宽135 HU、250 HU(腹部)、350 HU(纵隔)、500 HU分析比较病变检出率。结果窗宽为135 HU、250 HU(腹部)、350 HU(纵隔)、500 HU对腹部网膜病变的检出率分别为13.64%(3例)、63.64%(14例)、100%(22例)、100%(22例),但是500 HU对腹部肠管及实质脏器显示较350 HU差。结论综合图像质量认为350 HU(纵隔)窗宽是诊断原发性大网膜梗死的理想窗宽。     

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。     

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。     

多层螺旋CT在胃肠道穿孔诊断中的价值

目的 探讨多层螺旋CT(MSCT)在胃肠道穿孔诊断中的价值.方法 回顾性分析49例经手术证实胃肠道穿孔患者术前CT及X线表现,比较两种检查方法的诊断价值.结果 本组研究腹部平片及CT游离气体的阳性率分别为60.0％(27/ 45) 、93.9％(46/49),差异有显著统计学意义(P＜0.05).MSCT示游离气体部位为肝前间隙35例,肝十二指肠韧带区5例,肝门区4例,小网膜区3例,盆腔区9例.胃肠道穿孔病因:胃、十二指肠溃疡19例,胃肠道恶性肿瘤9例,小肠缺血性肠梗阻穿孔5例,外伤性小肠破裂4例,急性穿孔性阑尾炎12例.术前MSCT诊断符合率为85.7％(42/49).结论 MSCT对胃肠道穿孔及其病因的诊断均具有重要价值.     

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.     

急腹症大网膜病变CT表现

目的 探讨病理情况下大网膜的ＣＴ变化能否为临床提供有价值的诊断信息。材料与方法 搜集有大网膜变化的急腹症１１例,非急腹症大网膜病变４例。观察网、系膜ＣＴ变化设置适合窗口。结果 急腹症中如腹腔脓肿、中空器官穿孔等,病灶周围网、系膜密度增高,“索条”或“网格”影;而原发大网膜肿瘤周围变化远不及急性炎症时显著。此外,ＣＴ能明确显示大网膜外疝内容。结论 观察网、系膜变化,有助于急性腹腔脓肿、中空器官穿孔     

螺旋CT在胃肠道穿孔中的诊断价值

目的:评价胃肠道穿孔的螺旋CT诊断价值。方法:33例经手术证实的胃肠道穿孔患者中,术前行腹部平片检查者28例,腹部CT扫描者33例。回顾性分析其CT表现,比较两种检查方法的诊断结果。结果:本组中X线平片和CT显示腹内游离气体的阳性率分别为71.4%(20/28例)和90.9%(30/33例),差异有显著性意义(P<0.05)。CT显示腹内游离气体呈新月状或小气泡影(n=30),胃肠穿孔处周围局限性积液或蜂窝组织炎(n=21),阑尾周围脓肿(n=4),肠梗阻(n=8),胃肠壁增厚(n=16),胃肠壁肿块(n=2),少量腹水(n=5)。术前CT对胃肠道穿孔病因诊断的符合率为87.9%(29/33)。结论:螺旋CT对诊断胃肠道穿孔及其病因和并发症有明显优势。     

胃肠道穿孔的CT诊断

目的:分析胃肠道穿孔的CT征象,提高CT对胃肠道穿孔诊断的准确性。方法:分析53例经手术病理证实为胃肠道穿孔的CT征象。对有无腹腔游离气体、腹腔积液、腹膜炎及胃肠道壁的改变进行观察、分析。结果:53例胃肠道穿孔的主要CT征象:腹腔内游离气体(71.7%),腹腔积液(84.9%),腹膜炎改变(60.3%),脓肿(7.5%),胃肠道壁的改变(56.6%)。53例中,CT诊断为胃肠道穿孔48例(90.6%),对穿孔部位的诊断符合率为67.9%,对穿孔病因诊断符合率为58.4%。结论:CT平扫能清晰显示胃肠道穿孔的主要征象,结合临床综合分析,有助于提高CT诊断胃肠道穿孔的准确性,包括穿孔部位和病因的诊断。     

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

INTRODUCTION: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. MATERIAL AND METHODS: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the "A.Cardarelli" Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. RESULTS: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them showed indirect findings of perforation. In other 12 patients no direct or indirect finding of free peritoneal air was detected. CONCLUSIONS: Our experience documents that in 146 gastroduodenal perforations the free peritoneal air was not evident in 12 cases and in 66% of these patients the presence of intraperitoneal fluid could be the only sign of perforation. If free peritoneal air was detected with conventional radiography, other investigations were not indicated. In the absence of direct or indirect findings of pneumoperitoneum, US examination could help to confirm intestinal paresis and the evidence of intraperitoneal free fluid. Helical CT examination was useless before at least 6h from the onset of symptomatology, because in the absence of direct or indirect findings of penumoperitoneum at abdominal plain film and sonograpy, CT could not demonstrate any additional diagnostic information.     

Computed tomographic analysis of colonic perforation: “Dirty mass,” a new computed tomographic finding

The purpose of this study was to determine the potential of computed tomography (CT) for the diagnosis of colonic perforation. Abdominal CT and plain radiographic images in 29 cases of surgically proved colonic perforation were reviewed retrospectively. Three radiologists evaluated the presence of free air, the site of free air on CT, the finding of the focal collection of extraluminal fecal matter (“dirty mass”), and other CT findings. Plain radiographs depicted free air in 13 cases (44.8%); CT demonstrated free air in all cases except one (96.6%). The locations of free air on CT were as follows: peritoneal space only in 23 cases, pararenal space only in 2, both in 3, and no free air in 1. In 5 cases, pneumoperitoneum was demonstrated only in the lower abdomen. The finding of dirty mass was seen in 15 cases (51.7%). CT is particularly valuable for the diagnosis of colonic perforation.