系统性红斑狼疮累及消化道CT表现

目的 观察系统性红斑狼疮（SLE）累及消化道的CT表现。方法 回顾性分析17例经临床确诊为SLE累及消化道患者，均接受CT平扫，其中15例接受增强扫描，记录病变累及消化道的具体部位、肠壁厚度、CT征象及伴随表现。结果 SLE累及胃8例，十二指肠2例，空肠9例，回肠9例，升结肠9例，横结肠1例，降结肠6例，乙状结肠8例，直肠8例。15例CT表现为肠壁肿胀增厚，12例可见"同心圆征"，11例见"靶征"，肠腔扩张伴积气、积液13例，其中4例肠道假性梗阻；肠系膜"梳征"或"栅栏样"改变11例，肠系膜脂肪间隙模糊9例。伴随征象包括腹腔及盆腔积液15例，胸腔积液12例，心包积液3例，肠系膜上动脉栓塞1例，脾大3例，5例存在泌尿系病变（输尿管炎性狭窄、膀胱壁增厚、双肾或输尿管积水等），肠脂垂炎3例。结论 SLE累及消化道典型CT表现为消化道壁及肠系膜异常。     

儿童异基因造血干细胞移植术后肺急性移植物抗宿主病与感染CT表现

目的 观察儿童异基因造血干细胞移植（allo-HSCT）术后肺部急性移植物抗宿主病（aGVHD）的CT表现,并与感染性病变鉴别。方法 纳入148例allo-HSCT后出现肺部病变患儿,分为aGVHD组（n=85）和感染组（n=63）。比较组间年龄、术后发病时间及肺部CT征象及分布模式差异。结果 aGVHD组与感染组年龄与发病时间差异均具有统计学意义（P均<0.05）。aGVHD组常见CT征象为磨玻璃影（GGO,35/85,41.18%）、实变影（14/85,16.47%）及胸腔积液（12/85,14.12%）,多呈双侧、弥漫分布,可见胸膜下空逸;感染组常见征象包括实变影（33/63,52.38%）、GGO（32/63,50.79%）及支气管壁增厚（23/63,36.51%）,多呈单侧、局限性分布;2组病变分布模式差异均具有统计学意义（P均<0.05）。支气管壁增厚多见于感染组（P<0.05）。结论 儿童肺aGVHD的CT表现具有特征性,结合发病时间等信息可与感染性病变相鉴别。     

结肠憩室炎CT分级及其对临床治疗方案的预测

目的 探讨结肠憩室炎CT分级及其对临床治疗方案的预测意义。方法 回顾性分析41例已确诊为结憩室炎的患者的CT资料并对其进行CT影像学分级,1~3级预测为可行保守治疗,4~5级预测为需行手术治疗,并与临床实际治疗方案进行对照。结果 结肠憩室炎CT主要表现为突出于肠壁的小囊袋状突起,憩室壁及邻近肠壁水肿增厚（40/41,97.56%）、周围脂肪结构紊乱及邻近腹膜增厚（39/41,97.12%）。41例憩室炎患者术前CT分级预测治疗方案的准确率为85.37%（36/41）。结论 结肠憩室炎的CT表现有一定的特征性,CT分级有助于临床制定治疗方案。     

MSCT诊断粘连性肠梗阻绞窄

目的 探讨MSCT对粘连性肠梗阻绞窄的诊断价值。方法 回顾性分析经手术及病理证实的70例粘连性肠梗阻患者的MSCT征象,评价其对发生绞窄的诊断价值。结果 70例粘连性肠梗阻,手术及病理确诊34例发生绞窄,MSCT诊断29例发生绞窄,其中26例有既往腹部手术史。MSCT征象中,肠壁强化程度减低、弥漫性肠系膜水肿及血管增粗、肠系膜积液、肠壁增厚、C/U型肠襻与粘连性肠梗阻绞窄有关（P均<0.05）。MSCT诊断粘连性肠梗阻绞窄的敏感度85.29%（29/34）,特异度100%（36/36）,准确率92.86%（65/70）。结论 MSCT对判断粘连性肠梗阻绞窄具有较高价值。     

儿童造血干细胞移植后淋巴组织增殖性疾病影像学和临床表现

目的 观察儿童造血干细胞移植（HSCT）后淋巴组织增殖性疾病（PTLD）的影像学和临床表现。方法 回顾性分析13例经病理证实或临床诊断的HSCT后PTLD患儿,原发病包括再生障碍性贫血10例,骨髓增生异常综合征、湿疹-血小板减少-免疫缺陷综合征和β地中海贫血各1例。结果 13例PTLD患儿均见结内组织受累,均累及颈部淋巴结,其中3例累及腹腔淋巴结、3例累及腭扁桃体、2例累及腺样体;3例结外组织受累,包括中枢神经系统受累2例、胃壁受累1例。按部位观察,13例颈部均受累,3例腹部、2例中枢神经系统受累;移植与诊断PTLD时间间隔42~120天,平均（68±25）天;移植前13例均无EB病毒（EBV）感染,移植后均发生EBV感染;经对症治疗,5例好转出院,8例死亡。结论 儿童HSCT后PTLD发病较早、进展迅速、可累及全身多部位,移植后早期即需密切筛查、监测外周血EBV DNA载量,警惕PTLD发生;影像学与临床相结合有助于早期确诊。     

侧脑室脉络丛神经鞘瘤1例

目的 观察儿童郎格罕细胞组织细胞增生症（LCH）腹部超声表现。方法 回顾性分析28例经病理证实的LCH患儿腹部超声资料。结果 28例中，25例LCH累及多系统，3例仅累及肝胆。28例肝脏均不同程度增大，肝实质内部回声不均匀，可见散在或弥漫性低回声区，其中13例伴胆管壁广泛性不均匀性增厚、回声增强，胆管腔局部扩张或局部狭窄。17例伴脾肿大，5例伴胰腺肿大，13例伴不同程度腹腔积液，14例伴肝门区淋巴结肿大。结论 儿童LCH腹部超声表现具有一定特征性，有助于提高诊断准确率。     

腹部恶性纤维组织细胞瘤的CT表现

目的 观察腹部恶性纤维组织细胞瘤（MFH）的CT表现。方法 回顾性分析16例经病理证实的腹部MFH患者的临床、病理及影像学资料。结果 所有患者均接受CT平扫及增强扫描。11例单发,5例多发;腹膜后7例,肠系膜4例,肝脏3例,十二指肠、肾脏各1例。CT平扫15例病变呈低密度,1例呈等密度。1例病灶内见颗粒状钙化灶,2例周边见大量条索影。增强扫描12例病变不均匀强化,2例均匀强化,2例肝内MFH未见强化,其内可见分隔。病理结果：多型性8例,炎症型2例,黏液型1例,未明确分型MFH 5例。结论 腹部MFH缺乏特征性影像学表现,综合分析有助于术前诊断。     

64层螺旋CT分型诊断儿童原发性门静脉海绵样变性

目的 探讨64层螺旋CT在分型诊断儿童原发性门静脉海绵样变性（CTPV）中的价值。方法 回顾性分析37例经手术证实为原发性CTPV患儿的临床及CT资料,分别行MIP、VR、MPR重建,观察其特征性血管表现,根据病变累及范围及部位对CTPV进行分型。结果 37例中,CTPV的侧支血管范围及程度均获显示。8例Ⅰ型CTPV,海绵样变性仅发生于肝内门静脉左和（或）右分支;18例Ⅱ型CTPV,表现为Ⅰ型合并门静脉主干狭窄或消失;11例Ⅲ型CTPV,海绵样性变在Ⅱ型病变基础上进一步累及肠系膜上静脉及脾静脉。3例Ⅰ型CTPV患儿接受肝移植术;18例Ⅱ型CTPV,15例接受门-体静脉分流术,3例辅以脾切除及贲门血管离断术;8例Ⅲ型CTPV接受脾切除和贲门周围血管离断术。结论 64层螺旋CT对于诊断儿童原发性CTPV具有重要应用价值;MSCT分型对选择手术治疗方式、预后判断有较为重要的指导意义。     

儿童肠重复畸形的99TcmO4-动态平面显像、CT和超声表现

目的 探讨儿童肠重复畸形的超声、CT及⁹⁹Tc^mO₄-动态平面显像表现。方法 回顾性分析18例经手术病理证实为肠重复畸形患儿的超声（n=14）、CT（n=10）及⁹⁹Tc^mO₄-动态平面显像（n=18）表现。结果 18例中2例为广泛管状肠重复畸形,15例为单发囊状或囊实性畸形,1例为双囊状重复畸形。18例中3例含异位胃黏膜,15例未见异位胃黏膜。14例行超声检查的患儿中,11例表现为形态较固定的厚壁肠管样无声团诊为肠重复畸形,1例表现为一大一小"葫芦"形两腔相通的厚壁囊性管腔结构,均正确诊断,余1例误诊、1例漏诊。CT检查可见7例均表现为厚壁囊性为主占位,与肠道关系较密切,1例诊断为其他囊性病变,2例肠管状分布畸形漏诊。⁹⁹Tc^mO₄-动态平面显像的3例均为阳性,2例表现为与小肠分布相对应的弥漫性异常放射性浓聚,均正确诊断,1例为小团状异常固定放射性浓聚灶,提示肠重复畸形可能。结论 超声、CT及⁹⁹Tc^mO₄-动态平面显像检查各有优势,超声检查因无辐射、操作简便,常作为筛查首选,CT显示解剖结构较全面,⁹⁹Tc^mO₄-动态平面显像有助于诊断临床高度怀疑肠重复畸形,尤其对于CT、超声无明确阳性表现者。     

腹部X线检查在新生儿坏死性小肠结肠炎分型及预后中的价值

目的 探讨腹部X线检查在新生儿坏死性小肠结肠炎（NEC）分型及预后中的价值。方法 收集58例确诊新生儿NEC的患儿，根据临床转归将患儿分为轻症组（n=31）和重症组（n=27）。比较2组患儿腹部X线影像表现。结果 2组间胎龄、患病日龄、性别、胎数、生产方式的差异均无统计学意义（P均>0.05）；重症组出生体质量低于轻症组（P<0.05），极低体质量儿例数多于轻症组（P<0.05）；患儿门静脉积气和固定肠袢发生率均高于轻症组（P均<0.05）；2组间肠壁积气形态差异有统计学意义（P<0.05）。结论 腹部X线检查可有效辅助诊断NEC、分型；尤其对肠坏死和肠穿孔的判定及治疗具有指导价值。     

直接淋巴管造影后CT及增强CT对小肠淋巴管扩张症的诊断价值

目的探讨直接淋巴管造影后CT和增强CT对小肠淋巴管扩张症(IL)的诊断价值。方法回顾性分析28例IL患者的影像学资料。所有病例均接受直接淋巴管造影后再接受腹盆部CT平扫,4例于淋巴管造影前接受腹部增强CT检查,5例淋巴管造影及CT平扫后接受腹部增强CT扫描。结果患者中肠壁增厚、肠腔扩张15例,肠系膜水肿21例,胸、腹腔积液16例。直接淋巴管造影后CT显示不同程度淋巴管异常:对比剂漏入肠腔或分布于肠壁7例,肠系膜淋巴管扩张10例、碘油分布于胃壁1例、对比剂反流至肝门、脾门、胰腺周围、对侧髂淋巴管及胸腔21例。9例增强扫描患者中,肠壁分层强化呈"晕轮征"3例,肠黏膜明显线状强化7例。结论直接淋巴管造影后CT和增强CT对IL的诊断有重要价值,可观察胸、腹腔积液及脏器情况,并可用于复查。     

以急性腹痛为主要表现的SLE缺血性肠病的螺旋CT征象

目的探讨系统性红斑狼疮(SLE)所致缺血性肠病的螺旋CT表现.方法回顾性收集23例确诊为SLE、并因急性腹痛而行腹部螺旋CT扫描的病人资料,其中16例为增强扫描.阅片时着重观察肠道和肠系膜(血管)的异常CT表现.结果肠壁肿胀、增厚19例(19/23);12例出现肠壁"靶征"样强化(12/16);肠管扩张16例(16/23);肠系膜肿胀和脂肪密度增高21例(21/23),肠系膜血管充血、增粗18例(18/23),4例肠系膜血管呈"梳状"排列(4/16).其他CT征象包括腹水、胸水、心包积液、肝脾肿大、肾脏异常、腹膜后淋巴结肿等.结论肠壁和肠系膜(血管)的异常改变是SLE缺血性肠病最重要的CT征象.     

The diagnostic performance and interrater agreement of seven CT findings in the diagnosis of internal hernia after gastric bypass operation

Purpose

A reliable and immediate diagnosis of internal hernia is important for optimal and timely management of patients with a history of gastric bypass surgery. The aims of this study were to evaluate the interrater agreement and diagnostic performance characteristics of seven predefined CT findings of internal herniation in patients admitted on clinical suspicion of internal herniation after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

Abdominal CT scans of 117 patients performed on clinical suspicion of internal hernia after LRYGB surgery were evaluated by three radiologists (two experts and one resident) for the following: (1) Swirl sign, (2) strangulation of superior mesenteric vein (SMV), (3) engorged mesenteric vessels and edema, (4) engorged lymph nodes, (5) ascites, (6) mushroom sign, (7) hurricane eye sign, and finally the overall conclusion. The CT findings were compared to the laparoscopic explorative findings.

Results

The highest interrater agreements were seen for the swirl sign, SMV strangulation, ascites, and overall conclusion (all Kappa 0.82–0.83). The presence of internal hernia was significantly and independently associated with SMV strangulation (OR 18.3; 95% CI 4.3–78.1; p < 0.001) and mesenteric edema (OR 5.2; 95% CI 1.4–19.6; p < 0.001) on multivariate analysis, while the other CT findings were not independently associated with herniation. The highest sensitivity was observed for mesenteric edema (85.0%), while SMV strangulation had the highest specificity (94.8%).

Conclusion

CT is an accurate diagnostic tool for detection of internal hernia after LRYGB. SMV strangulation and mesenteric edema are highly predictive and easily identified features of internal herniation.

     

系统性红斑狼疮所致缺血性肠病的螺旋CT表现特征

目的：探讨系统性红斑狼疮（SLE）所致缺血性肠病的蚴旋CT表现特征。方法：回顾性分析23例因SLE病人急性腹痛而行腹部螺旋CT扫描检查的临床资料及CT图像,其中增强CT扫描16例,CT平扫7例。着重观察肠道、肠系膜和肠系膜血管的异常CT表现性,同时也记录其它腹部异常征象,如浆膜腔积液、实质性脏器异常、淋巴结肿大等。结果：肠壁肿胀、增厚19例（19／23,82．6％）,肠壁“靶征”12例（12／16,75％）,肠管扩张16例（16／23,69．6％）。肠系膜肿胀和脂肪密度增高21例（21／23,91．3％）,肠系膜血管充血、增粗18例（18／23,78．3％）,肠系膜血管“梳状”排列4例（4／16,25％）。其它CT异常征象包括腹水、胸水、心包积液、肝脾肿大、肾脏异常、腹膜后淋巴结肿等。结论：缺血性肠病是SLE病人出现急性腹痛最主要的病理改变,其肠壁、肠系膜和肠系膜血管是最常见和最重要的异常CT表现。螺旋CT增强扫描是评价SLE缺血性肠病最佳的影像学检查方法。     

Bowel obstruction complicated by ischemia: analysis of CT findings

Purpose

To analyze CT signs of bowel ischemia in patients with surgical bowel obstruction, and thereby improve CT diagnosis in this common clinical scenario. Surgical and histopathological findings were used as the reference standard.

Methods

We retrospectively analyzed CT findings in patients brought to surgery for bowel obstruction over 13 years. Etiology of obstruction (adhesion, hernia, etc.) was recorded. Specific CT features of acute mesenteric ischemia (AMI) were analyzed, including bowel wall thickening, mucosal hypoenhancement, and others.

Results

173 cases were eligible for analysis. 21% of cases were positive for bowel ischemia. Volvulus, internal hernia, and closed-loop obstructions showed ischemia rates of 60%, 43%, and 43%; ischemia rate in obstruction from simple adhesion was 21%. Patients with bowel obstruction related to malignancy were never ischemic. Sensitivities and specificities for CT features predicting ischemia were calculated, with wall thickening, hypoenhancement, and pneumatosis showing high specificity for ischemia (86%–100%).

Conclusion

Wall thickening, hypoenhancement, and pneumatosis are highly specific CT signs of ischemia in the setting of obstruction. None of the evaluated CT signs were found to be highly sensitive. Overall frequency of ischemia in surgical bowel obstruction is 21%, and 2–3 times that for complex obstructions (volvulus, closed loop, etc.). Obstructions related to malignancy virtually never become ischemic.

     

CT of small bowel ischemia

We evaluated the computed tomographic (CT) features of small bowel (SB) ischemia and necrosis and correlated the findings with clinical outcome or patient prognosis. Sixty-eight surgically or angiographically proved cases of SB ischemia were retrospectively reviewed. The CT features of intestinal ischemia were divided into three groups: (A) thinned bowel wall with poor enhancement, intramural gas, or portal venous gas; (B) thickened SB wall without superior mesenteric vein thrombosis; and (C) thickened SB wall with superior mesenteric vein thrombosis or intussusception. The evaluated factors included bowel wall or mucosal enhancement pattern, SB dilatation, mesenteric edema, and CT evidence of narrowing or occlusion of the superior mesenteric artery or vein. The bowel necrosis rates and mortalities were compared with chi-square test. Oral contrast material was not administered. Intramural gas and SB dilatation were associated with a higher bowel necrosis rate (eight of eight, 100%, and 17 of 21, 81%, respectively) in group A. Poor mucosal enhancement of the thickened bowel wall indicated a higher bowel necrosis rate in groups B (six of seven, 86%) and C (12 of 12, 100%) than did normal mucosal enhancement. Only intramural gas was accompanied with a higher mortality (six of eight, 75%). Intramural gas of a thinned bowel wall and poor mucosal enhancement of a thickened small bowel wall are useful signs of bowel necrosis. Intramural gas would indicate poor patient prognosis.     

Sonography of intestinal lymphangiectasia

Real-time ultrasonography was used to evaluate three pediatric patients with biopsy-proven intestinal lymphangiectasia. The sonographic findings were ascites, diffuse bowel wall thickening, mesenteric edema, dilated mesenteric lymphatics, and thickened walls of the gallbladder and urinary bladder. Recognition of the sonographic pattern of intestinal lymphangiectasia is useful since ultrasonography is often the first imaging examination performed in children with abdominal disorders.