螺旋CT平扫早期诊断肠和肠系膜钝性伤的临床价值

目的 探讨螺旋CT平扫对肠及肠系膜钝性伤的早期诊断价值.方法 回顾性分析32例经手术证实的急性肠及肠系膜钝性伤的CT表现和临床资料,所有病例均行CT平扫及增强检查,总结其CT征象的临床意义,并对CT平扫及增强检查结果进行对比分析.结果 螺旋CT平扫及CT增强在腹腔积液或血肿、腹腔游离气体、肠系膜渗出及血肿、肠壁肿胀、肠管破裂、肠管扩张伴积液方面,诊断率无显著性差异.结论 螺旋CT平扫对早期诊断急性肠和肠系膜钝性伤有较大临床价值,增强检查可作为CT平扫的重要补充.     

闭合性肠及系膜损伤的螺旋CT诊断

目的探讨闭合性肠及肠系膜损伤的螺旋CT特点。方法回顾性分析总结17例经手术证实的肠及系膜损伤的CT征象。结果腹腔或肠管间积液、积血16例,腹腔游离气体6例,肠系膜渗出12例,肠系膜血肿10例,肠壁肿胀增厚、血肿12例,肠管扩张并积液11例。CT术前诊断明确16例,1例表现为阴性。结论螺旋CT对闭合性肠及肠系膜损伤的诊断具有重要价值,可作出准确术前诊断。     

儿童肠及肠系膜钝性创伤的CT诊断

目的：探讨CT检查对儿童急性肠及肠系膜钝性创伤的诊断价值。方法：分析11例经临床诊断或手术证实的儿童肠及肠系膜钝性创伤CT表现，全部病例均有明确的腹部外伤史，6例手术治疗，5例保守治疗。结果：11例患者中，胃损伤1例，十二指肠损伤3例，小肠及肠系膜损伤7例。CT表现有气腹、腹腔积液、肠壁肿胀、肠系膜模糊、肠管扩张等。在手术治疗的6例中，胃穿孔1例，小肠穿孔4例．肠壁血肿1例。结论：CT诊断肠及肠系膜急性钝性创伤明显优于X线平片和B超检查。不仅可清晰显示少量腹腔积气，估计腹腔积液、积血的量，显示实质脏器损伤，还可直接显示肠壁、肠系膜血肿，对外科医生确定治疗方案有重要意义。     

肠及肠系膜钝挫伤的CT诊断

目的 探讨肠及肠系膜钝挫伤的CT表现.方法 对37例拟诊肠及肠系膜损伤的住院患者行CT扫描,在CT扫描后12 h内手术,并经手术和(或)病理证实肠及肠系膜损伤的部位及程度.术前就与肠及肠系膜损伤相关的5种CT征象双盲软读片.分别计算其诊断的灵敏度,特异度及总正确率.阅片结论与手术病理对照,采用配对四格表,运用Fisher确切概率法χ2检验.结果 本组术前综合运用主要CT征象对肠及肠系膜损伤的正确诊断率达86.5%(32/37).肠及肠系膜损伤的CT表现为肠壁增厚、腹膜腔游离气体影、肠系膜脂肪条索影、肠系膜血肿及肠壁周围积液影,其灵敏度分别为50.0%、16.7%、79.3%、23.1%和75.0%;特异度分别为85.7%、100%、40%,100%和44.4%.CT对肠及肠系膜损伤诊断与病理诊断没有显著性差异(χ2=3.2,P=0.073 6).结论 根据CT征象可在术前对肠及肠系膜钝挫伤做出较为准确的诊断.     

螺旋CT诊断溃疡性结肠炎的应用价值

目的:探讨螺旋CT诊断溃疡性结肠炎的临床应用价值.材料和方法:回顾性分析15例溃疡性结肠炎病例的双对比造影和螺旋CT检查结果,并行对照研究.结果:CT表现:肠壁轻度增厚15例,粘膜面呈锯齿状12例,肠壁分层2例,肠系膜密度增高2例,系膜淋巴结增大2例,肠管变细、缩短、肠袋变浅或消失11例.结论:螺旋CT能提供传统双对比造影检查方法以外的影像学信息,包括粘膜面、肠壁、肠管形态、肠系膜等的情况;三维重建在显示粘膜面、肠管的变形和病变的范围上有较大价值.     

Crohn肠病的多层螺旋CT诊断

目的 总结多层螺旋CT(MSCT)在诊断Crohn肠病中的应用价值.方法 观察21例经临床、影像和病理3方面综合诊断为Crohn肠病的MSCT表现,分析其影像学特点.结果 21例均表现为多节段肠壁增厚,其中直、乙状结肠受累2例,系膜缘增厚明显有13节段,肠壁均有不同程度强化.肠壁溃疡3例,瘘管2例,肠内瘘1例,肠梗阻2例,肠旁蜂窝织炎6例,炎性包块或腹腔脓肿6例.肠系膜淋巴结肿大13例,系膜密度增高10例,继发肠间距增宽5例,系膜血管增粗、密集12例,梳子征8例.MIP和MPR技术更有助于全面显示病变.结论 MSCT对Crohn肠病肠壁的病变,肠外并发症及肠系膜、血管、淋巴结异常均有良好显示,并能判断病程,指导临床治疗,不失为一较好的影像检查方法.     

肠及肠系膜钝性损伤的CT表现

目的 :探讨肠及肠系膜钝性损伤的CT表现。方法 :回顾性分析65例肠和肠系膜损伤患者的CT资料。结果 :65例中肠管破裂17例,表现为腹腔积液和积气;单纯肠系膜挫伤5例,表现为挫伤区域肠系膜脂肪模糊、水肿或血肿形成;肠和肠系膜并存损伤43例。10例合并肝、脾、肾等实质脏器中的1个或多个脏器损伤。结论:CT可作为肠及肠系膜钝性损伤的主要检查手段,腹腔积气和肠系膜血肿分别对肠管破裂和肠系膜挫伤的诊断具有较高特异性,而腹腔积液和肠管水肿对肠管损伤具有较高的敏感性。     

16层螺旋CT诊断肠克罗恩病临床分析(附9例报告)

目的 探讨肠克罗恩病的CT诊断特征.方法 回顾性分析9例经病理或临床证实的肠克罗恩病CT表现.结果 9例肠克罗恩病均表现为节段性分布肠壁肿胀、增厚,肠腔狭窄,增强后肠壁快速强化,周围肠系膜血管扩张.结论 肠克罗恩病具有一定的CT特征,16层螺旋CT扫描能更好的观察肠壁及肠壁外病变,确诊需依赖病理.     

CT平扫对肠及肠系膜损伤诊断价值探讨

目的探讨CT平扫在肠及肠系膜损伤诊断中的实际应用价值。方法回顾分析经手术或临床证实的53例腹部闭合性损伤中肠及肠系膜损伤病例的临床资料及CT平扫表现。结果 CT平扫主要定性诊断征象包括:腹腔积气17例;腹膜后积气1例;腹腔积液积血39例;肠壁增厚31例;肠系膜渗出及血肿17例;肠管扩张4例。37例CT平扫提示损伤部位,其中21例与手术或临床最终诊断结果一致。结论 CT平扫能对腹部闭合性损伤中肠及肠系膜损伤作出准确诊断。     

16层螺旋CT诊断缺血性结肠炎的临床价值

目的 评价16层螺旋CT在诊断缺血性结肠炎及判断缺血病因中的价值.方法 回顾性分析26例确诊为缺血性结肠炎患者的CT资料及临床资料.采用16层螺旋CT扫描,2例急诊CT平扫,24例均行平扫加双期增强扫描,获得图像采用多种后处理技术,15例行CT血管成像(CT angiography,CTA).结果 23例肠壁增厚,其中可逆性缺血20例,不可逆缺血3例.3例肠壁变薄者为不可逆缺血.21例肠壁密度减低,5例肠壁密度增高.增强扫描,可逆性缺血中有7例肠壁强化增加,不可逆性缺血中4例肠壁强化减弱或不强化,2例非阻塞性肠缺血表现为部分强化.6例肠壁积气和4例肠管扩张均见于不可逆性肠缺血;门静脉积气2例,7例出现肠梗阻;SMA/IMA主干和/或分支硬化性狭窄7例,其中4例出现肠系膜小血管广泛钙化;缆绳征21例;漩涡征3例.肠系膜静脉栓塞4例;5例为肠系膜动脉血栓形成,23例患者找到结肠肠缺血之病因.结论 16层螺旋CT在诊断缺血性结肠炎及判断缺血病因上具有重要价值.     

Role of computerized tomography in the diagnosis of peritoneo-intestinal lesions resulting from closed trauma. Experience at 2 emergency departments

INTRODUCTION: Small and large bowel mesenteric injuries from blunt abdominal trauma are rare and often difficult to diagnose. Computed Tomography used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. PURPOSE: A retrospective study of the CT examination of 24 patients, with surgically confirmed bowel and mesenteric injuries, was performed. Our goal was to evaluate the various CT signs of blunt bowel and mesenteric injury and the related frequency. MATERIAL AND METHODS: Our series includes 24 patients, 16 of them (first group) were investigated with CT at Cardarelli Hospital, Naples, while the remaining 8 (second group) at University of Bari. Patients of the first group, 11 men and 5 women, age ranging from 18 to 77 years, were submitted to a conventional abdominal CT performed after i.v. administration of contrast media. Patients of the second group, 7 men and 1 woman, age ranging from 4 to 81 years, were submitted to helical CT performed with the following parameters: 10 mm slice thickness, 5-mm contiguous intervals from the level of the diaphragm to the pubic bone, pitch 1.5. Helical CT was performed in all cases before and after i.v. administration of contrast material injected at a rate of 3.5 ml/sec. A scanning delay of 40 seconds after the beginning of contrast injection was routinely used. In all patients the following CT signs were retrospectively searched on: peritoneal or retroperitoneal fluid, mesenteric hematoma, hazy streaky changes in mesenteric fat, high-density clot (sentinel clot) adjacent to the involved bowel, pneumoperitoneum, retropneumoperitoneum, extravasation of intravenous contrast material, bowel wall thickening. RESULTS: In the first group the following CT signs were observed: mesenteric hematoma (87.5%), hazy streaky changes in mesenteric fat (56.25%), peritoneal or retroperitoneal fluid (37.5%), sentinel clot (25%), bowel wall thickening (18.75%), extravasation of intravenous contrast material (12.5%). In the second group the following CT signs were observed: peritoneal or retroperitoneal fluid (87.5%), bowel wall thickening (50%), mesenteric hematoma (37.5%), sentinel clot (25%), pneumoperitoneum (12.5%), retropneumoperitoneum (12.5%), hazy streaky changes in mesenteric fat (12.5%). DISCUSSION AND CONCLUSIONS: Bowel and mesenteric injuries from blunt trauma are infrequent and difficult to diagnose clinically, as the physical and laboratory findings may be subtle and are often overshadowed by other injuries in patients with multisystem trauma. CT represents a proven modality in the evaluation of bowel and mesenteric injuries: careful inspection and technique are required to detect often subtle findings. In our series of 24 patients with surgically confirmed bowel and mesenteric injuries, the presence of mesenteric hematoma and of peritoneal or retroperitoneal fluid were the more frequent CT signs observed. Radiologists may play a crucial role in the timely diagnosis of these injuries, allowing prompt and appropriate management of these patients.     

Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.     

Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

Objective

Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma.

Materials and Methods

We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage.

Results

The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection.

Conclusion

Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.     

钝性腹部空腔脏器及肠系膜损伤的 CT 诊断

目的：通过对照分析腹部钝性空腔脏器及肠系膜损伤患者术中发现及术前CT征象,寻找判断空腔脏器及肠系膜损伤的特征性CT表现,以助于提高诊断率。方法回顾性分析2011～2013年我院100例钝性腹部创伤患者,其中男性82例,女性18例;年龄11个月～77岁,平均37岁。将其分为A、B两组,A组为经手术证实的有钝性肠道及肠系膜损伤患者（50例）,B组为经手术证实的只有钝性实质性脏器损伤而没有空腔脏器及肠系膜损伤患者（50例）,分析两组中与空腔脏器及肠系膜损伤相关的CT征象,采用单因素分析方法,进一步得出有助于判断是否有空腔脏器及肠系膜损伤的CT征象。结果通过分析发现具有统计学意义的征象有：腹腔或腹膜后积气（P＜0.01,敏感度50％,特异度98％）,肠管壁增厚（P＜0.01,敏感度40％,特异度98％）,系膜增厚（P＜0.01,敏感度42％,特异度88％）,系膜密度增高（P＜0.05,敏感度16％,特异度98％）,腹腔脂肪间隙密度增高模糊（P＜0.05,敏感度18％,特异度96％）,腹膜增厚（P＜0.05,敏感度26％,特异度90％）。结论通过分析发现腹腔或腹膜后积气、肠管壁增厚、系膜增厚、系膜密度增高、腹腔脂肪间隙密度增高模糊等征象有助于判断空腔脏器及肠系膜损伤。     

Small bowel rupture after blunt trauma: Computed tomographic signs and their sensitivity

The purpose of this study is to describe the characteristic computed tomographic (CT) signs of small bowel perforation after blunt abdominal trauma and to evaluate their sensitivity. Nineteen preoperative CT scans were obtained from 16 patients with surgically proven small bowel rupture secondary to blunt abdominal trauma. Only the CT findings described in the original CT reports were used. Eleven of 19 CT scans (58 %) had findings that were unequivocal for bowel rupture (i.e., extraluminal air and/or extravasation of oral contrast medium). Seven CT scans (37 %) had findings that were suggestive of severe small bowel injury (i.e., focal small bowel wall thickening and/or free peritoneal fluid without other accompanying organ injuries). In all, 95 % of cases of small bowel rupture had either pathognomonic or suggestive CT findings. One CT scan did not demonstrate small bowel wall thickening, although a hemoperitoneum was present. CT is a sensitive method for suggesting severe small bowel injury and rupture secondary to blunt abdominal trauma.     

Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?

The CT diagnosis of bowel and mesenteric injuries is difficult and warrants optimal technique and skilled interpretation. We retrospectively reviewed 36 consecutive patients with blunt traumatic injuries to the bowel and mesentery at our regional level I trauma center during the past 3 years. Physical examination, laboratory, Computed tomographic (CT), and intraoperative findings were compared. Surgically proven bowel injuries (13 cases) occurred in the duodenum (three cases), ileum (two cases), jejunum (two cases), colon (three cases), and stomach (three cases). CT findings considered specific of bowel rupture were observed in 5/13 patients including: extraluminal oral contrast or luminal content extravasation (four cases) and discontinuity of hollow viscus wall (one case). In the remaining 8/13 CT findings considered suggestive of bowel injury consisted of: pneumoperitoneum (six), gas bubbles close to the injured hollow viscus (three), thickened (>4-5mm) bowel wall (five), bowel wall hematoma (three), intraperitoneal fluid of unknown source (three). Mesenteric injury (23 cases) were surgically observed at the level of the mesenteric vessels (17 cases), legament of Treitz (two cases), gastro-duodenal artery (one case), transverse (one case) and sigmoid mesocolon (one case). CT finding considered specific of mesenteric laceration was active extravasation of contrast material from the mesenteric vessels (10 cases). CT findings suggestive of mesenteric injury (13 cases) consisted of: mesenteric hematoma (five) and/or high attenuation fluid collections, within the mesenteric root (eight) and folds (four). Helical CT is sensitive in the identification of bowel and mesenteric injury after blunt trauma providing a wide spectrum of findings. However, CT cannot be used as the sole indicator in cases with isolated thichened bowel wall, mesenteric hematoma, bowel hematoma, pneumoperitoneum or gas bubbles. Persistent, active extravasation of intravenous constrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair; disruption of bowel wall and extravasation of oral contrast are definite signs of bowel rupture. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.     

CT imaging signs of surgically proven bowel trauma

The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa?=?0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa?=?0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa?=?0.491 (moderate); active IV contrast extravasation 36.3 %, kappa?=?1.00 (perfect); free intraperitoneal air 21.2 %, kappa?=?0.904 (very good), bowel wall discontinuity 6.1 %, kappa?=?1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa?=?0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa?=?1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105–111, 2014). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.     

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.     

Blunt injury to mesentery and small bowel: CT evaluation

Helical CT now allows rapid acquisition of sections through the abdomen and pelvis with optimal vascular opacification and minimal motion artifact. Oral contrast may aid in the identification of subtle bowel and mesenteric injuries and does not have any significant deleterious effects. CT findings of extraluminal enteric contrast, active hemorrhage, or free intraperitoneal-retroperitoneal air allow accurate diagnosis of SBMI in the setting of blunt abdominal trauma. Mesenteric hematoma in association with bowel wall thickening or the presence of significant amounts of free fluid without solid organ injury is highly suspicious for SBMI requiring laparotomy. CT alone or in concert with DPL and physical examination is a valuable tool in the timely diagnosis and treatment of bowel and mesenteric injury caused by blunt trauma.