多层螺旋CT观测游离气体分布对上下消化道穿孔的鉴别诊断

目的 评价多层螺旋CT中游离气体的分布对于鉴别上下消化道穿孔的价值.方法 回顾性分析76例经手术证实的消化道穿孔患者的腹部CT,包括上消化道穿孔49例,下消化道穿孔27例.比较2组患者中游离气体的不同分布有无统计学差异.结果 上下消化道穿孔在肝门、镰状韧带、圆韧带周围游离气体、胃肠道周围局限性小气泡、腹腔内肠系膜区、盆腔等方面二者均具有统计学意义(P<0.05).肝门周围、镰状韧带周围及圆韧带周围游离气体、上消化道周围局限性小气泡影常提示上消化道穿孔.四者诊断的灵敏度及特异度分别为85.7%、91.8%、77.6%、59.2%;93.9%、87.8%、89.8%、98.0%.下消化道肠壁周围局限性小气泡、腹腔内肠系膜区及盆腔内游离气体在诊断下消化道穿孔的灵敏度及特异度分别为44.4%、55.6%、11.1%; 100%、95.9%、100%.结论 CT图像上游离气体的分布有助于上下消化道穿孔的鉴别,综合游离气体的不同分布能提高穿孔部位诊断的正确率.     

多层螺旋CT局限性小气泡征在消化道穿孔中的定位诊断价值

目的 评价多层螺旋CT (MSCT)检查胃肠壁外局限性小气泡征(ELAB征)在消化道穿孔中的定位诊断价值.资料与方法 回顾性分析2007-02～2010-10经手术证实的89例消化道穿孔患者的腹部CT图像.按照精确定位法[胃区,小肠(按Cole法分6组),结肠(分4组:盲肠、升结肠,横结肠,降结肠,乙状结肠、直肠)]及上、下消化道分组法,观察胃肠壁外局限性小气泡征与消化道穿孔部位的相关性.分析镰状韧带征、圆韧带征、肝门周围游离气体征(PPFA征)的敏感性、特异性及准确性.结果 89例消化道穿孔中85例出现游离气体,其中18例表现为胃肠壁外局限性小气泡积聚.18例具有ELAB征的穿孔患者脏器定位(按照精确定位法)与手术结果对照,准确性为94.4％(17/18).镰状韧带征、圆韧带征、肝门周围游离气体征(PPFA征)在大体定位(上、下消化道分组法)中的准确性分别为74.2％ (66/89)、68.5％(61/89)、84.3％ (75/89).结论 多层螺旋CT胃肠壁外局限性小气泡征在消化道穿孔定位诊断中有重要价值.     

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.     

非创伤性下消化道穿孔的急诊影像学研究

目的:回顾性分析经手术证实的下消化道穿孔患者的影像资料,探讨急诊非创伤性下消化道穿孔的影像学诊断方法。方法:收集2005年～2007年我院经手术证实的57位下消化道穿孔患者的影像资料,包括立位腹平片、MSCT平扫或增强扫描及超声成像,所有影像学检查均在手术前24h内完成。以手术及术后病理所见为参考标准,评价立位腹平片、MSCT及超声影像诊断下消化道穿孔的准确性。结果:该组病例中有29例患者在手术前行立位腹平片检查,仅7例(24.1%)出现膈下游离气体。37例患者在手术前腹部超声检查,仅8例(21.6%)发现腹腔内游离气体,这8例患者中有4例(50%)经超声明确诊断了穿孔部位。10例患者在手术前行MSCT腹部平扫或增强扫描,9例患者(90%)的CT影像发现了腹腔内游离气体,其中有8例患者(88.9%)明确了穿孔部位。MSCT平扫或增强扫描发现下消化道穿孔所致腹腔内游离气体准确性明显优于X线立位腹平片(P=0.001)及腹部超声(P<0.001)。MSCT发现下消化道穿孔位置的能力较腹部超声(P=0.08)优越性不明显。结论:急诊腹部MSCT扫描能够准确发现下消化道穿孔所致腹腔内游离气体。     

超声诊断消化道穿孔的技巧探讨

目的：探讨消化道穿孔的超声检查方法及技巧,提高诊断准确率。方法：回顾性分析33例超声诊断消化道穿孔并经手术病理证实的患者的超声资料。所有患者均采用低频及高频超声联合扫查,重点观察腹腔游离气体和积液表现,并于X线检查结果对比。结果：低频及高频超声联合扫查,并通过改变患者体位观察膈下及上腹部腹膜腔,所有的患者均观察到腹腔游离气体及积液回声。结论：消化道穿孔的正确诊断率,与检查技巧相关性很大,采用双频（低频与高频结合）超声及改变患者体住法可以很好的检出腹腔游离积气,提高消化道穿孔的检出率。     

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.     

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。     

胃肠道穿孔患者采用腹部平片与多层螺旋CT诊断的临床效果对照研究

目的 比较多层螺旋CT与腹部平片诊断胃肠道穿孔患者的临床效果.方法 研究对象来源于收治的胃肠道穿孔患者45例,均采用多层螺旋CT与腹部平片诊断,比较两种方式的诊断效果.结果 45例患者接受腹部平片检查后提示胃肠壁均为阴性,游离气体检出率为60.0%,CT检出率为93.3%,对比有显著性差异(P<0.05);CT诊断胃肠道穿孔部位与原因的准确率为86.7%,显示征象为腹腔积液征与脂肪间隙密度提升.结论 多层螺旋CT诊断胃肠道穿孔患者相较于腹部平片临床准确度更高,值得推广.     

彩色多普勒超声诊断上消化道穿孔的价值分析

目的 探讨彩色多普勒超声对上消化道穿孔诊断的应用价值.方法 对72例急症上腹痛患者行彩色多普勒超声检查,通过分析超声影像有无腹腔游离气体及腹腔间隙游离液区,初步诊断上消化道穿孔.结果 72例患者,应用彩色多普勒超声检查,有31例观察到隔下、剑突下、右上腹部出现游离气体声像,经临床手术证实上消化道穿孔28例,诊断符合率为...     

Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography

Purpose

To evaluate the usefulness of the periportal free air (PPFA) sign on computed tomography (CT) to distinguish upper from lower gastrointestinal (GI) tract perforation.

Materials and methods

During a 30-month period, we retrospectively analyzed abdominal CT images of 53 consecutive patients with surgically proven GI tract perforation. We divided the patients into two groups, i.e. upper and lower GI tract perforation groups. According to the distribution of free air, we divided the peritoneal cavity into supramesocolic compartment and inframesocolic compartment. We observed the presence or absence of free air in each compartment in each group. When there was free air in the periportal area, it was defined as periportal free air (PPFA) and the sign was positive. To evaluate the usefulness of the PPFA sign, we compared the PPFA sign with the falciform ligament sign and the ligamentum teres sign, both of which are well-known CT signs of pneumoperitoneum. Statistical analyses were performed with univariate and multivariate analyses using SPSS version 11.5 for significant findings among the CT signs.

Results

Free air was seen in supramesocolic compartment in 29 of 30 (97%) patients in the upper GI perforation group and in 17 of 23 (74%) in the lower GI perforation group. Free air in inframesocolic compartment did not show significant difference in either group (p = .16). The PPFA sign was seen in 28 of 30 (93%) patients with upper GI tract perforation, but in only 8 of 23 (35%) patients with lower GI tract perforation (p < .0001). The falciform ligament sign was seen in 24 of 30 (80%) patients with upper GI tract perforation and in 10 of 23 (43%) patients with lower GI tract perforation (p = .020). The ligamentum teres sign was seen in 16 of 30 (53%) patients with upper GI tract perforation and in 2 of 23 (8%) patients with lower GI tract perforation (p = .008). Multivariate logistic regression analysis showed that the PPFA sign was the only variable, which adjusted odds ratio of 15.5 (p = .002).

Conclusion

The PPFA sign is a useful finding which can help to distinguish upper from lower GI tract perforation. When this sign is present, upper GI tract perforation is strongly suggested.     

What determines the periportal free air, and ligamentum teres and falciform ligament signs on CT: Can these specific air distributions be valuable predictors of gastroduodenal perforation?

Purpose

The purpose of this retrospective study was to determine what gives rise to the periportal free air, and ligamentum teres and falciform ligament signs on CT in patients with gastrointestinal (GI) tract perforation, and whether these specific air distributions can play a clinically meaningful role in the diagnosis of gastroduodenal perforation.

Material and methods

Ninety-three patients who underwent a diagnostic CT scan before laparotomy for a GI tract perforation were included. The readers assessed the presence of specific air distributions on CT (periportal free air, and ligamentum teres and falciform ligament signs). The readers also assessed the presence of strong predictors of gastroduodenal perforation (focal defects in the stomach and duodenal bulb wall, concentrated extraluminal air bubbles in close proximity to the stomach and duodenal bulb, and wall thickening at the stomach and duodenal bulb). The specific air distributions were assessed according to perforation sites, and the elapsed time and amount of free air, and then compared with the strong predictors of gastroduodenal perforation by using statistical analysis.

Results

All specific air distributions were more frequently present in patients with gastroduodenal perforation than lower GI tract perforation, but only the falciform ligament sign was statistically significant (p < 0.05). The presence of all three specific air distributions was demonstrated in only 13 (20.6%) of 63 patients with gastroduodenal perforation. Regardless of the perforation sites, the falciform ligament sign was present significantly more frequently with an increase in the amount of free air on multiple logistic regression analysis (adjusted odds ratio, 1.29; p < 0.001). The sensitivity, specificity, accuracy, and positive predictive and negative predictive values of each strong predictor for the diagnosis of gastroduodenal perforation were higher than those of specific air distributions. The focal wall thickening (accuracy, 95.7%) was the most useful parameter for the diagnosis of gastroduodenal perforation.

Conclusion

The prediction of the perforation site of the GI tract on CT should be based on the presence of strong predictors of the site of bowel perforation, and the specific free air distribution should be regarded as complementary predictors.     

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。     

Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients

Purpose The aim of this study was to investigate how accurately we could diagnose the level of gastrointestinal (GI) tract perforation using multidetector computed tomography (MDCT). Materials and methods We reviewed 155 patients with surgically confirmed GI tract perforation. MDCT scans were obtained with eight-detector CT; 5 mm thick axial images and 2.5 mm thick coronal multiplanar reconstruction (MPR) images were generated for all patients. Contrast enhancement was performed in 44 of the 155 patients. Two board-certified radiologists reviewed the images for direct findings (free air, ruptured GI tract wall) and indirect findings (inflammatory changes, fluid collection, focal thickening of the GI tract wall) and attempted to identify the perforation site in each patient. Results Free air was seen in more than 95% of the patients with perforation at sites other than the appendix; free air was seen in 44% of patients with appendicitis. On contrast-enhanced CT performed in 44 patients, rupture of the wall of the GI tract was directly visualized in 14 (32%) on axial images only and in 23 (52%) on axial or MPR images, respectively. The perforation site was correctly diagnosed in 90% of the patients when the radiologists referred to both direct and indirect findings. Conclusion MDCT was valuable for identifying the presence and level of GI tract perforation.     

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.     

Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites

Our objective is to describe the characteristic CT findings of gastrointestinal (GI) tract perforations at various levels of the gastrointestinal system. It is beneficial to localize the perforation site as well as to diagnose the presence of bowel perforation for planning the correct surgery. CT has been established as the most valuable imaging technique for identifying the presence, site and cause of the GI tract perforation. The amount and location of extraluminal free air usually differ among various perforation sites. Further, CT findings such as discontinuity of the bowel wall and concentrated free air bubbles in close proximity to the bowel wall can help predict the perforation site. Multidetector CT with the multiplanar reformation images has improved the accuracy of CT for predicting the perforation sites.     

Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

Objectives

To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time.

Methods

One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection.

Results

The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups.

Conclusions

MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction.

Key Points

? Perforation of the stomach and duodenum can be accurately predicted with MDCT. ? Knowledge of CT findings predicting perforation site can improve diagnostic accuracy. ? Elapsed time does not significantly affect accuracy in predicting perforation sites.