64层螺旋CT、超声及X线诊断肠梗阻的临床对比分析

目的：探讨64层螺旋CT、B超、腹部x线平片诊断肠梗阻的临床价值。方法：选择2009年10月～2010年10月我院经手术证实为肠梗阻的218例患者为研究对象。其中64层螺旋CT检查135例;B超检查167例;腹部x线平片196例。比较三种方法术前诊断正确性。结果：64层螺旋CT、B超、腹部x线平片对肠梗阻诊断的准确率分别为94．1％、86．8％、72．4％;对肠梗阻部位诊断的准确率分别为80．7％、63．4％和53．5％;对梗阻原因的诊断准确率分别为82．9％、59．2％、34．1％;对绞窄诊断的准确率分别为76．7％、58．1％和27．9％;64层螺旋CT对肠梗阻、梗阻部位和梗阻原因的诊断与B超、x线片相比具有显著性差异（P〈0．01）;B超与x线片相比也具有具有显著性差异（P〈0．01）。结论：64层螺旋CT对肠梗阻诊断具有较高的敏感性,明显优于B超及腹部x线平片检查,对临床及时制定治疗方案有极大的帮助。     

结肠癌致肠梗阻的CT诊断

目的：探讨结肠癌致机械性肠梗阻的螺旋CT诊断的优越性。材料和方法：搜集64例曾于术前做腹部CT检查并经手术或纤维结肠镜病理证实为结肠癌引起机械性肠梗阻病例，就以下CT及腹部平片表现进行分析：①梗阻近、远侧肠管表现；②梗阻部位改变；③并发症的CT征象。结果：64例肠梗阻中，判断肠梗阻的有无，CT检查诊断64例（100％），X线平片诊断60例（93．7％）；肠梗阻病因的判断，CT诊断64例（100％），平片诊断0例（0％）。全组64例在CT上均见肠腔内软组织肿块影、肠壁增厚和肠腔狭窄，其中4例见缺血性结肠炎。结论：结肠癌引起机械性肠梗阻的CT检查，对诊断梗阻的原因、部位、程度及发病缓急可提供更有价值的资料。     

肠梗阻的CT诊断价值

目的 :探讨CT检查对肠梗阻的诊断价值。方法 :对 3 6例肠梗阻患者的腹部X线平片和CT表现进行分析。其中 2 4例行手术治疗 ,12例行胃肠减压、抗感染保守治疗。 12例有腹部手术史。结果 :腹部X线平片和CT准确显示梗阻程度的病例分别为 2 0例 ( 5 5 .6% )和 3 4例 ( 94.4% )。CT直接准确诊断梗阻病因 19例 ,包括结肠直肠癌 16例 ,肠系膜囊肿伴绞窄性肠梗阻 1例 ,结肠淋巴瘤合并肠套叠 1例 ,结肠脂肪瘤合并肠套叠 1例。 12例有腹部手术史者中 10例为粘连性肠梗阻 ,2例为麻痹性肠梗阻 ,结合手术史 ,CT诊断无误。结论 :对梗阻病因的判断CT明显优于腹部X线平片 ,CT可显示狭窄移行段的形态 ,有助于判断病因 ,可为临床确定治疗方案提供较可靠的依据。     

16层螺旋CT在腹部闭合性外伤诊断中的临床分析

目的 探讨16层螺旋CT在腹部闭合性外伤诊断中的应用效果.方法 收集我院收治的104例腹部闭合性外伤患者,行16层螺旋CT扫描分析患者的病因及预后.结果 16层螺旋CT检查组病因检出率显著高于常规检查组,差异有统计学意义（x2 =25.642,P＜0.05）,且16层螺旋CT检查组病死率显著低于常规检查组,差异有统计学意义（x2=7.785,P＜0.05）.结论 16层螺旋CT在腹部闭合性外伤诊断方面准确可靠,可为临床诊治提供重要依据.     

多层螺旋CT在诊断肠梗阻的应用研究

目的:探讨多层螺旋CT(MSCT)三维成像技术在肠梗阻诊断及临床上的应用,寻求诊断肠梗阻的新方法.方法:选取疑似肠梗阻患者96例作为研究对象,随机分为观察组和对照组各48例.对照组患者采用X线平片进行诊断,观察组患者采用多层螺旋CT进行扫描诊断,并将诊断结果与手术和病理结果进行比较.结果:MSCT诊断肠梗阻的准确率为95.0％,X线平片诊断准确率为72.5％,MSCT诊断肠梗阻的准确率明显优于X线平片,两种诊断方法比较差异有统计学意义(P＜0.05).结论:MSCT三维成像技术可明确肠梗阻的病因、梗阻部位及患病程度,提高诊断肠梗阻的能力,为临床治疗提供可靠依据.     

肠梗阻的腹部X线平片和CT诊断价值对比

目的探讨肠梗阻腹部X线平片和CT诊断价值差异。方法收治肠梗阻患者共80例腹部X线平片和CT影像学资料,比较两种检查方式用于肠梗阻诊断总符合率。结果 CT用于肠梗阻诊断总符合率显著高于腹部X线平片(P0.05);CT用于肠梗阻患者梗阻部位和梗阻原因诊断符合率均显著高于腹部X线平片(P0.05);CT用于肠梗阻诊断图像清晰度和检查舒适度均显著高于腹部X线平片(P0.05);腹部X线平片用于肠梗阻诊断操作简便度显著高于CT(P0.05)。结论 CT图像清晰度及检查舒适度优于腹部X线平片,但腹部X线平片操作更为简便,且价格低廉。     

机械性肠梗阻CT诊断

目的：总结机械性肠梗阻CT表现及诊断价值。方法：分析30例经手术（16例）及临床（14例）证实的肠梗阻CT及临床资料,比较腹部平片与CT对肠梗阻存在、定位、病因、有否绞窄以及治疗方法选择的价值。结果：CT证实肠梗阻存在100%,平片的70%;病因诊断准确性CT为96%,平片13%;CT能对肠肿瘤及时发现并分期（9例）,及早诊断肠绞窄（2例）及发现肠外肿块（4例）,有助于及早选择外科治疗,结核、局限炎症、肠套叠等首选保守治疗,常规CT检查发现肠管异常扩张应扩大扫描范围,往往能发现引起肠梗阻的病因（本组因此偶然发现肠肿瘤3例）。结论：肠梗阻或疑有肠梗阻的病人在平片、B超诊断信息不足时尽早CT检查对于明确病因,治疗选择及改善预后有较大意义。     

增强螺旋CT在肠梗阻诊断中的临床应用价值

目的探讨增强螺旋CT在肠梗阻诊断中的临床应用价值。方法对临床怀疑肠梗阻并且X光片提示有肠梗阻和可疑肠梗阻的43例病人，经肘静脉穿刺高压注入优维显后行全腹部多层螺旋CT扫描。结果43例病人CT表现均有肠梗阻，梗阻部位明确43例，病因明确42例。结论增强螺旋CT扫描能客观准确的展现梗阻部位、梗阻原因及梗阻周围情况，对临床治疗有明确的指导意义。     

儿童小肠机械性梗阻的CT诊断

目的 探讨CT检查对儿童小肠机械性梗阻的诊断价值。方法 分析31例手术确诊为小肠机械性梗阻患者的腹部X线平片与CT表现。年龄9个月至14岁,男17例,女14例。急性小肠梗阻29例,慢性小肠梗阻2例。其中7例有腹部手术史。结果 腹部X线平片与CT准确显示梗阻程度分别为19例和29例。CT准确显示梗阻病因18例,包括小肠石4例,肠套叠5例,腹腔局部感染渗出粘连6例,腔内型肠重复畸形1例,先天性脐疝1例,先天性肠旋转不良1例。本组7例有腹部手术史者全部为粘连性梗阻,结合手术史,CT准确判断病因25例。腹部X线平片与CT假阴性诊断分别为4例和2例。结论 CT对发现肠绞窄和肠壁积气的敏感性较腹平片高。CT显示狭窄移行段的形态有助于判断病因,对梗阻病因的判断CT明显优于腹部X线平片。可为临床确定治疗方案提供比较可靠的依据。     

MSCT检查在肠梗阻诊断中的应用

肠梗阻是外科常见的急腹症,早期诊断尤其是检出机械性、绞窄性肠梗阻对外科治疗具有重要意义,梗阻病因的明确对治疗方案的选择有极其重要的指导意义。传统的影像学检查方法（腹部X线平片或透视）诊断准确性不高,大约20％～30％的病例腹部X线平片检查可无异常发现,梗阻大部分定位不确定,而且最主要是无法对梗阻作出病因诊断。随着MSCT技术的应用,CT检查可显著提高肠梗阻诊断的准确性和病因分析水平。     

Gallstone ileus diagnosed by computed tomography

We report a case of gallstone ileus in which CT was the first study to suggest the diagnosis by demonstrating an ectopic gallstone and biliary gas not visible on abdominal plain radiography. Radiologists should be aware of the CT findings in gallstone ileus, so that a more rapid preoperative diagnosis may lead to decreased morbidity and mortality in these patients.     

小儿肠梗阻的腹部X线平片和CT诊断价值分析

目的：分析腹部X线平片和CT对小儿肠梗阻的诊断价值，重点探讨小儿绞窄性肠梗阻的CT表现。材料和方法：收集2002年1月-2004年6月复旦大学附属儿科医院手术证实肠梗阻23例，术前24h均拍摄腹部正侧位X线平片，其中14例行腹部CT扫描。结果：23例肠梗阻术前诊断正确率：腹部X线平片为69．6％（16／23）：CT为100％（14／14）。其中，绞窄性肠梗阻术前诊断正确率：腹部X线平片为38．9％（7／18）；CT为90．9％（10／11）。11例绞窄性肠梗阻的主要CT表现包括：小肠壁增厚9例；CT平扫肠壁密度增高7例和“靶征，，2例；CT增强扫描肠壁强化低于正常者6例，3例延迟扫描强化。肠系膜血管增粗水肿5例，4、肠壁积气4例，腹水6例。结论：CT诊断小儿肠梗阻，特别是显示肠绞窄，较腹部X线平片优越。     

Gallstone ileus: CT findings

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus. We report a case in which gallstone ileus was initially diagnosed by CT. Received: 30 July 1999; Revised: 18 October 1999; Accepted: 18 October 1999     

Gastrointestinal complications of cytosine-arabinoside chemotherapy: findings on plain abdominal radiographs

We analyzed the findings on plain abdominal radiographs in 24 patients who had adverse gastrointestinal reactions after chemotherapy with cytosine-arabinoside (Ara-C) for treatment of acute leukemia or non-Hodgkin lymphoma. Ara-C was given with vincristine, VP 16-213, daunorubicin, amsacrine, adriamycin, or corticosteroids in various combinations and dosages. The abnormalities noted on plain abdominal radiographs included paralytic ileus (73%), cecal distension (38%), pneumatosis intestinalis (27%), thickened loops of small bowel (19%), and pneumoperitoneum (8%). One patient had small-bowel ileus simulating an obstruction. In 23%, death was directly related to gastrointestinal complications. Bowel wall erosions, necrosis, and transmural or submucosal hemorrhage were the main findings at autopsy. This experience suggests that plain abdominal radiographs are useful in the diagnosis of gastrointestinal complications associated with chemotherapy with Ara-C.     

Clinical and radiological diagnosis of gallstone ileus: a mini review

Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.     

Arthrosonography of the irritable hip in childhood: a review of 1 year's experience

A retrospective study of 87 children presenting acutely with an "irritable hip" was undertaken to assess the role of arthrosonography of the hip joint. Arthrosonography detected 52 hip-joint effusions, of which 16 were aspirated and an effusion confirmed in 14 (88%). In 82 cases plain radiography was compared with arthrosonography for the detection of hip-joint effusions. Of 47 children with a positive ultrasound diagnosis, 28 (59%) showed abnormal findings on plain radiographs and, of 35 cases with negative ultrasound findings, 22 (63%) had a negative diagnosis by plain radiography. Patients with more severe clinical signs were more likely to have an ultrasonic diagnosis of an effusion (87%-100%) than those with mild clinical signs (25%). The ultrasonic measurement of the hip-joint capsule to femoral neck distance was 2.2 mm +/- 0.5 mm (mean +/- 1 SD) in normal hips and 6.3 mm +/- 1.5 mm in the joints with effusions. Our study suggests that arthrosonographically the normal capsular space is less than 3 mm and the difference between the two sides less than 2 mm. It is suggested that hip arthrosonography is a more accurate method for detecting hip-joint effusions than plain radiography; it may help select cases for hospital admission and should be performed before aspiration is attempted.     

Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus

In recent years the increasing use of ultrasonography and computed tomography in the assessment of diseases causing acute abdomen and the diagnostic possibilities of magnetic resonance have decreased the role of conventional radiology techniques, especially of plain abdominal film in the diagnosis of acute abdomen. However, serial plain abdominal film is still the first diagnostic procedure used in the assessment of patients with acute abdominal pain, providing important diagnostic information if correctly performed and carefully observed. In this paper serial plain abdominal film findings related to the different types of ileus (spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus) are presented.     

A cholecysto-enteric fistula with a gallstone ileus diagnosed by CT]

Gallstone ileus is an uncommon but severe complication of cholecystitis, which can only occur following perforation of the gallbladder and formation of a cholecystoenteric fistula. The diagnosis can be established by means of abdominal plain film when the classic triad described by Rigler (small-bowel obstruction, ectopic gallstone and pneumobilia) is observed. A patient with abdominal obstruction and equivocal findings on plain film X-ray and abdominal sonography is presented, in whom the gallstone ileus was reliably diagnosed by CT.     

多层螺旋CT评价动脉粥样硬化病变的实验研究

目的 通过与病理学对照,探讨MSCT对兔主动脉粥样硬化病变的诊断价值.方法 15只新两兰兔分3组,每组5只.A组球囊损伤后高脂饲料喂养,B组和C组未作球囊损伤,分别用单纯高脂饲料和基础兔饲料喂养,16周后每组均行MSCT增强扫描,A组采用16层MSCT,B、C组采用64层MSCT.将CT结果与病理做盲法对照.采用Fisher检验和x2检验,以病理结果为金标准,计算16及64层MSCT探查斑块的敏感度及特异度.结果 16和64层MSCT分别有60与75个病理切片与相应层面CT图像对照,16和64层MSCT探查粥样硬化斑块敏感度分别为41.5%(22/53)和64.9%(24/37),特异度分别为85.7%(6/7)和89.5%(34/38).结论 64层MSCT较16层可以提高对兔主动脉粥样硬化斑块检出的敏感度,但两者均能较准确地排除兔主动脉粥样硬化病变.