闭合性腹部实质脏器损伤的CT评价

目的:探讨腹部实质脏器损伤的CT表现及临床价值。方法:回顾性分析120例闭合性腹部实质脏器损伤的CT表现。结果:单脏器损伤113例,包括肝损伤16例,脾损伤51例,肾损伤43例,胰腺损伤3例;多脏器损伤7例,包括肝损伤伴右肾损伤1例,肝损伤伴脾损伤2例,脾损伤伴左肾损伤3例,脾损伤伴胰腺损伤及左肾盂输尿管连接处损伤1例。腹部实质脏器损伤的CT表现包括挫伤、撕裂伤、实质内血肿及被膜下血肿。首次CT平扫漏诊肝撕裂伤1例,脾损伤3例,肾撕裂伤2例,左肾盂输尿管连接处损伤1例。结论:CT检查可早期准确诊断腹部实质脏器损伤,为临床治疗提供重要依据。     

胰腺撕裂伤的CT诊断

目的:探讨胰腺撕裂伤的CT表现。方法:搜集18例经临床手术证实的胰腺撕裂伤病例资料,分析其CT平扫及增强表现。普通CT扫描层厚5mm,螺旋CT均行薄层多平面重组(MPR)。结果:胰腺内血肿3例,胰腺局限或弥漫性肿胀11例,网膜囊积液12例,胰周积液及左侧肾前筋膜增厚18例,平扫9例胰腺实质内可见低密度撕裂口,增强扫描所有病例胰腺实质内均可见低密度撕裂伤口,其中胰头5例,胰颈8例,胰腺体尾部5例。主胰管损伤CT诊断符合率70%。合并其他脏器损伤12例。结论:胰腺撕裂伤有较特征性的CT表现,CT薄层增强扫描可准确诊断胰腺撕裂伤。CT对主胰管损伤的判断有一定的限度。     

重症急性胰腺炎胸部影像学表现对其诊断及预后的价值

目的分析重症急性胰腺炎(SAP)的胸部X线及CT表现,探讨SAP并发急性肺组织损伤的机理及联系,提高其对SAP临床诊断和预后价值的认识.方法对临床及胰腺CT诊断的39例SAP行X线胸片检查,其中11例加做胸部CT,所有病例均有3次以上的X线胸片复查.男17例,女22例,年龄26～64岁.结果在胰腺CT诊断SAP时显示腹水34例,同时胸片及胸部CT出现肺水肿征象者16例(41%),24h内出现者24例(61.5%),48h内出现者37例(94.9%),72h内均出现上述征象.共出现胸水19例.16例最早出现肺水肿征象者中11例有胸水,1例合并心包积液,10例发展为成人呼吸窘迫综合征(ARDS),死亡7例.结论SAP的胸部影像表现对提示ARDS的早期诊断和预后有重要意义,亦可作为判断SAP病变严重程度的临床指标之一.     

急性胰腺炎CT动态复查在临床治疗中的价值

目的:探讨CT动态复查扫描对急性胰腺炎临床治疗的价值.方法:对58例经手术病理及临床CT复查确诊急性胰腺炎的资料进行回顾性分析.全部病例均做平扫与增强扫描,胰腺区域采用薄层扫描.结果:CT显示胰实质内点状坏死6例,片状坏死4例.其中9例初诊为急性水肿型胰腺炎,经24～72h复查显示点状及段状坏死.4例原为点状坏死发展为片段坏死.9例在后期CT复查发现假性囊肿.结论:CT动态复查对急性胰腺炎的动态发展随时做出准确的定性、定量诊断与临床随即调整治疗方案有重要价值.     

胰腺导管内乳头状黏液性肿瘤的CT诊断价值

目的:探讨胰腺导管内乳头状黏液性肿瘤的螺旋CT诊断价值.方法:回顾性分析50例经手术切除和病理学证实的胰腺导管内乳头状黏液性肿瘤的临床、CT等影像学资料,其中男34例,女16例,年龄32～87岁,平均61岁.结果:50例IPMN患者多发于老年人,年龄大于60岁28例(56%),临床主要表现为腹痛和(或)胰腺炎.CT诊断主胰管型20例(35.7%),分支胰管型21例(25%),混合型9例(39.3%);术后病理示胰腺导管内乳头状黏液性瘤28例,胰腺交界性导管内乳头状黏液瘤5例,胰腺导管内乳头状黏液性癌9例,胰腺浸润性导管内乳头状黏液癌8例.22例胰腺导管内乳头状黏液性癌中,其中3例胰腺钙化,3例伴有淋巴结转移,5例侵犯血管,2例肝脏转移.恶性的IPMN常发生在混合型和主胰管型中(n=14),而分支型多为良性肿瘤(n=18).结论:胰腺导管内乳头状黏液性肿瘤有相对特征性的影像学表现,CT对IPMN的诊断、分型和恶变预测具有重要的临床应用价值.     

急性闭合性胰腺损伤的CT诊断

目的 评价螺旋CT双期增强扫描对急性闭合性胰腺损伤的诊断价值.方法 回顾性分析21例临床资料完整的急性闭合性胰腺损伤的CT征象.结果 本组21 例中胰头损伤5例,胰体尾部损伤16例.胰挫伤或挫裂伤11 例(11/21),占52.38 %,胰内血肿6 例(6/21),占28.57 %,胰腺横断4 例(4/21),占19.05 %.增强扫描门脉期对胰腺实质的损伤灶显示达100%.均未能直接显示胰管断裂征象.结论 CT检查对急性闭合性胰腺损伤的诊断具有重要价值.     

胰腺损伤并假囊肿的CT诊断

目的:总结分析胰腺损伤并假囊肿的CT表现。材料和方法:回顾性分析手术或临床证实的胰腺损伤并假囊肿5例的CT表现。结果:胰腺断裂和实质出血形成胰腺假囊肿1例,并发重症胰腺炎2例,合并脾脏、横结肠系摸和十二指肠损伤各1例。CT表现为类圆形,密度均匀,薄壁单发囊肿3例,厚壁单发囊肿1例,不规则无包膜多发囊肿1例。胰腺体尾部3例,胰头部2例。结论:CT是诊断胰腺损伤并假囊肿的首选方法,结合临床、外伤病史可作出正确诊断。     

128层螺旋CT后处理技术对胰腺导管内乳头状黏液瘤的诊断价值

目的探讨128层螺旋CT后处理重建技术对胰腺导管内乳头状黏液瘤(IPMN)的诊断价值。方法对25例手术病理证实的胰腺导管内乳头状黏液性肿瘤进行回顾性分析研究,运用多平面重组(MPR)和曲面重组(CPR)技术并结合轴位图像分析其影像学表现及鉴别诊断。结果 25例患者中,13例主胰管型,7例分支胰管型,5例混合型。MPR和CPR能清晰显示胰管扩张状况、肿块邻近脏器受侵情况以及肿块与胰管的关系等。结论多层螺旋CT后处理技术对胰腺导管内乳头状黏液瘤的定性诊断较常规的CT扫描有显著提高,为临床提供诊断依据。     

胰腺癌CT误诊分析

目的　分析胰腺癌CT误诊和漏诊原因 ,提高对胰腺癌CT诊断和鉴别诊断能力。方法　对 17例术前误诊的胰腺癌病例进行回顾性分析。CT检查采用螺旋CT动脉期和静脉期扫描 ,层厚 3～ 5mm。结果　 17例胰腺癌中 ,术前CT误诊为慢性胰腺炎 4例 ,慢性胰腺炎伴假性囊肿 2例 ,胰腺假性囊肿 1例 ,壶腹部癌 2例 ,十二指肠恶性肿瘤 2例 ,胃癌 2例 ,CT未见明确肿块而漏诊 4例。术后诊断胰头癌 15例 ,胰体部癌 1例 ,胰尾部癌 1例。病理诊断胰腺腺癌 15例 ,胰腺癌伴慢性胰腺炎 1例 ,导管内乳头状癌 1例。结论　注意螺旋CT扫描方法 ,仔细阅片 ,全面分析 ,能减少CT对胰腺癌的误诊率和漏诊率     

儿童胰腺损伤的MSCT诊断

目的 探讨MSCT在儿童胰腺损伤的诊断价值.方法 回顾性分析经临床、实验室检查及CT明确诊断和手术探查(4例)及临床随访证实的18例闭合性腹部外伤致胰腺损伤患儿的CT表现并按损伤程度进行分级.结果 胰腺损伤CT表现的直接征象有:胰腺肿大(7例),胰腺实质裂伤(5例),实质裂伤伴胰管断裂(2例),胰腺内出血/积液(5例).间接征象有:胰周被膜和肾周筋膜增厚(6例),小网膜囊、胰周及肾旁间隙出血/积液(10例),胰周及腹膜后炎性反应(3例),胰周假性囊肿(10例).合并肝、肾及十二指肠损伤各1例,脾损伤2例.Ⅰ级7例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.结论 结合临床及外伤病史,MSCT检查对儿童胰腺损伤能作出正确诊断并可作为首选方法.     

Evaluation of non-contrast-enhanced CT in blunt abdominal trauma]

We compared the findings of noncontrast-enhanced CT with those of contrast-enhanced CT in 126 patients with blunt abdominal trauma to evaluate the usefulness of noncontrast-enhanced CT. In 112 of the patients, visceral injuries were confirmed by surgery or clinical follow-up including CT. Although noncontrast-enhanced CT diagnosed all patients with 12 intestinal injuries requiring immediate surgery, contrast-enhanced CT missed two of these patients because high density hematomas on noncontrast-enhanced CT became isodense after IV administration of contrast material. However, contrast-enhanced CT was superior to noncontrast-enhanced CT in the diagnosis of hepatic and renal injuries. A case of renal artery occlusion was only visualized on contrast-enhanced CT. We conclude that both noncontrast- and contrast-enhanced CT should be performed for the CT evaluation of blunt abdominal trauma.     

Blunt pancreatic trauma: A persistent diagnostic conundrum?

Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.     

Computed tomography in blunt abdominal trauma: an analysis of clinical management and radiological findings.

We have retrospectively assessed the computed tomography (CT) findings in 92 patients suffering severe blunt abdominal trauma. Surgical findings and clinical follow-up were correlated with the CT findings. In nine patients CT was first used after emergency surgery and provided baseline data which was useful for further management. In two patients CT did not demonstrate small hepatic lacerations seen during previous surgery. No deaths were recorded. In 16 patients surgery followed CT within 24 h; there was good correlation between the CT and operative findings in 10 patients. However, CT failed to detect significant solid organ injury in five patients and was misleading (false positive) in another patient. There were two deaths amongst these 16 patients. Sixty-seven haemodynamically stable patients were initially managed non-operatively. Fifteen of these 67 patients had normal CT examinations; only one had subsequent laparotomy (for reasons unconnected with the trauma) where no injury was detected; there were no deaths. Of the 52 patients with an abnormal CT examination, 43 were successfully managed non-operatively. There were three deaths, including one where an injury missed at CT contributed to the demise of the patient. After an initial trial of non-operative management, the remaining six patients went to surgery where there was good concordance with the CT findings except for one missed renal injury. Active non-operative management of blunt abdominal trauma is widely accepted in haemodynamically stable patients and this report shows how CT supports this policy of surgical restraint in such cases. However, on review CT missed 13 injuries in nine patients overall; stricter attention to technique and better equipment may lead to improved results in the future.     

Comparison of computed tomography and conventional cystography for detection of traumatic bladder rupture

Computed tomography (CT) is the method of choice for evaluating patients with blunt abdominal and/or pelvic trauma. However, the sensitivity of CT for detecting bladder ruptures has been questioned. We reviewed both the conventional cystograms and the CT examinations of 25 patients who had both studies as the initial evaluation of blunt abdominal and pelvic trauma in the last 5 years. Five of these 25 patients had bladder ruptures, three extraperitoneal and two intraperitoneal. All five injuries were detected by both CT and conventional cystography. In one patient the conventional cystogram was falsely positive. In this case the correct diagnosis was made by CT, and a repeat cystogram confirmed that no bladder injury was present. Our results indicate that CT, if properly performed, is as sensitive for detection of bladder injuries as conventional cystography.     

Comparison of computed tomography and conventional cystography for detection of traumatic bladder rupture

Computed tomography (CT) is the method of choice for evaluating patients with blunt abdominal and/or pelvic trauma. However, the sensitivity of CT for detecting bladder ruptures has been questioned. We reviewed both the conventional cystograms and the CT examinations of 25 patients who had both studies as the initial evaluation of blunt abdominal and pelvic trauma in the last 5 years. Five of these 25 patients had bladder ruptures, three extraperitoneal and two intraperitoneal. All five injuries were detected by both CT and conventional cystography. In one patient the conventional cystogram was falsely positive. In this case the correct diagnosis was made by CT, and a repeat cystogram confirmed that no bladder injury was present. Our results indicate that CT, if properly performed, is as sensitive for detection of bladder injuries as conventional cystography.     

The use of MRCP in the detection of pancreatic injuries after blunt trauma

From January 2000 to November 2001, five consecutive, hemodynamically stable trauma patients (age range 8–69 years, mean age 34 years) with parenchymal injurieswere evaluated by magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). One patient also underwent a MRCP-facilitated secretin test. MRI depicted pancreatic laceration in two patients, ductal disruption and a post-traumatic intraparenchymal pseudocyst in one, migrating pancreatic fluid collection in the mediastinal space with disruption in another, and main pancreatic duct rupture and dilatation in the patient evaluated with MRCP following secretin administration. MRI with MRCP is an effective noninvasive test for detecting and managing pancreatic injuries after blunt trauma. Secretin administration improves ductal visualization, particularly of nondilated ducts. Finally, MRI was useful in the follow-up studies of parenchymal damage and minor ductal injuries, providing high-quality images of the pancreatic duct and biliary tract. Electronic Publication     

腹腔实质脏器损伤B超与CT检查比较分析

目的：比较腹腔实质脏器损伤B超与CT的诊断在价值。方法：本文分析24例腹腔实质脏器损伤患者的B超和CT检查结果。并对CT表现和B超显示结果进行了比较分析。结果：B超CT用于检查腹部闭合伤时均有较高的敏感性和准确性。B超检查方便、快捷、可多体位、多切面、多次反复检查,是检查腹腔实质脏器闭合性损伤首选检查方法。当B超疑有腹部实质脏器损伤时,再行CT增强扫描以明确损伤范围和程度,为临床治疗提供依据。结论 ＣＴ和Ｂ超相结合可提高腹腔实质脏器损伤诊断准确率,为临床治疗提供依据。     

Blunt abdominal trauma in children: evaluation with emergency US

PURPOSE: To assess the accuracy of emergency abdominal ultrasonography (US) in the detection of both hemoperitoneum and parenchymal organ injury in children. MATERIALS AND METHODS: Imaging findings were recorded prospectively in 744 consecutive children who underwent emergency US from January 1995 to October 1998; free fluid and parenchymal abnormalities of specific organs were also noted. Patients with intraabdominal injuries were identified retrospectively. Computed tomographic (CT) findings, intraoperative findings, and clinical outcome were compared with the initial US findings. Sensitivity, specificity, and positive and negative predictive values were calculated for patients who underwent CT, laparotomy, or both after US. RESULTS: Seventy-five (10%) of 744 patients had intraabdominal injuries, and US depicted free fluid in 42 of them. US had 56% sensitivity, 97% specificity, 82% positive predictive value, and 91% negative predictive value for detection of hemoperitoneum alone. US helped identify parenchymal abnormalities that corresponded to actual organ injury without accompanying free fluid in nine patients (12%). Inclusion of identification of parenchymal organ injury at US increased the sensitivity of US to 68%, with an accuracy of 92%. CONCLUSION: US for blunt abdominal trauma in children is highly accurate and specific, but moderately sensitive, for detection of intraabdominal injury.     

CT of blunt pancreatic trauma: a pictorial essay

Blunt trauma to pancreas is uncommon and clinical features are often non-specific and unreliable leading to possible delays in diagnosis and therefore increased morbidity. CT has been established as the imaging modality of choice for the diagnosis of abdominal solid-organ injury in the blunt trauma patient. The introduction of multidetector-row CT allows for high resolution scans and multiplanar reformations that improve diagnosis. Detection of pancreatic injuries on CT requires knowledge of the subtle changes produced by pancreatic injury. The CT appearance of pancreatic injury ranges from a normal initial appearance of the pancreas to active pancreatic bleeding. Knowledge of CT signs of pancreatic trauma and a high index of suspicion is required in diagnosing pancreatic injury.     

CT of hemodynamically unstable abdominal trauma

This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41 patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out. On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric, 12 renal and 2 vascular injuries. Seven patients had retroperitoneal and 2 patients adrenal hematomas. All but five lesions (three renal, one pancreatic, and one splenic) were hypodense when CT was performed earlier than 8 h following the injury. Postcontrast studies (n = 17), revealed 4 splenic, 3 hepatic, 1 pancreatic, 3 renal, and 2 bowel and mesenteric injuries beyond what was found on noncontrast CT. Surgical confirmation (n = 21) was obtained in 81.81 % of splenic, 66.66 % of hepatic, 83.33 % of pancreatic, 100 % of renal, 100 % of retroperitoneal, and 85.71 % of bowel and mesenteric injuries. The majority of false diagnoses was obtained with noncontrast studies. Computed tomography is a remarkable method for evaluation and management of patients with hemodynamically unstable abdominal trauma, but only if it is revealed in the emergency room. Contrast injection, when it could be done, revealed lesions that were not suspected on initial plain scans. Received: 13 March 1997; Revision received: 1 December 1997; Accepted: 6 May 1998