MSCT对缺血性肠病的诊断价值

目的分析缺血性肠病的多层螺旋CT(MSCT)表现,探讨MSCT对该病的诊断价值。方法回顾性分析30例经病理证实为缺血性肠病患者的临床资料和MSCT表现。结果在30例患者中,MSCT表现为肠壁增厚19例(其中表现为可逆性缺血17例,表现为不可逆性缺血2例),肠壁变薄8例(均表现为不可逆性缺血),肠壁无明显增厚或变薄1例,肠壁增厚与变薄并存2例。在可逆性肠缺血患者中,肠壁出现分层强化呈"靶征"11例,肠壁强化正常或增加3例,肠腔扩张、积液10例;在不可逆性肠缺血患者中,强化减弱或无强化7例,肠腔扩张、积液2例。在30例患者中,肠系膜水肿、浑浊22例,4例合并腹水;肠壁和/或门脉积气9例。结论肠系膜动脉狭窄或闭塞易导致肠系膜不可逆性缺血,通常可引起肠壁变薄;而可逆性肠系膜缺血多表现为肠壁不同程度的增厚。MSCT能快速、准确地诊断缺血性肠病,并能对其发病原因、病变范围、病情程度等作出准确评估。     

多层螺旋 CT 后重建技术在诊断小肠肠梗阻中的应用价值

目的：探讨多层螺旋CT后重建技术在诊断小肠不全性肠梗阻中的应用价值。方法：搜集64例经手术治疗及随访观察明确诊断为肠梗阻的患者。观察肠系膜血管聚集、拉伸、牵拉、扭曲,小肠狭窄及扩张程度,并进行统计学处理。结果：（1）MPR显示：肠道肿块18例,肠道浸润性狭窄6例,肠道炎性狭窄23例,肠套叠9例,漩涡征11例。显示肠系膜上动脉钙化斑块9例,非钙化斑块6例。肠壁增厚35例,肠壁呈环形强化20例,肠壁内点状积气5例,肠系膜水肿8例,肠系膜静脉内积气1例,肠壁无强化5例。腹腔积液13例。（2）CTA显示：肠系膜上动脉旋转11例,肠系膜上动脉移位45例,肠系膜血管聚集15例,肠系膜血管分散18例,肠系膜上动脉闭塞14例。结论：利用128层螺旋CT扫描,联合血管容积再现（VR）及多平面重建（MPR）后重建技术,可以早期确定梗阻的具体部位、梗阻的原因;客观地分析判断病变肠管缺血程度。     

64排CT扫描对肠壁缺血性病变的诊断价值分析

目的:探讨64排CT扫描对肠壁缺血性病变的诊断价值。方法:选取2016年2月—2017年2月期间本院收治的肠壁缺血性病变48例患者,术前均进行64排CT诊断,将病理诊断结果作为金标准,统计患者64排CT诊断的符合率,并对肠壁缺血性病变影像学特征进行分析。结果:48例患者病理诊断均为肠壁缺血性病变,其病理改变为血管狭窄病变,并伴有不同程度黏膜充血、局部水肿、接触性出血、溃疡等,其中24例为肠系膜下动脉狭窄,15例为肠系膜上下动脉均狭窄,9例为腹主动脉狭窄; 64排CT诊断总符合率为95. 83%,其中24为肠系膜下动脉狭窄,诊断符合率为100. 00%,其中14例为肠系膜上下动脉均狭窄,诊断符合率为93. 33%,其中8例为腹主动脉狭窄,诊断符合率为88. 89%,64排CT诊断总符合率与病理诊断相比,差异无统计学意义(P> 0. 05);影像学特征:肠壁发生缺血性病变时,肠壁环形呈现增厚及分层强化,并出现肠壁节段性扩张、狭窄、肠壁变薄现象,且未见病变肠袋;肠腔、肠壁及静脉均呈现积气现象;肠系膜呈细小状,且出现密集增粗影/稀疏细小征象;部分患者还表现出肠系膜水肿、腹水现象。结论:64排CT扫描对肠壁缺血性病变的诊断具有较高价值,其诊断符合率较高,且具有明显的影像学特征,临床推广价值较高。     

多层螺旋CT在急性缺血性肠病诊断中的价值

目的探讨多层螺旋CT(MSCT)诊断急性肠缺血的临床应用价值。方法回顾性分析24例经临床证实的急性肠缺血患者的CT表现。所有患者均行CT检查,包括平扫、动脉期、门脉期扫描及血管重建,2例行MSCT灌注扫描;21例行DSA检查及介入治疗;3例行肠切除手术。结果应用MSCT血管重建技术诊断肠系膜上静脉血栓形成13例、肠系膜上动脉栓塞5例、肠系膜上动脉狭窄5例、腹腔干狭窄1例。不同病因和不同程度的肠缺血CT间接征象有一定差异:肠系膜静脉血栓形成时,肠壁增厚、肠系膜水肿、腹水多见;肠壁积气仅见于全层坏死,而其他征象均可见于不同病因、不同程度的肠缺血。结论MSCT能准确诊断肠缺血并明确病因,有助于判断缺血程度。     

双能量CT增强扫描对缺血性肠病的诊断价值

目的:探讨双能量CT(DECT)对诊断缺血性肠病的临床价值。方法:回顾性分析29例经临床证实的急性肠缺血患者的双能量CT表现。所有患者均行双源双能量CT增强检查,包括动脉期、门脉期、平衡期及虚拟平扫、后处理血管重建;24例行DSA检查及介入治疗;5例行肠部分切除手术。结果:应用DECT血管重建技术诊断肠系膜上静脉血栓形成12例、肠系膜上动脉栓塞9例、肠系膜上动脉狭窄7例、肠系膜上动脉痉挛1例。本组29例均获得外科手术或DSA介入诊疗证实。肠系膜动脉血栓形成时,肠壁可有强化相对减弱;肠系膜静脉血栓形成时,肠管管壁肿厚、肠系膜水肿、腹腔积液;肠壁气肿只见于全层坏死,而其它征象均可见于不同病因、不同程度的肠缺血。结论:DECT能准确诊断缺血性肠病的原因,并有助于判断缺血的程度,减少临床误诊误治。     

肠壁缺血性病变经多层螺旋CT诊断的作用

目的：探讨肠壁缺血性病变经多层螺旋CT诊断的作用。方法：选取116例肠壁疑似缺血性病变患者为研究对象，所有患者入院时均接受多层螺旋CT检查及病理检查，并以后者检查结果为金标准，计算多层螺旋CT在诊断肠壁缺血性病变中的应用效能及对病变类型的检查效果。结果：多层螺旋CT对肠壁缺血性病变的诊断准确性、敏感性、特异性分别为93.10%、95.12%、88.24%,误诊率及漏诊率分别为11.76%、4.88%。多层螺旋CT对肠系膜下动脉狭窄、血管狭窄、腹动脉狭窄、肠系膜上下动脉狭窄等不同病变类型的检出率与病理检查结果比较，差异无统计学意义(P>0.05)。典型病例影像分析结果显示，肠系膜上动脉存在狭窄表现且有主干栓塞情况患者的附壁横断面影像特征是没有血栓形成；肠系膜上动脉血管的直径大小不一，且有明显的纤细状形态，肠系膜下动脉血管则呈代偿性增大。结论：多层螺旋CT对肠壁缺血性病变的诊断准确性较高，且可有效分辨出不同病变类型。     

肠系膜上动脉病变致缺血性肠病的MSCT诊断

目的：回顾性分析多层螺旋CT在肠系膜上动脉病变致缺血性肠病的影像表现,为临床早期诊断提供依据。方法收集2012年8月至2015年8月在本院行CT检查并经临床证实的肠缺血患者6例,采用多层螺旋CT进行全腹CT扫描,其中4例增强扫描。以横断面原始CT图像加多种后处理技术进行肠系膜上动脉成像评价。结果6例患者中3例急性肠缺血,临床表现急性腹痛,3例均为肠系膜上动脉血栓,CT增强扫描显示肠系膜上动脉血栓,管腔内充盈缺损,轻度、中度狭窄,狭窄度介于50%左右。慢性肠缺血3例,表现为与进食有关慢性腹痛,肠系膜上动脉长段或局限性钙化狭窄。6例中2例发生轻症肠梗阻,肠管积气积液扩张,肠壁增厚模糊。6例患者临床非手术治疗,疗效明显。结论螺旋CT可以明确肠系膜上动脉病变致缺血性肠病的早期诊断,对临床治疗具有重要指导意义。     

能谱CT单能量小肠成像应用于克罗恩病临床评估的价值

目的探讨能谱CT单能量小肠成像应用于克罗恩病临床评估的价值。方法48例临床确诊为克罗恩病的患者行腹部CT能谱成像。原始图像经信号-噪声比(CNR)分析获得最佳成像Kev值,重建单能量图像。观察指标包括病变肠管位置、肠壁厚度、肠管狭窄程度、肠管强化程度、肠壁周围表现(浆膜层、脂肪间隙、系膜血管)、淋巴结肿大及相关并发症;计算正常肠壁与病变肠管动、静脉期强化率△A%与△V%。所有患者行内镜(结肠镜或小肠镜)检查,2例患者行手术治疗,金标准为活检病理。结果 (1)能谱CT单能量成像结合物质分离功能清晰显示病变肠管范围,病变肠段共132处,肠壁厚度3.1-26mm。病变累及空肠9例,回肠39例,回盲部42例,结直肠29例;25例显示肠壁水肿、增强同心圆样或分层样改变,39例浆膜层毛糙,18例显示肠管周围脂肪间隙模糊,36例显示肠系膜血管增多征象,其中24例有明显的"梳齿"征表现。22例显示肠系膜及腹膜后淋巴结增大,淋巴结大小约3.5-14.5mm。1例出现肠管穿孔,腹腔脓肿形成;3例肛瘘,4例不全小肠梗阻,2例有肠管狭窄伴胶囊内镜滞留。(2)平扫CD病变肠壁与正常肠壁CT值无显著性差异(P0.05),动脉期、静脉期CD病变肠壁强化程度及强化率均显著高于正常节段肠壁(P0.01);病变节段肠壁动脉期与静脉期肠壁强化率无显著性差异(P0.05)结论能谱CT单能量小肠成像对克罗恩病的诊断、临床评价具有明显优势,可作为CD的首选影像学检查方法。     

多层CT在诊断原发性急性肠系膜缺血中的价值

目的探讨多层CT在诊断原发性急性肠系膜缺血中的临床价值。方法回顾性收集临床及CT资料完整的原发性急性肠系膜缺血患者资料共计27例。所有患者均经临床和/或手术证实,并行全腹部CT平扫及动脉期和门静脉期扫描。影像重点分析包括:肠系膜血管受累部位、CT表现、相应肠管表现及其他继发表现,如腹水、系膜改变等。结果 27例患者中,肠系膜上动脉血栓形成栓塞3例,肠系膜下动脉血栓形成1例,肠系膜上静脉血栓形成23例,CT表现为血管腔内充盈缺损。间接征象包括:肠腔扩张积液19例、肠壁水肿增厚15例、肠系膜水肿、密度增高15例、腹腔积液6例。结论多层CT对诊断原发性急性肠系膜缺血有非常重要的临床价值,能明确血管病变的部位、范围和程度。     

重视肠系膜缺血疾病的CT诊断价值

目的探讨CT诊断肠系膜缺血疾病的临床价值。方法选择我院2014年11月-2015年10月收治的疑似肠系膜缺血疾病患者48例作为研究对象,全部病例均行CT检查,包括平扫、门静脉期和动脉期扫描,回顾性分析患者的CT检查结果和临床表现。结果48例患者中,28例患者肠系膜上存在静脉血栓、20例患者存在动脉栓塞。CT检查可见动脉远端闭塞、CTA显示缺损充盈管腔内、肠腔中积液。同时有13例患者存在肠壁增厚,24例患者肠壁水肿增厚。结论针对肠系膜缺血疾病的患者可行CT检查准确的诊断出来,其成像能清晰的显示阻塞血管的部位、范围及大小,对明确诊断和后期治疗提供了较好的依据。     

Small bowel stricture complicating superior mesenteric vein thrombosis

Superior mesenteric vein (SMV) thrombosis is a relatively rare disease.Most patients may be successfully treated with anti-coagulation alone.However,bowel stricture may develop due to intes-tinal ischemia which may require surgical treatment.This report describes a rare case of small bowel stricture occurring one month after successful treatment of SMV thrombosis.After segmental resection of strictured bowel,the patient’s post-operative course was uneventful.     

联合肠型脂肪酸结合蛋白、D-乳酸及D-二聚体在急性肠系膜上动脉闭塞患者中的临床意义

目的探讨联合肠型脂肪酸结合蛋白（intestinal fatty acid binding protein,I-FABP）、D-乳酸及D-二聚体在急性肠系膜上动脉闭塞患者早期诊断的临床意义。方法选择急性腹痛患者93例,其中32例为通过腹部血管B超、CTA或DSA确诊的急性肠系膜上动脉闭塞患者作为观察组,其余61例患者为对照组。检验93例患者入院就诊后I-FABP、D-乳酸及D-二聚体水平。对照两组间I-FABP、D-乳酸及D-二聚体水平。结果观察组I-FABP、D-乳酸及D-二聚体水平均高于对照组（P＜0.05）。I-FABP、D-乳酸、D-二聚体水平及三者联合在诊断急性肠系膜上动脉闭塞患者形成的受试者工作特征（ROC）曲线下面积分别是0.810（95% CI 0.719～0.902,P＜0.001）、0.806（95% CI 0.707～0.904,P＜0.001）、0.695（95% CI 0.584～0.806,P=0.002）、0.918（95%CI 0.850～0.985,P＜0.001）。结论I-FABP、D-乳酸及D-二聚体对早期诊断急性肠系膜上动脉闭塞患者有临床意义。三者联合检测可显著提高早期诊断急性肠系膜上动脉闭塞的特异性及敏感性。     

Value of Multi-detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection

Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD). Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia. Results There were 5 cases of type I ISSMAD, 14 cases of typeⅡ, 1 case of typeⅢ, 7 cases of typeⅣ and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6%vs. 76.0%,t=–14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment. Follow-up was complete in 30 cases. Follow-up CT angiography of superior mesenteric artery showed dissection remodeling in 12 patients. Conclusion Multi-detector CT is a valuable method in diagnosis and classification of ISSMAD and monitoring the changes of dissection.     

急性肠系膜上动脉缺血的支架置入与药物溶栓近、中期疗效分析

目的 比较支架置入与药物溶栓治疗急性肠系膜上动脉缺血的近、中期疗效.方法 收集2004年1月至2008年12月,中国医科大学附属第一医院因肠系膜上动脉狭窄或闭塞引起急性肠缺血住院患者35例.其中,支架置入12例(介入治疗组),外周药物溶栓23例(药物溶栓组).介入治疗组采用球囊扩张及支架置入并辅以抗凝、祛聚及扩血管治疗,药物溶栓组采用尿激酶配合抗凝、祛聚及扩血管治疗.两组患者出院后均口服氯吡格雷及阿司匹林并进行随访.用Fisher确切概率法比较分析两组疗效差异的显著性.结果 药物溶栓组临床有效7例,无效16例(加重或死亡7例,治疗失败行部分肠切除9例).介入治疗组10例置入支架(1例术后第3天死于急性心肌梗死),2例开通失败.随访1～48(15±12)个月.药物溶栓组1例病情平稳,6例死于再发急性肠系膜动脉栓塞;支架置入组7例病情平稳,1例术后20个月死于急性心肌梗死(无肠缺血症状),1例术后28个月再发肠缺血,经肠系膜动脉置管溶栓后症状消失.结论 支架置入在改善肠系膜上动脉闭塞引起肠缺血及提高患者生存率方面均显著优于药物保守治疗,为尚未出现肠坏死患者的治疗方案的选择提供了可靠依据.

Abstract：

Objective To compare the short-term and medium-term result of stent implantation with pharmaceutical thrombolysis in patients with acute superior mesenteric artery occlusion. Methods From January, 2004 to December, 2008, thirty-five patients diagnosed acute superior mesenteric ischemia, 12 patients treated with stent implantation ( interventional therapy group) and 23 patients with pharmaceutical thrombolysis(thrombolytic therapy group). Interventional therapy group treated with balloon dilatation and stent implantation assisted with anticoagulation, antiplatelet and vascular dilation agents. Thrombolytic therapy group used urokinase combined with anticoagulation, antiplatelet and vascular dilation agents. All patients had tsken clopidogrel and aspirin orally after discharged and followed up. The clinical effects of both groups were evaluated separately and the Fisher exact test was used to analysis the significant differences. Results In the 23 cases of thrombolytic therapy group, 7 cases was effective, 16 cases was ineffective(7 cases aggravated or died, 9 cases turn to surgical operation). In the 12 cases of interventional therapy group, 10 cases treated with stent implantation( 1 case died of acute cardiac infarction 3 days after interventional operation), 2 cases failed in racanalizing. All patients were followed up after discharged (range 1 -48 months, mean 15 ± 12 months), 1 case in thrombolytic therapy group was stable, 6 cases died of the recurrence of acute superior mesenteric artery occlusion; 7 cases in interventional therapy group was stable, 1 case died of acute cardiac infarction 20 months after interventional operation ( intestinal ischemia not appeared ), 1 case had intestinal ischemia reoccurred and recovered by superior mesenteric artery thrombolysis. Conclusions In the treatment of acute superior mesenteric ischemia, stent implantation was obviously superior to pharmaceutical thrombolysis in improving intestinal ischemia and survival, therefore it could provided a reliable choice for the patients who had not appeared intestinal necrosis.     

CT血管造影在孤立性肠系膜上动脉夹层中的诊断价值

目的探讨螺旋CT血管造影（CT angiogaphy,CTA）及其后处理技术在孤立性肠系膜上动脉（superior mesenter-ic artery,SMA）夹层诊断中的应用价值。方法回顾性分析5例CTA诊断的孤立性SMA夹层病例临床资料及影像特征。结果 5例患者CT轴面源像及后处理重建图像可清晰显示SMA夹层真假腔、动脉瘤样扩张、剥离内膜片、继发血栓范围、有无肠道缺血表现、分支血管受累情况等。结论 CTA技术能够精确评估孤立性SMA夹层病变情况,可作为孤立性SMA夹层首选检查方法。     

A hybrid technique: intra-arterial catheter-directed thrombolysis following the recanalization of superior mesenteric artery in acute mesenteric ischemia

Acute mesenteric ischemia is a deadly process with overall mortality rate of 40％.1 Acute thrombosis of an atherosclerotic lesion with previous partial occlusion is one of the common causes.Peri-operative mortality of superior mesenteric artery (SMA) thrombosis is higher because of the difficulty in diagnosis,the extensive nature of the bowel ischemia infarction,and the complex surgical revascularization.2 We described a hybrid approach employing fluoroscopically assisted embolectomy and balloon angioplasty,followed by intra-arterial catheter-directed thrombolysis during laparotomy in patients suffering from acute SMA thrombosis. METHODS Patients The hybrid technique was used in a total of four patients with acute mesenteric ischemia in the last 2 years.The clinical records of all patients were retrospectively reviewed.Only patients with acute SMA thrombosis were included.Patients suffering from acute SMA embolism with a history of atrial tachyarrhytmias were excluded.Co-morbid medical conditions,radiologic findings,complete peri-operative data,and follow-up information were obtained for all patients.