胆石性肠梗阻的影像诊断

目的研究胆石性肠梗阻影像表现及其诊断价值.方法回顾性分析15例经临床证实的胆石性肠梗阻患者的影像表现及其诊断价值.结果所有病例CT表现均见肠梗阻征象、肠腔内迷走结石（异位结石）及胆囊、胆系积气,2例显示腹腔游离积液,除1例胆囊切除者外另14例均见胆囊变形,胆囊与十二指肠分界不清,4例可见明确显示胆肠瘘.5例同时进行了腹部立卧位X线平片检查,其中1例碘水造影显示机械性肠梗阻、肠腔内充盈缺损、胆肠瘘,1例显示胆管积气,3例显示肠梗阻征象,2例未见异常.7例同时进行了腹部超声检查,均提示胆囊异常,其中3例显示胆系积气.结论胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻最佳诊断方法,X线平片及超声可以作为筛查手段.     

多层螺旋CT在胆石性肠梗阻诊断中的价值

目的 探讨多层螺旋CT在胆石性肠梗阻诊断中的价值.方法 回顾分析15例经手术证实的胆石性肠梗阻病例的临床及影像资料.15例均行全腹部CT平扫、X线腹部平片和腹部超声检查.结果 多层螺旋CT显示肠梗阻共15例,不完全性小肠梗阻12例,完全性肠梗阻3例;异位结石15例,其中9例位于回肠,4例位于空肠, 1例于胆囊内及回肠内均可见结石,1例于胆囊-十二指肠瘘口及回肠内各见一结石;胆囊积气15例,胆道积气13例;胆囊窝结构紊乱15例,其中6例MPR图像清晰显示胆囊-十二指肠瘘.多层螺旋CT的诊断准确率可达100%.结论 多层螺旋CT在胆石性肠梗阻的定位和定性诊断中具有重要价值,为手术方案的制订提供影像学信息.     

胆石性肠梗阻的CT诊断

目的:评价CT对胆石性肠梗阻的诊断价值。方法:回顾性分析5例经手术证实的胆石性肠梗阻患者的CT检查资料及临床表现。结果:所有病例CT表现均见肠腔内异位结石、肠梗阻、胆系积气及胆囊窝结构紊乱,1例显示腹腔游离积液,1例结石位于十二指肠降段,1例结石位于空肠,另3例结石位于回肠。结石呈圆形或椭圆形,直径2.5~5cm,梗阻以上肠管扩张,可见气液平,1例完全性肠梗阻病例梗阻以下肠管空虚。5例术前CT诊断准确率为100%。结论:胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻的最佳方法。     

超声对胆石性肠梗阻的诊断价值

目的探讨胆石性肠梗阻的超声表现及诊断价值。资料与方法回顾性分析11例经手术病理证实的胆石性肠梗阻患者的临床资料与超声表现,并与X线平片、CT结果进行比较。结果 11例超声均显示肠腔内异位结石和肠梗阻征象,9例有胆道系统积气,8例可见胆囊变形、轮廓模糊,5例可见胆肠瘘直接征象,7例有少量腹水,5例可见局部肠壁增厚。结论超声检查胆石性肠梗阻有典型征象,对定位和定性诊断具有重要价值,可作为首选检查方法为临床选择治疗方案提供影像依据。     

CT平扫对Bouveret综合征的诊断价值

目的探讨多层螺旋CT平扫对Bouveret综合征的诊断价值。资料与方法回顾性分析7例经手术证实的Bouveret综合征患者的CT表现及临床资料。结果 7例CT平扫均见肠腔内异位结石,结石上方肠梗阻,梗阻以下肠管空虚;胆道及胆囊积气2例,胆囊窝结构紊乱伴积气5例。结石位于空肠1例,位于回肠6例。1例随访可见胆石梗阻部位移动。结石呈圆形或类圆形,直径3～5 cm,高密度阳性结石4例,低密度阴性结石3例。7例术前CT平扫确诊为Bouveret综合征,准确率为100%。结论单纯CT平扫能对Bouveret综合征进行确诊,"肠袢扩张、胆系积气、异位结石"为Bouveret综合征三大重要的CT平扫表现。     

X线及CT联合应用对胆石性肠梗阻的诊断价值

目的：探讨X线及CT联合应用对胆石性肠梗的阻诊断价值。方法：回顾性分析10例胆石性肠梗阻患者的X线及CT表现。结果：10例患者中2例胆结石位于十二指肠,4例胆结石位于空肠,3例胆结石位于回肠,1例胆结石位于横结肠,结石直径2．5～6．5cn2,平均3．5cm;4例出现胆囊一十二指肠瘘,1例出现胆囊一结肠瘘,1例出现胆囊一十二指肠一结肠复合瘘,瘘口平均直径约1．5cm,其影像学表现包括肠管扩张积气积液、梗阻段肠腔内环形高密度结石影、胆囊积气及消化道造影剂外漏。结论：X线及CT联合应用可明确诊断胆石性肠梗阻,为临床治疗提供重要信息。     

胆石性肠梗阻的CT诊断

目的探讨CT对胆石性肠梗阻的诊断价值。资料与方法回顾性分析8例经手术证实的胆石性肠梗阻患者的CT检查资料。所有病例均有胆囊结石、胆囊炎病史1～10年,并经B超和临床证实,其中5例有明确胆囊炎反复发作病史。发病时患者出现持续性中上腹痛,腹胀,恶心,呕吐,3例患者出现停止肛门排气排便典型肠梗阻症状,5例患者表现为不全性肠梗阻症状。结果所有病例CT图像上均可见胆囊窝结构紊乱,邻近胃窦或十二指肠降段壁增厚,胆囊空虚,胆囊及肝内胆管积气。1例胆石位于十二指肠降段;4例结石位于空肠段,其中2例结石位于屈氏韧带处;另3例结石位于回肠末段。结石呈圆形或椭圆形,直径2．7～5．0cm,梗阻以上肠管扩张,积气积液明显,可见液平面。3例完全性梗阻病例梗阻以下肠管空虚,5例不全梗阻病例梗阻以下肠管内仍可见少量气体及液体,结肠内可见粪便气体混合影。8例均在术前经CT得到正确诊断,准确率为100％。结论CT对胆石性肠梗阻的诊断准确性高。凡65岁以上老年人出现间歇性不完全性机械性肠梗阻,特别是既往有胆道病史而无腹部手术史者,应考虑胆石性肠梗阻的可能,应行CT检查明确诊断。     

胆石性肠梗阻诊治体会

肠梗阻是外科常见急腹症之一 ,它的特点是肠内容物不能通过肠道而引起的病理生理变化及临床表现。胆石性肠梗阻是由于一个或多个胆石嵌顿肠腔引起机械性阻塞。本文收集本院 1987- 0 1～ 2 0 0 1- 12收治 6例胆石性肠梗阻资料 ,报道如下。1　临床资料1.1　一般资料 :本组男性 2例 ,女性 4例。年龄 5 6～ 81岁 ,平均 68.5岁。均以急腹症入院 ,发病时间最短 3ｄ ,最长 1周。入院时有典型机械肠梗阻表现。腹部平片均提示 :小肠积气、扩张、肠腔内液平面。有 1例腹部平片提示胆道内积气。Ｂ超提示胆囊图形异常 2例 ,胆囊萎缩 1例 ,胆囊图形显示不…     

胆石性肠梗阻的X线诊断(附8例报告)

本文报道8例胆石性肠梗阻,并复习有关文献。较大的胆石常经胆肠瘘进入肠道。结石直径大于4cm,肠腔狭窄等因素都易导致结石在肠道内嵌顿。本病多见老年慢性胆囊炎胆石症患者,女性尤为好发,临床上小肠梗阻常为不完全性,症状呈间断变化为其特征。主要X 线表现有:(1)肠梗阻;(2)腹部直接或间接显示胆石影;(3)胆管积气或存在胆肠瘘。CT 和超声对诊断有帮助。胆石嵌顿于十二指肠球部造成胃出口梗阻为本病的罕见类型,称为Bouveret‘s 综合征。     

胆囊十二指肠内瘘伴胆石性肠梗阻的CT诊断价值分析

目的:评价螺旋CT对胆囊-十二指肠内瘘伴胆石性肠梗阻的诊断价值。方法:对8例经手术证实为胆囊-十二指肠内瘘伴胆石性肠梗阻的螺旋CT表现及重建技术进行回顾性分析。结果:8例患者中,2例胆石位于十二指肠降段;2例位于空肠;1例位于空回肠交界处;另外3例位于回肠内。胆石短径为(4.70±1.20)cm,长径为(6.09±1.90)cm。胆囊-十二指肠内瘘伴胆石性肠梗阻的CT直接征象主要有瘘口的显示以及胆石位于梗阻段肠腔内;间接征象主要有胆囊及胆道积气;胆囊塌陷及胆囊与十二指肠分界模糊、结构紊乱;肠梗阻。以上两种直接征象若同时存在即可作出诊断,如一种直接征象同时伴有两种或两种以上间接征象亦可作出诊断。结论:胆囊-十二指肠内瘘伴胆石性肠梗阻具有典型的CT表现,螺旋CT能够对其作出明确诊断。     

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     

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.     

婴幼儿急性肠套叠的临床与影像学分析(附58例报告)

目的　探讨婴幼儿急性肠套叠的影像学表现及临床意义。方法　总结经手术证实的 58例婴幼儿急性肠套叠,分析腹部立位片和空气灌肠的X线改变及CT、超声的影像学表现。结果　(1)手术 58例肠套叠中回结型,回盲型 33例,回回结型,回盲结型,回结结型 25例。病理及手术证实肠套叠合并肠坏死 23例。(2)主要影像学表现:小肠结肠气体减少 12例,肠胀气和不全性肠梗阻 18例,小肠梗阻 17例,腹部立位无明显异常 8例。空气灌肠显示套头呈杯口状,分叶状包块影 28例。超声显示靶环征 3例,CT显示分层状同心圆形肿块 1例。结论　婴幼儿急性肠套叠影像学表现典型,对于诊断十分重要。     

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.     

Osteosarcoma. A new diagnostic approach in presurgical loco-regional staging

The value of Magnetic Resonance (MR) imaging was examined in the anatomical staging of bone osteosarcomas. Eleven patients were studied--8 central and 3 parosteal osteosarcomas. The accuracy of MR imaging was compared to that of plain film, scintigraphy, CT, and angiography. MR imaging was superior to both CT and radionuclide scanning in defining intramedullary extension and in showing skip metastases. Cortical erosion in central osteosarcomas was demonstrated by MR imaging, CT, and plain film; in 1 case of parosteal osteosarcoma MR imaging was superior to CT in showing cortical penetration. In two cases MR imaging did not accurately demonstrate the relationship of the tumor to the major vessels; only angiography showed vascular involvement. MR imaging was useful in delineating extraosseous extension. The importance is stressed of a correct use of MR imaging towards an accurate diagnosis. In fact, intramedullary extension and skip metastases were better demonstrated on T1-weighted images with large fields, while T2-weighted images and small fields were needed for the best overall evaluation of extraosseous involvement. In conclusion, MR imaging should be used for preoperative staging of osteosarcomas in those cases where diagnosis was made on the basis of clinical, radiographic, and bioptic findings.     

骨肉瘤骨膜异常的影像表现与病理研究

目的 总结骨肉瘤骨膜异常的类型和影像特点,探讨骨肉瘤骨膜异常的病理基础.方法 经手术病理证实的骨肉瘤128例,男76例,女52例.年龄5～66岁,平均19岁.全部患者均经X线及MR检查,其中MR平扫加增强109例,扩散成像23例;CT检查48例,36例加行增强扫描;病理大体标本、大切片及定位取材常规切片共14例.将影像检查结果与手术、病理结果进行对照分析.结果 影像和病理表现:(1)骨膜水肿96例,只能在MRI上显示.病理上表现为骨膜结构疏松,无肿瘤细胞浸润.(2)骨膜掀起、增厚,可在CT、MRI上显示,但以MRI敏感(CT显示13例,MRI显示42例).病理上为骨膜掀起、增厚,无肿瘤浸润.(3)无骨膜新生骨的骨膜破坏48例,只能在MRI上显示.病理上为灶性或整个骨膜被肿瘤浸润.(4)线状骨膜新生骨,X线片、CT及MRI上各显示42、13及22例.病理上骨膜新生骨呈单层排列.(5)层状骨膜新生骨,X线片、CT及MRI上各显示21、6及21例.病理上,新生骨小梁呈多层排列.(6)放射状骨膜新生骨,X线片、CT及MRI上各显示13、7及14例,在X线片、CT上,越近病变中心针状影越长、密度越高.病理上,针状影间为肿瘤组织.(7)混合型骨膜新生骨,X线片、CT及MRI上各显示7、4及8例.为2种或2种以上的骨膜新生骨的混合表现.结论 (1)骨肉瘤可引起多种形态的骨膜异常,不同骨膜异常有不同的影像表现及病理基础.(2)所提出的对骨膜异常的分类,以病理所见为基础,较好地概括了骨膜各种病理改变的3种影像表现.(3)MRI可显示X线片、CT不能显示的骨膜水肿、无骨膜新生骨的骨膜破坏等更早期的骨膜异常,显示骨膜掀起、增厚也较CT更敏感.     

Gallstone ileus analysis of radiological findings in 27 patients

PURPOSE: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. MATERIAL AND METHODS: 27 patients (23 women and 4 men, age range 58-96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4mm, reconstruction interval 4mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air-fluid levels, ectopic stones. RESULTS: Plain abdominal films showed the following findings: air-fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air-fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler's triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy.     

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.     

颈椎不稳症的影像诊断(附50例报告)

目的探讨颈椎不稳症的影像学诊断。方法回顾性分析50例经临床证实的颈椎不稳症患者的X线平片、CT和MRI检查资料。结果50例中上颈椎不稳16例,其中,寰枕关节不稳2例,表现为枕底—齿突线和斜坡—齿突线不连续,14例为寰枢关节不稳,其中,寰枢关节脱位7例;下颈椎不稳34例,其中,前屈不稳20例,后伸不稳14例。结论X线平片、CT和MRI综合分析能对颈椎不稳症作出准确的诊断。