原发性小肠淋巴瘤的影像学诊断价值

目的 探讨胃肠道淋巴瘤的影像学表现，提高对该病的影像学诊断水平。方法回顾性分析12例手术病理证实的小肠淋巴瘤，分析其影像学表现。结果小肠淋巴瘤12例，其中累及十二指肠1例，空肠2例、回肠和回盲部9例；其中11例行CT检查，1例行全消化道钡餐检查；表现为肠壁增厚（2／12）软组织肿块（7／12）及肠管扩张（3／12）。结论消化道管壁广泛或局部增厚并形成软组织肿块是小肠淋巴瘤主要的影像学表现；少数病例仅表现为肠管明显扩张，在诊断时需要注意。     

15例原发性小肠淋巴瘤的影像表现

目的：对胃肠道淋巴瘤影像学表现进行探讨,将对该疾病行影像学诊断水平提高。方法选择曾于我院进行治疗,并经过手术病理证实小肠淋巴瘤患者15例,对其临床资料进行回顾分析,对其影像学表现进行分析。结果在这30例小肠淋巴瘤患者中,有2例患者累及十二直肠,有3例患者空肠,有10例患者为回肠与回盲部病变;对其中12例患者行CT检查,其中3例患者行全消化道钡餐检查,患者表现为3例肠壁增厚,8例患者为软组织肿块,4例为肠管扩张。结论对于小肠淋巴瘤疾病,其主要影像学表现就是消化道管壁广泛或者局部出现增厚并且有软组织肿块形成,有少部分病例为肠管明显扩张表现,在对患者进行诊断时要加强注意。     

小肠恶性淋巴瘤患者消化道钡餐造影及CT检查比较

目的:对小肠恶性淋巴瘤患者进行消化道钡餐造影、CT检查,比较二者诊断小肠恶性淋巴瘤的差别.方法:对22例经病理检查证实为小肠恶性淋巴瘤的患者作消化道钡餐造影,并对其中16例进行CT检查.结果:①消化道钡餐造影诊断:肠管扩张与狭窄交替18例,溃疡13例,瘘道4例.②CT诊断:肠壁增厚16例,肠管扩张、狭窄12例(其中单纯狭窄6例),溃疡4例,腹腔、肝门、脾门淋巴结肿大5例.结论:消化道钡餐造影及CT检查在诊断小肠恶性淋巴瘤方面各有利弊,应根据临床选择合适的诊断方法.     

腹茧症的影像学诊断

目的探讨腹茧症的腹部平片、B型超声、消化道造影及CT诊断。方法回顾我院近10年来收治并经手术证实6例腹茧症患者的临床资料,分析其腹部平片、B型超声、消化道造影及CT表现。结果临床表现均有腹痛、腹胀,1例术前经影像学检查诊断为腹茧症,另5例术前分别诊断为慢性阑尾炎1例、卵巢肿瘤蒂扭转1例、肠梗阻3例。6例患者小肠全部或部分包裹于一层灰白色致密坚韧包膜内。腹部平片表现为中腹部小肠扩张伴宽大气液平面;B超可见包绕在肠管团周围强回声的纤维膜;消化道造影表现为受累小肠呈菜花状、弓形排列或＂扭麻花状＂聚集于中下腹部,形态较固定;典型CT表现为小肠于中下腹部聚集呈包块状,周围可见膜状软组织密度影。术后病理确诊为腹茧症。结论本病术前诊断较困难,但结合临床病史,综合分析影像学检查资料,多可做出术前诊断。     

多层螺旋CT和MR在胃肠道非霍奇金氏淋巴瘤诊断中的价值

目的 探讨胃肠道非霍奇金氏淋巴瘤(Non-Hodgkin's lymphoma,NHL)的MSCT及MRI特征性表现及其诊断价值。方法 分析35例胃肠道NHL的MSCT及MRI资料。其中MSCT检查28例,MRI检查7例,全部病例经手术或活检病理证实为非霍奇金氏淋巴瘤。结果 本组35例共发现非连续病灶46处。表现为胃肠壁的弥漫性或偏心性增厚16例,息肉样或团块状黏膜下肿块15例,肠管呈动脉瘤样扩张4例,伴有病灶周围、肠系膜及后腹膜淋巴结肿大17例。结论 胃肠道NHL的MSCT及MRI表现具有一定的特征性,是治疗前诊断的有效检查方法。     

腱鞘巨细胞瘤的影像表现分析

目的 探讨腱鞘巨细胞瘤的影像学诊断价值。方法 回顾性分析12例腱鞘巨细胞瘤患者资料,男性7例,女性5例;年龄21~70岁,中位年龄43岁。其中9例行X射线检查,5例行CT检查,4例行MR检查。结果 病变位于手部4例,足部4例,踝关节2例,膝关节1例,肘关节1例。X射线及CT表现为骨旁稍高密度软组织肿块,邻近骨质见侵蚀或小囊样破坏,无明显骨膜反应。MRI:病灶在TlWI上接近于骨骼肌信号,T2WI呈等高信号,内见斑片状低信号区,均无明显关节积液。结论 腱鞘巨细胞瘤的影像表现具有一定的特征,可以作出较明确的诊断。     

多层螺旋CT对眼眶淋巴瘤的诊断价值

目的 评价多层螺旋CT在眼眶淋巴瘤诊断中的价值。方法 8例经临床病理证实的眼眶淋巴瘤患者均行多层螺旋CT平扫加动态增强扫描,后进行多平面重建。回顾性分析多层螺旋CT的影像表现。结果 眼眶淋巴瘤8例。6例跨越眶隔前后部呈不规则铸型,矢状位及冠状位重建肿块包绕眼球生长,其中3例浸润肌锥内外间隙;2例位于泪腺,其中1例合并腮腺肿块。所有病例均未见眼环增厚与变形。所有病变多层螺旋CT平扫呈软组织肿块,密度类似于眼外肌,其内未见坏死;动态增强扫描动脉期病变轻度强化,1min病变中度强化,延迟扫描病变进一步强化。结论 眼眶原发淋巴瘤的多层螺旋CT表现具有一定的特征性,多层螺旋CT检查对本病具有重要的诊断价值。     

子宫静脉平滑肌瘤病的CT及MRI影像分析

目的 探讨子宫静脉平滑肌瘤病(IVL)的CT及MRI特点及诊断.方法 对5例经手术病理证实的子宫IVL患者的CT及MRI特点进行回顾性分析,3例行CT检查(平扫+增强),1例行MRI平扫+增强检查,1例同时行CT、MRI检查.结果 4例行CT检查者中3例表现为盆腔内实性或囊实性肿块伴髂静脉、下腔静脉扩张,血管腔内见不规则充盈缺损,其中2例累及右心房和右心室,1例累及左肾静脉,增强后盆腔肿块及血管腔内充盈缺损影呈较一致性强化,经下腔静脉多平面重建后见充盈缺损影相互延续;1例子宫肌瘤术后患者单纯表现为髂静脉-下腔静脉扩张,腔内充盈缺损影部分突入右心房内.2例行MRI检查患者中,1例盆腔内肿块T1WI呈中等、稍低信号,T2WI呈低信号,1例髂静脉-下腔静脉扩张,腔内流空效应消失并见低信号肿块影,并呈"蛇头状"突入右心房;1例子宫肌瘤术后患者表现为髂静脉-下腔静脉扩张,腔内流空效应消失并见条索状充盈缺损影.结论 影像学检查能对子宫IVL做出一定诊断,并准确描述病变范围及用于肿瘤术前评估.     

26例十二指肠恶性肿瘤的CT表现分析

目的 探讨十二指肠恶性肿瘤的CT表现，以提高其诊断水平及鉴别诊断。方法 回顾性分析26例手术病理证实的十二指肠恶性肿瘤的CT平扫和增强资料。结果 原发十二指肠恶性肿瘤12例，其中十二指肠腺癌5例，恶性淋巴瘤3例，恶性间质瘤4例；十二指肠继发性恶性肿瘤14例，其中壶腹癌4例，胰头癌9例，胰腺无功能性神经内分泌癌1例。十二指肠腺癌CT表现为肠腔局限性不规则环状狭窄伴软组织肿块，增强扫描肿块有中度强化；恶性淋巴瘤的特点是长范围的肠壁增厚或肠腔外肿块，增强扫描肿块有轻度强化；恶性间质瘤的特点是巨大软组织肿块伴明显、不均匀强化，肠梗阻不明显。壶腹癌表现为十二指肠降部内侧壁的局限性肿块，增强有轻度强化，伴肝内外胆管扩张；胰头癌累及十二指肠表现为十二指肠内侧壁凹凸不平，邻近的胰头部肿块，增强扫描不强化，伴肝内外胆管扩张；胰腺无功能性神经内分泌癌侵及十二指肠表现为胰头部巨大肿块伴明显强化，肝内外胆管不扩张，肿块与十二指肠分界不清。结论 十二指肠恶性肿瘤的CT表现具有一些特点，可以做出正确的诊断。     

胃肠道间质瘤的影像表现及诊断价值

目的研究各种影像学诊断方法在胃肠道间质瘤(GIST)中的应用,提高其诊断价值。方法对经病理证实的17例GIST的影像学表现进行回顾性分析。其中8例行胃肠道钡餐造影,9例行CT检查并1例同时行MRI检查。结果①胃肠钡餐X线显示:1例食道中下段弧形压迹,正常粘膜推压移位,4例胃体呈类圆形充盈缺损,2例胃窦肿瘤呈不规则充盈缺损及腔内钡斑,粘膜破坏,1例仅见外压性改变;②CT显示:5例胃部及4例小肠肿瘤向腔内外生长,平扫均为等密度,边界清楚,发生于小肠的可见小肠推移。1例肿块内见不规则钙化斑;(3)MRI显示:1例胃内肿瘤于T1WI呈低、等信号,T2WI呈高信号为主的混杂信号,双期增强扫描示肿瘤静脉期强化较动脉期显著。结论钡餐造影和CT是诊断胃肠道间质瘤的主要手段。     

D-木糖吸收试验评价短肠综合征病人的吸收功能

目的:总结D-木糖吸收试验在评价短肠综合征病人残存小肠表面积和吸收功能中的作用.方法:比较22例短肠综合征病人和50例正常人之间5 h尿木糖排泄率、第1、2、3 h血清木糖水平及木糖吸收曲线下面积(AUC)的差异.检验短肠综合征病人木糖吸收水平与残存小肠长度、小肠表面积及蛋白质吸收功能之间的相关性.对6例行肠康复治疗的短肠病人,观察其康复治疗前后木糖及蛋白质吸收水平的变化及其相关性.结果:短肠综合征病人5 h尿木糖排泄率、第1、2、3 h血清木糖及AUC均显著低于对照组(P＜0.05),5 h尿木糖排泄率与残存小肠长度(r=0.581)、残存小肠表面积(r=0.618)及蛋白质吸收率(r=0.640)之间存在显著相关性(P均＜0.05).6例病人肠康复治疗后木糖及蛋白质吸收水平均增加,两者之间存在相关性但未达显著程度(r=0.719,P=0.107).结论:木糖吸收试验是评价短肠综合征病人肠道吸收功能的简单、准确的方法.5 h尿木糖排泄水平是反映短肠病人的肠道吸收功能的较好指标之一.     

多层螺旋CT在消化道肿瘤诊断中的临床应用

目的：探讨多层螺旋CT在胃肠道肿瘤诊断中的价值。方法：通过对48例胃肠道肿瘤患者的多层螺旋CT轴位图像和重建的3D、MIP及仿真内镜图像进行观察分析,分别对胃肠道肿瘤进行诊断。结果：（1）肿瘤部位及组织学类型：直肠癌14例,结肠癌21例,胃癌13例;中低分化腺癌41例,黏液腺癌4例,类癌3例。（2）CT表现：胃壁及肠壁增厚35例、胃腔及肠腔内肿块23例、肠腔变窄伴不同程度梗阻26例、浆膜面模糊35例、淋巴结转移24例、远处器官转移11例、腹水8例。结论：多层螺旋CT在胃肠道肿瘤的诊断中,具有一定的优越性。     

Evaluation of diagnostic yield and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding

BACKGROUND AND AIMS: The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months. RESULTS: A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding. CONCLUSIONS: Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.     

Double-balloon enteroscopy for the diagnosis and treatment of patients with unexplained gastrointestinal blood loss

In 3 patients, 2 women aged 56 and 57 and a 65-year-old man, who presented with overt and occult gastrointestinal bleeding, no focus of the bleeding could be found during gastroscopy and colonoscopy. The patients were then examined and treated by double-balloon enteroscopy (DBE). DBE is a relatively new endoscopic technique that allows high-resolution visualisation of the entire small intestine with full endoscopic instrumentation. The 56-year-old woman had coeliac disease and an enteropathy-associated T-cell lymphoma with stenoses over approximately 150 cm of bowel length. She was given chemotherapy and responded well. The 57-year-old woman suffered from Rendu-Osler-Weber syndrome with multiple angiodysplasias in the small intestine. She was treated 5 times with argon plasma coagulation during DBE, for more than 40 angiodysplasias, and thereafter no longer needed blood transfusions. The 65-year-old man had a history of recurrent melanoma. During DBE, multiple metastases of a melanoma in the small intestine were found and tattooed. The tumours were later surgically excised, with no further metastases in the following 2 years. DBE has proven to be a good diagnostic and therapeutic tool in the management of small intestinal diseases.     

Water-soluble contrast media in obstructed in ischemic small intestine. A clinical and experimental study

In this study the attention was focused on the possible application of the new low-osmolar water-soluble contrast media in already existing routines for radiologic diagnostic work-up and management of the abdominal emergencies of simple intestinal obstruction and ischemia: Iohexol was a good, or better, alternative to sodium diatrizoate regarding taste acceptance and patient reactions: Seventy-five per cent of patients characterized the taste of iohexol as good or neutral, while 52% gave sodium diatrizoate similar scores. The scores were also consistently in favor of iohexol as compared with sodium diatrizoate for the other chosen criteria; nausea, vomiting and diarrhea, but a larger number of patients may be needed for conclusive evaluation. Water-soluble media may have therapeutic effects on intestinal obstruction when preceded by conventional gastric suction using a short gastric tube: Twenty-three of 25 patients with subtotal small bowel obstruction due to peritoneal adhesions improved following the ingestion of either iohexol or sodium diatrizoate. Hyperosmolar contrast media might stimulate peristalsis and dilute the bowel contents, hence, easing the passage through a subtotally obstructed bowel. In rats, a direct relationship was found between contrast medium osmolality and the degree of intestinal distension, fluid influx to the bowel lumen and the speed of contrast medium progression. The water-soluble, low-osmolar contrast media seem promising as diagnostic aids in examination of the gastrointestinal tract: The low-osmolar contrast media gave better intestinal details on films than both barium sulphate and sodium diatrizoate in rats with intestinal obstruction or ischemia when high volumes of radiopaques were employed. Also in patients iohexol retained its radiographic density in the small bowel better than sodium diatrizoate. The diagnostic efficacy of the water-soluble radiographic media varied directly with their osmolality and the resulting fluid influx to bowel lumen. Hyperosmolality stimulated contrast medium progression and bowel distension, and reduced the radiographic density of the contrast media and the alignment to the bowel wall. Water-soluble contrast media may aid the diagnosis of bowel ischemia and the evaluation of the degree of ischemic injury: No bladder opacification, following absorption of water-soluble contrast media from the simply obstructed bowel, was observed in the majority of the animals and was only faintly present in 8%. Distinct radiographic opacification of the urinary bladder in rats with intestinal ischemia was demonstrated as early as 1-2 hours after the administration of contrast medium.(ABSTRACT TRUNCATED AT 400 WORDS)     

Gastric and intestinal bezoars

The authors report a retrospective study of 10 cases of gastric and small bowel bezoars. There was one gastric trichobezoar diagnosed by an abdominal mass and 9 small bowel obstruction due to phytobezoars. All patients underwent surgery: the gastric trichobezoar was removed through a gastrotomy; small bowel bezoars were treated either by enterotomy (n = 3), fragmentation (n = 5) or bowel resection (n = 1). Non operative treatment is efficient in gastric phytobezoars. Surgery is advisable for trichobezoars and small bowel bezoars. Prevention is main and patients who have gastric surgery must be alarmed from consumption of cactus in our country Tunisia.     

Gastrointestinal complications of mycosis fungoides

Mycosis fungoides (MF) is an uncommon T-cell lymphoma which characteristically involves the skin. Two patients with MF are described who developed fatal complications secondary to involvement of the gastrointestinal tract. One developed malabsorption due to small intestinal involvement; the other had a massive haemorrhage from an ulcerated nodule of tumour in the stomach. The potential for extracutaneous spread is discussed, and it is emphasized that bowel infiltration should be considered in any patient with MF who develops gastrointestinal symptoms or complications.     

食生山楂引起肠石性小肠梗阻的CT诊断

目的探讨食用生山楂引起肠石性肠梗阻的CT诊断价值。方法对山东铝业公司医院2006—2009年间收治的13例食用生山楂引起的肠石性小肠梗阻的临床资料进行了CT影像学表现回顾性分析。结果 13例均有生食山楂病史。11例CT表现为完全性和不完全性肠梗阻改变,2例仅表现阶段性局限小肠轻度扩张积水。其中9例CT见＂包裹性粗纱布网眼征＂,7例见小肠粪中山楂核形成＂宝石镶嵌征＂,2例由于山楂石引起肠扭转CT表现,3例腹水及网膜周围渗出征象,术后证实肠管部分坏死,5例合并胃山楂石症。结论 CT平扫检查具有快速简便,对肠石症的病因、部位和梗阻程度有较高的诊断价值,对指导临床治疗及手术具有重要意义。     

Single‐Center,Adult Chronic Intestinal Failure Cohort Analyzed According to the ESPEN‐Endorsed Recommendations,Definitions, and Classifications

Background/Aims: The objective of this study was to describe a clinically well‐defined, single‐center, intestinal failure (IF) cohort based on a template of definitions and classifications endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN). Methods: A cross‐sectional, retrospective, adult IF cohort, receiving parenteral support (PS), was extracted from the Copenhagen IF database at the tertiary IF center, Copenhagen University Hospital, Rigshospitalet, Denmark. Results: Rigshospitalet provided PS to 188 adult patients with IF on December 31, 2011. Six patients received only fluids and electrolytes, while 97% required parenteral energy (17 ± 12 kcal/kg/d). Although 92% of the cohort had undergone intestinal resection, only 53% were classified as patients with short bowel syndrome (SBS) according to the pathophysiological classification. In the remaining cohort, patients were distributed as 5% with intestinal fistula, 12% with intestinal dysmotility, 5% with mechanical obstruction, and 14% with mucosal diseases. Twelve percent had a combination of pathophysiological causes. The patients with SBS (n = 100) were subdivided according to bowel anatomy into group 1 (jejuno/ileostomy, n = 82), group 2 (jejuno‐colonic‐anastomosis, n = 16), and group 3 (jejuno‐ileo‐colonic‐anastomosis, n = 2). When evaluating the cohort requirements for PS using the ESPEN chronic IF classification based on the need for fluid volume and energy, 53% of the patients with IF were distributed in the maximum categories. Conclusion: The orphan condition of IF with its large patient heterogeneity mandates establishment of uniform definitions and a harmonization of classifications. As illustrated, the ESPEN‐endorsed definitions and classifications are well designed and may serve as a common uniform template to facilitate both intra‐ and intercenter comparisons between reference centers and thus outcome results.