载体介导靶向小肠气钡双对比造影法的研究

目的 介绍一种简便易行的小肠双对比造影法－载体介导靶向小肠气钡双对比造影法并初步评价其效果。材料与方法 以小肠溶空胶囊为载体盛装产气剂，口服后载体胶囊至小肠溶解，产生CO2，配合口服钡剂形成小肠气钡双对比。选取80例拟行小肠造影检查者，随机分成2组，每组40例。试验组采用本方法，对照组采用普通单钡法。结果 试验组29例小肠双对比效果较满意，8例效果一般，有局部小肠双对比效果，3例无双对比效果，总有效率92．5％。对照组40例均为单钡造影效果。结论 载体介导靶向小肠气钡双对比造影法确能形成小肠气钡双对比，小肠观察效果较普通单钡法有明显提高，但有待于进一步完善。     

多层螺旋CT及CTA诊断小肠间质瘤的价值

目的：探讨多层螺旋CT及其血管造影三维重建(3D-CTA)对小肠间质瘤的诊断价值。材料和方法：回顾性分析经手术、病理证实的11例小肠间质瘤的多层螺旋CT平扫和双期增强扫描及3D-CTA表现。结果：11例中,恶性8例、交界性2例和良性1例；肿瘤起源于空肠3例、回肠7例和十二指肠1例。CT平扫示良性间质瘤密度较均匀,恶性者密度不均,增强扫描动脉期示肿瘤均呈明显增强,良性者较均匀,恶性者不均匀,静脉期示肿瘤仍有明显增强；3D-CTA可清晰显示肿瘤供血血管。结论：小肠间质瘤的多层螺旋CT表现有一定的特征性,3D-CTA能清晰显示肿瘤供血血管,并有利于肿瘤定位。     

数字化小肠气钡造影在小肠病变中的诊断价值

目的 评价数字化小肠气钡造影在诊断小肠病变中的用途。方法 22例经手术病理证实的小肠病变，其中，恶性病变10例，良性病变12例，均经数字化小肠气钡造影。结果 在22例患者中，数字化小肠气钡造影正确诊断19例，1例空肠腺癌被误诊为炎症，2例空肠增殖性结核被误诊为恶性占位性病变。诊断敏感性、特异性、准确率、阳性预测值以及阴性预测值分别为80%，92%，87%，89%以及92%。结论 数字化小肠气钡造影对小肠病变具有较高的诊断与鉴别诊断能力，对临床上疑有小肠病变的患者应作为首选方法。     

多层螺旋CT对小肠间质瘤的血供分析

目的:应用多层螺旋CT血管成像技术(3D-MSCTA)对小肠间质瘤的血供特点进行分析、研究,为诊断和临床治疗提供理论依据。方法:搜集12例经手术后病理证实的小肠间质瘤,术前均行多层螺旋CT平扫及双期增强扫描,并行3D-MSCTA重建。结果:12例中,肿瘤起源于空肠、回肠者10例,十二指肠1例,小肠系膜1例。CT增强扫描病灶均呈明显强化,3D-MSCTA均清晰显示了增粗的肿瘤供血血管。结论:小肠间质瘤为富血供肿瘤。     

内镜导引下插管小肠双对比造影50例分析

目的:通过改进小肠插管技术,提高小肠检查率和小肠病变的发现率。方法:经胃内镜引导把B-D导管置入空肠上部。结果:50例病人插管成功率100%(50/50);满意率98%(49/50);病变阳性率86%(43/50)。结论:胃内镜导引下小肠插管双对比能明显提高小肠检查率和小肠病变发现率,可作为常规应用。     

MSCT与气钡双重造影在小肠不明原因出血中的诊断价值

目的 评价多层螺旋CT扫描结合小肠气钡双重造影检查在小肠出血诊断中的价值.方法 对我院经胃镜及结肠镜检查未能明确的消化道出血患者行腹部CT并结合小肠气钡双重造影检查.结果 腹部多层螺旋CT检查及小肠气钡双重造影检查的诊断符合率分别为74.1％及55.2％.结论 采用腹部螺旋CT检查结合小肠气钡双重造影检查可以提高小肠出血的诊断符合率.     

胃镜引导插管小肠双对比造影方法研究

目的：探讨小肠双对比造影检查的有效方法。方法：72例受检者被随机分成2组；试验组(36例)应用研制的小肠造影导管，在胃镜直视下钳夹导管头端并送达十二指肠水平部，头端气囊充气固定导管，退出胃镜后，经导管灌注适量稀钡胶浆及空气行小肠双对比造影。对照组(36例)采用改进的F9心导管在透视下插管。结果：实验组插管成功35例(成功率97．1％)，对照组插管成功27例(成功率75％)。结论：研制专用的小肠造影导管并经胃镜引导插管行小肠双对比造影检查，其成功率明显高于普通插管方法。     

小肠肿瘤的影像学诊断

尽管小肠肿瘤发病率只占全胃肠道肿瘤不到2％,小肠影像学诊断技术也取得明显改进,但延误诊断仍相当严重,原因在于小肠肿瘤患者与其它胃肠道疾病的临床表现相似,影像学诊断方法未能被合理采用,故关注小肠肿瘤的两类临床特征－出血,占位和综合利用多种影像技术的优势,可提高小肠肿瘤的发现率和诊断率。     

小肠双向双对比造影对成人Meckel憩室的诊断价值

目的：探讨小肠双向双对比造影对成人小肠Meckel憩室的诊断及临床应用价值。方法：回顾性分析30例成人小肠Meckel憩室的临床及双向双对比造影影像资料,30例均行小肠双向双对比造影检查。结果：29例清晰显示憩室的开口、形态和盲端结构,憩室口部的“三叉路口”或“T”形黏膜为其特征性表现,1例憩室逆行翻入回肠后再导致回肠套叠,在非低张状态下观察憩室均有肠管样蠕动,具有一定张力;29例行开腹手术或腹腔镜手术治疗,证实双向双对比造影技术显示病变直观、定位准确,诊断明确。结论：气钡双向双对比造影能明确显示成人小肠Meckel憩室的直接形态并做出准确诊断,该检查方法简单、易行、患者痛苦少,可作为成人无痛性消化道出血的常规检查方法。     

Theoretical diagnosis of ulcerative diseases of the small intestine

The macroscopic appearance of the shape of ulcerations and distribution pattern of the lesions was analyzed in 45 operated or dissected cases presenting inflammatory small intestinal diseases, in order to establish a basis for X-ray diagnosis. Characteristic macroscopic findings could be found for each inflammatory disease. The differential diagnosis of inflammatory small intestinal disease requires X-ray demonstration of the shape of ulcerations and their distribution pattern. The double contrast method is the best suited because it offers excellent visualization of the ulcerative lesions in almost every region of the small intestine on the survey films. The X-ray findings in 30 cases examined with the double contrast method in the two weeks preceding surgery were analyzed. The aspect displayed was correlated with the shape, size and position of the ulcerations. Differential diagnosis should essentially rely on the characteristic shape of the ulcerations and subsequently on the distribution pattern of the lesions on double contrast films. The theoretical differential diagnosis of inflammatory diseases of the small intestine should be done by confrontation of these findings.     

Diagnostic radiology for tumors for the small intestine(author's transl)

The fractionated gastrointestinal tract presents technical problems which result in a large number of diagnostic errors in regard to tumors of the small intestine. Pharmacoradiologic processes and Sellink's sounding method deal successfully with these problems. The methods were described and their advantages for tumor diagnostics in the small intestine were stressed. The mesenteric angiography is important as an alternative and supplementary examination for small intestine diagnostics. Indications and interpretation possibilities were described.     

Progress in radiology: colorectal tumors: pathology and detection.

The prognosis in colorectal neoplasia has not improved in the past 20 years despite improved diagnostic techniques. The greatest promise lies in wider screening and earlier radiographic and endoscopic detection. To clarify the radiologist's role in finding large bowel tumors, the clinical, pathologic, and radiologic literature is reviewed. Since individuals over 40 years of age harbor the bulk of colon neoplasms, the most diligent efforts to detect these lesions should be made in this group. Controlled studies comparing single and double contrast barium enema techniques are lacking, but available data suggest that the double contrast examination is more sensitive for detection of the numerous small, but potentially malignant colon tumors. Careful radiographic technique, including a thoroughly clean colon, is critical for accurate detection regardless of which technique is used.     

小肠原发性恶性肿瘤的临床X线诊断(附21例分析)

目的 :提高小肠恶性肿瘤的诊断水平。方法 :回顾分析 2 1例资料完整并经 X线检查和手术病理证实的小肠原发性恶性肿瘤的 X线征象。结果 :2 1例中平滑肌肉瘤 9例 ,腺癌 8例 ,恶性淋巴瘤 4例 ,各有其比较特征性 X线表现。结论 :小肠恶性肿瘤虽有各种不同的 X线表现 ,只要认真细致连续观察 ,仍可作出正确的诊断及鉴别诊断。小肠低张气钡双重造影是目前诊断小肠肿瘤比较可靠、首选的检查方法     

肠道恶性淋巴瘤的影像诊断

目的　探讨肠道恶性淋巴瘤的影像特点。方法　复习经手术及病理证实的肠道恶性淋巴瘤 3 2例 ,其中X线钡餐 2 0例 ,双对比灌肠 12例 ,CT扫描 10例 ,B超 19例。结果　钡剂造影发现小肠或回盲受累 2 0例 ,包括小肠局部扩大 6例 ,腔内多发息肉状增生 7例 ,肠壁浸润 4例 ,腔内增生伴溃疡 3例。病灶局限于大肠者 12例 ,分别是腔内肿块 6例 ,肠腔狭窄 5例和粘膜粗大 1例。 10例CT中见肠壁不规则增厚 5例 ,腔内偏侧肿块 2例 ,肠扩大伴壁厚 3例。B超发现异常 13例 ,其中肠壁增厚的条状低回声 5例 ,假肾征 6例 ,团状低回声 2例。结论　肠道淋巴瘤的X线、CT、超声表现各有特点 ,X线钡剂造影与CT或超声结合可提高诊断准确率     

Double contrast examination of the pericardial cavity in a case of exsudative pericarditis (author's transl)

1)Radiographic examinations of the pericardial cavity by double contrast technique yield good information about the pericardial layer itself, the pericardial cavity and its contents. -- 2) Pericardial puncture and fluid aspiration and subsequent creation of a pneumopericardium with installation of water soluble contrast material are important diagnostic tools and have an important therapeutic effect as well. -- 3) For an appropriate examination 300--400 ml gas (oxygen in inflammatory, room air in carcinomatous conditions) and 5--8 ml of 60% water soluble contrast material (0.1 ml per kg bodyweight) should be installed.     

CT of the small intestine

CT of the small intestine continues to be a diagnostic challenge. Three protocols have turned out to be useful. The frequently used general protocol is highly suitable for most indications that require an overview of the small intestine and in cases where no specific queries regarding the small intestine have to be answered. A dedicated protocol with opacification of the small intestine by means of a probe appears to be useful in patients with a suspected tumour or to exclude a tumour as well as in cases of inflammatory bowel disease. Filling of the bowel ensures optimal distention and, in combination with intravenous contrast medium administration, allows differentiation of tumours from inflammatory lesions. In cases of suspected intestinal ischaemia, angiographic techniques should be used. State-of-the-art techniques such as bolus tracking and acquisition of a dynamic scan for determination of individual circulation time facilitate optimal arterial opacification of the intestinal wall. The results obtained in our patients suggest that the use of multislice CT in combination with optimal opacification improves sensitivity. Further studies have to show whether the improved diagnostic options also translate into an improved clinical outcome or survival rate.     

小肠平滑肌肿瘤的血管研究

目的：观察小肠平滑肌肿瘤血管形态。方法：对８例正常小肠标本及１０例（１５个瘤体）经病理证实的平滑肌瘤手术切除标本，采用血管造影、解剖镜观察、石蜡切片光镜观察及图像分析。结果：小肠平滑肌肿瘤血管丰富，共同特征是：供血动脉增粗，沿瘤蒂进入瘤中心，呈放射状分布、簇状增生、丰富吻合，形似“蜘蛛网”状。血管扭曲、中断，瘤体内造影剂池明显者提示平滑肌肉瘤。结论：小肠平滑肌肿瘤属多血供肿瘤，良、恶性之间血管存在一定特点。这有助于介入诊断及螺旋ＣＴ诊断。     

Value of small bowel double contrast enema in clinical interventions

The double contrast enema is the most effective morphological screening method for the evaluation of the whole small bowel. Its sensitivity is 85%, its specifity 96.7%. In specific clinical problems the number of pathological roentgen findings rises: from 34.4% when all indications are taken into consideration to 58% in indications specific to the small intestine such as Morbus Crohn or the malabsorption syndrome. Search for tumours and the double contrast of the small bowel in unclear gastro-intestinal bleeding are unproductive. The weak point of this screening method is the lower part of the small intestine. Therefore, the selective peroral or retrograde analysis of the terminal ileum supplement the contrast method. A precondition for good results is an adequate technical standard. Besides the clinical results some technical results are therefore discussed such as contrast medium quantities, examination and X-ray time, radiation exposure and influences on the image quality.     

Double contrast examination in disease of the anorectal region.

Patients with symptoms from the anorectal region will not always be rectoscopically examined and sometimes lesions of the ano-rectal region are overlooked by the rectoscopist. In order to increase the overall diagnostic accuracy and make possible an early diagnosis of pathological changes in the ano-rectal region, the radiologist should take responsibility also for this part of the bowel. Minor lesions are often difficult to demonstrate by the conventional barium enema, but they are readily seen on an adequately performed double contrast examination. Of special importance is the diagnosis of small polypoid tumors which may become malignant. An early diagnosis and subsequent surgical removal of these tumors prevent spread and minimizes the surgical procedure.     

回肠末端良性溃疡的X线表现及其诊断价值

探讨结肠和小肠双对比造影X线检查对回肠末端溃疡的影像表现及其诊断价值。材料和方法22例经 结肠镜证实的回肠末端溃疡患者,其中18例结肠造影,16例小肠造影。将造影对病变的显示分为显示满意、显示较差和 未显示三组。结果结肠和小肠造影对病变的显示率分别为94.4％和93.8％。病变显示满意率分别为67％和50％。多 发溃疡占54.5％。54.5％的溃疡小于1cm。40.9％为纵行溃疡,31.8％为类圆形溃疡。36.4％的溃疡伴有肠管狭窄, 22.7％伴有假憩室形成。结论当临床怀疑回肠末端病变时,应首先选择结肠造影。