CT在机械性肠梗阻诊断中的作用

目的：探讨CT对临床或（和）X线平片疑为肠梗阻疾病的诊断价值。方法：回顾性分析临床或（和）X线平片疑为肠梗阻疾病的52例患者的平扫及增强CT检查表现，并与手术病理结果比较。结果：52例手术治疗患者中，48例（92%）手术结果与CT表面相符，包括肠肿瘤12例，肠粘连10例，肠套叠9例（含5例肿瘤），肠扭转及腹外疝各5例，胆石3例，回盲部感染3例，Crohn病1例。肠肿瘤和肠粘连各误诊2例；5例肠壁缺血（提示肠绞窄）4例CT诊断明确，主要表现为洱壁增厚及肠壁强化减弱。结论：CT能区分机械性肠梗阻和其他原因引起的肠管扩张，快速显示梗阻的部位和病因，提示肠绞窄，有助于临床及时制定正确的治疗方案，因此，对疑为肠梗阻的病人只要条件允许宜尽快作CT检查。     

结肠癌致肠梗阻的CT诊断

目的：探讨结肠癌致机械性肠梗阻的螺旋CT诊断的优越性。材料和方法：搜集64例曾于术前做腹部CT检查并经手术或纤维结肠镜病理证实为结肠癌引起机械性肠梗阻病例，就以下CT及腹部平片表现进行分析：①梗阻近、远侧肠管表现；②梗阻部位改变；③并发症的CT征象。结果：64例肠梗阻中，判断肠梗阻的有无，CT检查诊断64例（100％），X线平片诊断60例（93．7％）；肠梗阻病因的判断，CT诊断64例（100％），平片诊断0例（0％）。全组64例在CT上均见肠腔内软组织肿块影、肠壁增厚和肠腔狭窄，其中4例见缺血性结肠炎。结论：结肠癌引起机械性肠梗阻的CT检查，对诊断梗阻的原因、部位、程度及发病缓急可提供更有价值的资料。     

机械性肠梗阻CT诊断

目的：总结机械性肠梗阻CT表现及诊断价值。方法：分析30例经手术（16例）及临床（14例）证实的肠梗阻CT及临床资料,比较腹部平片与CT对肠梗阻存在、定位、病因、有否绞窄以及治疗方法选择的价值。结果：CT证实肠梗阻存在100%,平片的70%;病因诊断准确性CT为96%,平片13%;CT能对肠肿瘤及时发现并分期（9例）,及早诊断肠绞窄（2例）及发现肠外肿块（4例）,有助于及早选择外科治疗,结核、局限炎症、肠套叠等首选保守治疗,常规CT检查发现肠管异常扩张应扩大扫描范围,往往能发现引起肠梗阻的病因（本组因此偶然发现肠肿瘤3例）。结论：肠梗阻或疑有肠梗阻的病人在平片、B超诊断信息不足时尽早CT检查对于明确病因,治疗选择及改善预后有较大意义。     

64层螺旋CT、超声及X线诊断肠梗阻的临床对比分析

目的：探讨64层螺旋CT、B超、腹部x线平片诊断肠梗阻的临床价值。方法：选择2009年10月～2010年10月我院经手术证实为肠梗阻的218例患者为研究对象。其中64层螺旋CT检查135例;B超检查167例;腹部x线平片196例。比较三种方法术前诊断正确性。结果：64层螺旋CT、B超、腹部x线平片对肠梗阻诊断的准确率分别为94．1％、86．8％、72．4％;对肠梗阻部位诊断的准确率分别为80．7％、63．4％和53．5％;对梗阻原因的诊断准确率分别为82．9％、59．2％、34．1％;对绞窄诊断的准确率分别为76．7％、58．1％和27．9％;64层螺旋CT对肠梗阻、梗阻部位和梗阻原因的诊断与B超、x线片相比具有显著性差异（P〈0．01）;B超与x线片相比也具有具有显著性差异（P〈0．01）。结论：64层螺旋CT对肠梗阻诊断具有较高的敏感性,明显优于B超及腹部x线平片检查,对临床及时制定治疗方案有极大的帮助。     

儿童小肠机械性梗阻的CT诊断

目的 探讨CT检查对儿童小肠机械性梗阻的诊断价值。方法 分析31例手术确诊为小肠机械性梗阻患者的腹部X线平片与CT表现。年龄9个月至14岁,男17例,女14例。急性小肠梗阻29例,慢性小肠梗阻2例。其中7例有腹部手术史。结果 腹部X线平片与CT准确显示梗阻程度分别为19例和29例。CT准确显示梗阻病因18例,包括小肠石4例,肠套叠5例,腹腔局部感染渗出粘连6例,腔内型肠重复畸形1例,先天性脐疝1例,先天性肠旋转不良1例。本组7例有腹部手术史者全部为粘连性梗阻,结合手术史,CT准确判断病因25例。腹部X线平片与CT假阴性诊断分别为4例和2例。结论 CT对发现肠绞窄和肠壁积气的敏感性较腹平片高。CT显示狭窄移行段的形态有助于判断病因,对梗阻病因的判断CT明显优于腹部X线平片。可为临床确定治疗方案提供比较可靠的依据。     

婴幼儿肠梗阻X线表现回顾

目的：为了增强对肠梗阻X线诊断价值的认识，以达到早期诊断、及时治疗，本文回顾分析了经CT检查(4例)和经手术证实的肠梗阻患者的常规X线表现。方法：用4例婴幼儿肠梗阻CT表现与常规X线表现进行对比分析。结果：CT检查准确显示出了梗阻的病因(小肠结石、畅套叠、绞窄性小肠梗阻和炎症性小肠梗阻)。结论：CT对发现肠绞窄和肠壁积气的敏感性较腹平片高；CT对梗阻的定位和抉窄肠段的形态表现也优于X线检查，所以为及时确定临床治疗方案提供了可靠的依据。     

绞窄性肠梗阻的多层螺旋CT征象

目的绞窄性肠梗阻为急腹症之一,病死率高,本研究旨在探讨绞窄性肠梗阻的多层螺旋CT表现,提高术前CT诊断正确率。资料与方法经手术证实为绞窄性肠梗阻的43例患者(研究组),同期搜集97例单纯性肠梗阻作为对照组,比较两组的CT征象,分析CT征象诊断绞窄性肠梗阻的敏感度、特异度、阳性预测值和阴性预测值。结果 43例绞窄性肠梗阻中,肠扭转14例,腹内疝8例,闭孔疝4例,股疝17例。研究组CT表现为"鸟嘴征"43例,肠壁气泡4例,肠壁密度增高4例,肠壁强化减弱5例,"X征"8例,扩张肠袢壁增厚11例,肠壁内缘模糊5例,附属系膜血管扩张16例,闭袢16例,"漩涡征"13例,以上CT征象与对照组比较,差异均有统计学意义(P<0.05、P<0.001)。诊断绞窄性肠梗阻敏感度最高的CT征象为"鸟嘴征"(100.0%),特异度最高的CT征象为肠壁气泡、肠壁密度增高、肠壁强化减弱、"X征",均为100.0%。结论 "鸟嘴征"是诊断绞窄性肠梗阻最敏感的CT征象,肠壁气泡、肠壁密度增高、肠壁强化减弱、"X征"为绞窄性肠梗阻最特异的CT征象,扩张肠袢壁增厚、肠壁内缘模糊、附属系膜血管扩张、"漩涡征"、闭袢为绞窄性肠梗阻常见的CT征象。     

螺旋CT检查在绞窄性小肠梗阻诊断中的作用

目的：探讨CT检查在诊断绞窄性肠梗阻中的价值。方法：对CT诊断并经手术证实的32例绞窄性肠梗阻患者的病例资料进行回顾性分析。所有患者均行CT平扫及三期增强扫描。分析内容包括肠系膜血管改变、肠壁强化程度及腹水情况等,并与手术结果进行对比分析。结果：32例绞窄性肠梗阻主要征象有病变段肠管无强化和强化减弱（23/32,72%）,腹腔积液（21/32,66%）,系膜血管改变和网膜浑浊、密度增高（18/32,56%）。结论：肠壁强化程度减退、漩涡征、肠腔积血及腹腔积血是绞窄性肠梗阻比较可靠的征象。螺旋CT检查是诊断有无绞窄性肠梗阻的首选检查方法。     

绞窄性肠梗阻的螺旋CT增强扫描征象分析

目的:分析螺旋CT增强扫描图像上绞窄性肠梗阻的征象,提高对绞窄性肠梗阻术前诊断的准确性.方法:64例手术证实的绞窄性肠梗阻病例纳入研究,男43例,女21例,年龄23～72岁,平均42岁.采用单排螺旋CT进行全腹部扫描,对比剂以2～3ml/s速度注射,注射后60s扫描,层厚10mm.参照术中所见,回顾性分析上述CT资料,包括:①间接征象:肠腔扩张积液,肠壁增厚及肠壁密度改变(靶征),肠系膜脂肪水肿及渗出(缆绳征),肠系膜血管增粗并肠系膜扭曲(漩涡征),肠壁间、肠系膜间及门静脉积气,腹水;②直接征象:肠系膜上动脉或上静脉充盈缺损.结果:正确诊断54例,正确率82.8％.CT显示肠腔扩张积液47例(73％),其中6例积液呈高密度提示肠腔内积血(9.3％);肠壁水肿增厚19例(29.6％),其中11例增强后肠壁密度不匀,呈“靶征”(17％),8例肌壁未见强化(12.5％);肠系膜脂肪水肿及渗出(缆绳征)43例(67％),肠系膜血管增粗并肠系膜扭曲呈“漩涡”状9例(14％),肠壁间积气、肠系膜积气各1例,门静脉积气2例,腹水31例(48.4％).肠系膜上动脉或上静脉充盈缺损3例.结论:绞窄性肠梗阻CT表现有一定特征,可做出提示性诊断.     

老年绞窄性肠梗阻的影像学诊断

目的:分析老年绞窄性肠梗阻的影像学特征,探讨老年绞窄性肠梗阻的影像学诊断.材料和方法:对照分析本院近年来经临床、手术病理证实的16例老年绞窄性肠梗阻患者的X线、CT、DSA的影像资料和病理结果.结果:16例老年绞窄性肠梗阻中,血运性肠梗阻8例,肠粘连3例、肠套叠2例、嵌顿疝2例、阑尾包块1例.16例X线立、卧位摄片,均见腹部肠腔扩张,积气、积液,CT有12例见节段性肠壁增厚、黏膜下水肿呈"靶征",7例见大量腹水.5例行肠系膜动脉CTA多平面重建(MPR)见局部肠系膜动脉分支狭窄变细.2例行DSA见肠系膜上、下动脉纤细、远端分支显示不清.结论:老年性肠梗阻X线见局限性肠壁增厚,CT见肠壁黏膜下水肿呈"靶征"应考虑绞窄性肠梗阻可能,CTA见局部肠系膜动脉分支狭窄变细或闭塞,有助于绞窄性肠梗阻的诊断.     

小肠机械性梗阻的CT诊断

目的 :探讨 CT对小肠机械梗阻的诊断价值。方法 :对 2 1例手术和临床证实的小肠机械性肠梗阻病人的 CT表现进行了分析。全部病人为腹平片和临床检查确诊为小肠机械梗阻病人。男 14例 ,女 7例 ,平均年龄 44 .8岁。结果 :完全性小肠梗阻 13例 ,绞窄性小肠梗阻 5例 ,不完全性小肠梗阻 3例。 1/ 3病例术前 CT显示梗阻病因 ,包括腹腔肿块 ,炎性狭窄。 5例中 4例 (80 % ) CT征象提示肠绞窄存在 ,早于腹平片。肠壁郁血增厚大于 3 mm,肠腔大量积液 ,气液平面中液多于气 ,腹腔广泛性液体渗出伴肠系膜水肿则提示绞窄性肠梗阻。结论 :在明确梗阻病因上 CT较腹平片有明显优势。显示典型绞窄性梗阻征象的敏感性与特异性较腹平片高 ,但无典型征象并不能排除绞窄性肠梗阻存在     

Vascular complications in intestinal obstructions. The role of computed tomography

INTRODUCTION: We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction. SUBJECTS AND METHODS: 32 patients with small bowel obstruction, subdivided in two groups, were examined with CT. The first group consisted of 12 patients with small bowel obstruction complicated by ischemic injury. It was due to loop strangulation in 10 cases and loop distension secondary to colon carcinoma in 2 cases. At surgery the loop strangulation was caused by adhesions in 9 cases and by jejunal hernia in 1 case. Vascular complications were segmentary small bowel infarction in 7 cases, colonic infarction in 2 cases and ischemia, which was resolved after loop debridement, in 3 cases. The second group consisted of 20 patients with intestinal occlusion due to adhesions complicated by a closed loop in 4 cases. All patients were examined with(out) i.v. contrast agent administration. Filling of the intestinal loops by oral contrast agent was never performed. RESULTS: CT identified the vascular injury secondary to intestinal obstruction in 11/12 patients (91%). In one case it was not possible to diagnose mild ischemia, which was found of surgery. CT findings were: loops distention in all the cases; wall thickening in 11 cases with intramural gas in 8 cases and slight contrast enhancement in 1 case; ascites in 2 cases; mesenteric edema in 9 cases; gas at the mesenteric root in 1 case. In the control group, small bowel obstruction was diagnosed with CT in all cases based on the presence of distended loops up to the occlusion site. Parietal alterations above the lesion were never found. CONCLUSION: CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.     

Closed loop intestinal obstruction: role of computerized tomography]

PURPOSE: The obstruction of a bowel segment at both ends results in a closed loop obstruction. Progression to strangulation frequently occurs if surgical intervention is delayed. The role of plain radiography in the diagnosis of closed loop obstruction and strangulation has been shown to be limited, while the recent literature has demonstrated the growing role of computed tomography (CT). This paper reports our experience in the study of closed loop obstruction by CT. MATERIAL AND METHODS: The CT studies of 12 patients with surgically confirmed closed loop obstruction were retrospectively reviewed. The following CT signs were used for the diagnosis: a) fluid-filled distended loops, b) C-shaped incarcerated loop, c) radial distribution of several dilated bowel loops and mesenteric vessels converging toward the point of obstruction, d) triangular or fusiform tapering of the closed loop and/or whirl sign in the site of obstruction. RESULTS: On the basis of these signs, the diagnosis was made in 11 of 12 patients. Only 1 patient, who had a negative CT study, was positive at a subsequent enteroclysis. CT findings of strangulation were associated in 3 cases: slight wall thickening with vascular congestion and mesenteric ascites, confirmed at surgery. DISCUSSION AND CONCLUSIONS: Small bowel obstruction can be distinguished into simple and closed loop obstructions. The latter is a more severe condition which is often complicated by strangulation with vascular impairment, edema and intramural and mesenteric hemorrhage. Consequent arterial insufficiency rapidly leads to ischemia, infarction and necrosis. The radiologist plays a role in the early recognition of the closed loop obstruction and of any sign of strangulation. The role of CT in the diagnosis and workup of patients with suspected intestinal occlusion has been analyzed in the literature with reported 63% sensitivity, 78% specificity and 66% accuracy. CT is also capable of revealing the causes of occlusion in 73-95% of cases. The above CT signs, as confirmed in our experience, allow to identify closed loop obstruction and also small bowel strangulation, thus supplying a valuable contribution to diagnosis and accurate preoperative evaluation. We conclude that CT can accurately demonstrate the presence of closed loop obstruction and can be the technique of choice in patients in whom obstruction is associated with clinical signs suggestive of strangulation.     

CT findings of small bowel strangulation: the importance of contrast enhancement

The purpose of this study is to illustrate computed tomography (CT) findings suggestive of small bowel strangulation. We have performed the precontrast and postcontrast CT with single and multidetector CT scanners and evaluated the bowel wall changes and mesentery changes and correlated them with the operative findings. The direct CT findings suggestive of small bowel strangulation included high-density bowel wall on precontrast scans; lack of, or diminished contrast enhancement of the involved bowel wall; localized mesenteric fluid accumulation (mesenteric congestion); and localized pneumatosis. The indirect CT signs included C- or U-shaped loops with mesenteric vessels converging toward the obstruction site, ascites, target sign, two adjacent collapsed round loops, and whirl sign. We particularly emphasize the importance of contrast enhancement of bowel mucosa for early diagnosis to differentiate strangulation from a mechanical obstruction without bowel ischemia, and also the importance to differentiate proximal secondary gas-filled dilated small bowel loops from distal primary involved fluid-filled small bowel loops because these two types of small bowel loops are present in the single peritoneal cavity. As early recognition of small bowel strangulation may help improve the patient outcome because the involved bowel loops can be preserved without resection, it is essential to become familiar with the CT signs suggested small bowel obstruction strangulation.     

Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction.

BACKGROUND: There are limited studies in the literature comparing plain radiography, US and CT in the evaluation of intestinal obstruction. We carried out this prospective study to compare the relative efficacies of these three imaging techniques in patients with intestinal obstruction. MATERIAL AND METHODS: Thirty-two patients presenting with clinical suspicion of intestinal obstruction were subjected to plain radiography, US and CT and the findings were compared with reference to the presence or absence of obstruction, the level of obstruction and the cause of obstruction. The final diagnosis was obtained by surgery (n=25), or by contrast studies and/or clinical follow-up in those who were treated conservatively (n=7). RESULTS: Out of 32 patients, 30 had mechanical intestinal obstruction (22 had small bowel obstruction and 8 had large bowel obstruction). Of the remaining 2 patients, 1 had adynamic ileus and the other had a mesenteric cyst. CT had high sensitivity (93%), specificity (100%) and accuracy (94%) in diagnosing the presence of obstruction. The comparable sensitivity, specificity and accuracy were, respectively. 83%, 100% and 84% for US and 77%, 50% and 75% for plain radiography. The level of obstruction was correctly predicted in 93% on CT, in 70% on US and in 60% on plain films. CT was superior (87%) to both US (23%) and plain radiography (7%) in determining the aetiology of obstruction. CONCLUSION: CT is a highly accurate method in the evaluation of intestinal obstruction especially for determining the level and cause of obstruction and should be the technique of choice when clinical or plain radiographic findings are equivocal.     

Small bowell volvulus - combined radiological findings]

PURPOSE: We retrospectively evaluated the radiological findings observed at plain abdominal film, abdominal sonography and abdominal CT performed in 66 patients with surgically proven small bowel volvulus. MATERIAL AND METHODS: Sixty-six patients (35 women and 31 men, ranging in age 38-77 years) with surgically proven small bowel volvulus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain film was performed in the upright position (postero-anterior view) in 46 cases, and in the supine position in 20 cases. On plain abdominal film we evaluated the following findings: bowel loops dilatation, air-fluid levels and site of obstruction. At abdominal US, performed with 3.5 e 7.5 MHz probes, we retrospectively searched for: bowel loop dilatation, bowel wall thickening, peristalsis alteration, extraluminal fluid. CT was performed with a helical unit (thickness 4 mm, reconstruction interval 4 mm, 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 CT findings were searched for: whirl sign, beak sign, extraluminal fluid, bowel loop dilatation, bowel wall thickening, bowel wall or mesenteric alterations. RESULTS: Plain abdominal film showed the following findings: air-fluid levels (92.4% of cases), bowel loops dilatation (71.2%), site of obstruction (42.4%). Abdominal sonography demonstrated bowel loop dilatation (48.5%), extraluminal fluid (48.5%), peristalsis alteration (27.3%), bowel wall thickening (27.3%). The most frequent CT findings were: bowel loop dilatation (95.5%), bowel wall thickening (78.8%), beak sign (69.7%), mesenteric alterations (66.7%), extraluminal fluid (54.5%), whirl sign (13.6%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the most frequent radiological findings in our series. Plain abdominal film allowed us to identify signs of obstruction, whereas signs of bowel wall necrosis were accurately shown by abdominal CT.     

Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction

OBJECTIVE: The purpose of our study was to determine prospectively the value of helical CT and of various signs of ischemia in the context of acute bowel obstruction. SUBJECTS AND METHODS: All patients seen over a 3-year period with a CT diagnosis of small-bowel obstruction were included. There were 144 examinations in 142 patients. Images were interpreted prospectively with consensus by a fellow and an experienced gastrointestinal radiologist. Attention was focused on the presence of the following signs of strangulation and ischemia: reduced enhancement of the small-bowel wall, mural thickening, mesenteric fluid, congestion of small mesenteric veins, and ascites. A diagnosis of ischemia was made if enhancement of the bowel wall was reduced or if at least two of the other signs were found. Results were correlated with surgical findings in 73 cases and clinical follow-up in 71 cases. RESULTS: A diagnosis of ischemia was made at surgery in 24 patients. CT diagnosis was correct in 23 patients (96% sensitivity). There were nine false-positive diagnoses (93% specificity). The negative predictive value of CT was 99%. Reduced enhancement of the bowel wall had a sensitivity of 48% and specificity of 100%, mural thickening had a sensitivity of 38% and specificity of 78%, mesenteric fluid had a sensitivity of 88% and specificity of 90%, congestion of mesenteric veins had a sensitivity of 58% and specificity of 79%, and ascites had a sensitivity of 75% and specificity of 76%. CONCLUSION: Helical CT is a highly sensitive method to diagnose or rule out intestinal ischemia in the context of acute small-bowel obstruction.