多层螺旋CT对肠扭转的诊断价值

目的探讨多层螺旋CT(MSCT)对肠扭转的诊断价值。方法收集急腹症MSCT双期增强扫描病例80例,其中10例患者图像经多平面重组(MPR)及肠系膜血管最大密度投影(MIP)处理,诊断为肠扭转。结果MSCT诊断10例肠扭转,主要征象有肠系膜血管“漩涡征”10例,肠管“漩涡征”5例,靶环征或双晕征5例,肠系膜上动脉、静脉(SMA、SMV)换位征3例,鸟喙征4例,SMV血栓形成2例,腹水征10例。诊断均经手术证实。结论MSCT双期增强扫描及多平面重组(MPR)与肠系膜血管最大密度投影(MIP)对肠扭转的诊断有重要价值。     

16层螺旋CT肠系膜上动、静脉成像诊断小肠扭转的前瞻性研究

目的前瞻性研究肠系膜上动、静脉CT血管造影（CTA）对小肠扭转（SBV）的诊断价值。资料与方法使用16层螺旋CT对16例经临床及CT平扫拟诊SBV的患者行肠系膜上动、静脉CTA检查。肠系膜上动、静脉采用最大密度投影（MIP）及容积再现（VR）重组。以手术或随访作为参考标准,分析CTA对SBV的诊断价值。结果16例中,有2例表现为肠系膜上静脉主干远段的反折,其中1例见肠系膜上动脉分支的反折;3例表现为肠系膜上静脉不同属支的反折,其中1例见肠系膜上静脉主干的轴向扭曲;走行异常的血管均与扩张小肠袢位置相吻合。10例CTA诊断为非SBV。5例SBV均经手术证实,CTA诊断的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为100％（5／5）、90．9％（10／11）、83、3％（5／6）、100％（10／10）、93．8％（15／16）。结论肠系膜上动、静脉CTA是诊断SBV的有价值的检查技术,肠系膜上静脉或其属支的反折为SBV主要的CTA表现。     

16层螺旋CT肠系膜上动静脉成像诊断小肠扭转的初步研究

目的探讨小肠扭转时肠系膜上动、静脉的CTA表现及其诊断价值。方法回顾性分析经手术证实的5例小肠扭转病人的肠系膜上动、静脉CTA表现。使用Siemens 16层螺旋CT,于工作站重建肠系膜上动、静脉最大密度投影(MIP)及容积再现(VR)图像。分析肠系膜上动、静脉CTA对于小肠扭转的诊断价值。结果5例病人均清晰显示肠系膜上动脉主干,但远级分支模糊。2例表现为肠系膜上静脉主干远段的扭曲,3例表现为肠系膜上静脉不同属支的扭曲及走行异常,走行异常的血管均与扩张小肠袢位置相吻合。1例见肠系膜上静脉主干的轴向扭曲。2例显示走行异常的肠系膜上静脉属支增粗。5例病人均正确诊断小肠扭转。结论肠系膜上静脉或其属支的扭曲为小肠扭转主要的CTA表现,行肠系膜上动静脉CTA对小肠扭转具有确诊价值。     

肠旋转不良伴中肠扭转的CT诊断

目的：研究CT对肠旋转不良伴中肠扭转（volvuhus in intestinal malrotation,VIM)的诊断价值。方法：回顾性分析6例手术证实的VDIM的CT表现。男5例,女1例,年龄7～25岁,平均13岁。结果：6例均表现为肠系膜根部类团块影,其中4例见典型“漩涡征”,2例呈类“靶征”,但增强扫描亦出现“漩涡征”。毗邻部肠袢扩张,肠系膜静脉不同程度淤积扩张,2例伴受累系膜、肠壁重度水肿。6例均见系膜根部肠系膜上动脉（superior mesenteric artery,SMA）、肠系膜上静脉（superior mesenteric vein,SMV)血管正常排列迷失。结论：“漩涡征”伴系膜根部SMA、SMV正常排列迷失为本病的特征性CT表现。     

64层螺旋CT在腹内疝中的诊断价值

目的探讨腹内疝的多层螺旋CT(MSCT)表现及其临床诊断价值。方法对24例经手术证实的腹内疝病例的CT资料进行回顾性分析。结果 24例腹内疝均表现为肠梗阻。22例显示疝口,并见"肠管异位聚集征"、"囊袋征"和肠系膜血管走行异常,20例见"鸟嘴征",15例见"靶征"。伴发肠扭转14例,显示肠管和肠系膜血管的"漩涡征",14例均出现"绞窄征",表现为肠壁增厚、血性腹水。结论多层螺旋CT结合多平面重建对腹内疝具有重要的诊断价值,及时准确诊断对患者的预后具有重要的作用。     

多层螺旋CT肠系膜血管成像的临床应用

目的:探讨多层螺旋CT肠系膜血管成像(MMSCTA)的临床应用价值。方法:对32例经证实的肠系膜血管病变患者进行多层螺旋CT(MSCT)检查,采用多种后处理技术(VR、MIP、MPR、CPR)进行肠系膜血管成像,观察肠系膜血管病变的情况。结果:32例患者中,肠系膜上动脉(SMA)栓塞2例,MMSCTA及DSA示SMA充盈缺损;SMA血栓形成1例,MMSCTA及DSA示SMA主干呈长条状充盈缺损;肠系膜上静脉(SMV)栓塞9例,MMSCTA示SMV充盈缺损7例,2例不显影;胰腺癌侵犯SMA、SMV者13例,MMSCTA示肠系膜血管被包埋,血管狭窄中断;SMA主干或分支狭窄伴软斑形成7例。结论:多层螺旋CT肠系膜血管成像是肠系膜血管病变的一种无创性有价值的检查方法。     

成人肠扭转MSCT的诊断价值

目的 探讨成人肠扭转多层螺旋CT(MSCT)征象.方法 回顾性分析72例经手术病理确诊为成人肠扭转患者的16层MSCT腹部检查影像资料.结果 有血管的漩涡征70例、肠管的漩涡征58例、靶环征35例、鸟喙征37例.结论 MSCT检查对成人肠扭转的诊断、治疗具有重要指导作用,肠系膜血管的“漩涡征”是诊断肠扭转的特异性征象.     

16层螺旋CT诊断缺血性结肠炎的临床价值

目的 评价16层螺旋CT在诊断缺血性结肠炎及判断缺血病因中的价值.方法 回顾性分析26例确诊为缺血性结肠炎患者的CT资料及临床资料.采用16层螺旋CT扫描,2例急诊CT平扫,24例均行平扫加双期增强扫描,获得图像采用多种后处理技术,15例行CT血管成像(CT angiography,CTA).结果 23例肠壁增厚,其中可逆性缺血20例,不可逆缺血3例.3例肠壁变薄者为不可逆缺血.21例肠壁密度减低,5例肠壁密度增高.增强扫描,可逆性缺血中有7例肠壁强化增加,不可逆性缺血中4例肠壁强化减弱或不强化,2例非阻塞性肠缺血表现为部分强化.6例肠壁积气和4例肠管扩张均见于不可逆性肠缺血;门静脉积气2例,7例出现肠梗阻;SMA/IMA主干和/或分支硬化性狭窄7例,其中4例出现肠系膜小血管广泛钙化;缆绳征21例;漩涡征3例.肠系膜静脉栓塞4例;5例为肠系膜动脉血栓形成,23例患者找到结肠肠缺血之病因.结论 16层螺旋CT在诊断缺血性结肠炎及判断缺血病因上具有重要价值.     

肠扭转的CT诊断(附16例分析)

目的:探讨肠扭转CT平扫的影像学特征.方法:对16例经手术证实的肠扭转患者的CT平扫检查及其影像学表现进行了分析.结果:肠扭转CT平扫的主要征象为:①直接征象:肠袢呈C形15例,肠系膜血管扭曲征16例,远端肠管呈鸟嘴征13例,漩涡征6例;②间接征象:扭转肠袢内积液、积气者14例(其中单纯肠管内积液者6例),近端肠管见液平面者12例,腹膜腔内积液者3例.结论:CT平扫对肠扭转的早期诊断及指导临床治疗有重要价值.     

CT血管造影在消化道疾病诊断中的应用

目的 探讨多层螺旋CT血管造影在消化道疾病诊断中的应用. 资料与方法 对27例经临床或病理证实的消化道疾病患者的中小血管CTA表现进行分析. 结果 5例小肠缺血中3例CTA表现为肠系膜上动脉闭塞,2例表现为肠系膜上动脉狭窄.7例小肠Crohn病CTA均表现为肠管的动脉远端分支迂曲扩张,6例出现"梳样征";肠系膜上动脉压迫综合症CTA表现为肠系膜上动脉与腹主动脉的夹角变小;11例消化道肿瘤的CTA可显示肿瘤的供血动脉及肿瘤与血管的关系. 结论 CT血管造影能直观显示消化道疾病患者的血管情况.     

Multiphasic MDCT in small bowel volvulus

Objective

Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV).

Methods

Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV.

Results

On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case.CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case.Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV.

Conclusion

Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.     

MSCTA对急性肠系膜上动静脉栓塞的诊断价值

目的:探讨MSCTA对急性肠系膜上动静脉栓塞的诊断价值。方法:回顾性分析13例经临床证实的肠系膜血管栓塞患者的急诊CT平扫、CTA及三维重建资料。结果:13例中肠系膜上动脉栓塞(superior mesenteric artery embolism,SMAE)7例、肠系膜上静脉栓塞(superior mesenteric vein embolism,SMVE)6例。直接征象:7例SMAE中,平扫见血栓密度影2例,CTA均见充盈缺损;6例SMVE中,平扫见血栓密度影4例,CTA均见充盈缺损。间接征象:13例中肠梗阻5例,腹水6例。SMAE:血管壁钙化5例,薄纸样肠壁改变2例,肠壁水肿增厚强化减弱3例;SMVE:增强扫描管壁环形强化、管径扩张5例,缆绳征4例;受累肠管、肠系膜广泛水肿增厚,增强扫描可呈明显减弱或未强化特点,肝脏门脉期强化减弱不均匀2例;合并门静脉、脾静脉血栓2例。结论:CTA对肠系膜上动静脉栓塞的诊断敏感性较CT平扫高,对于CT平扫阴性的患者行CTA检查很有价值。     

肠系膜静脉结扎致急性肠缺血的多层螺旋CT研究

目的 探讨MSCT显示肠系膜静脉结扎致急性肠缺血的早期征象及其动态演化规律.方法 12只巴马猪,采用数字表法随机分成3个实验组(术后6、12、18 h组)和1个对照组,每组3只.实验组9只猪剖腹结扎肠系膜上静脉(SMV)主干远端空肠、回肠和回结肠支,分别于术前及术后6、12和18 h采用MSCT行平扫和增强后动脉、静脉和延迟期扫描.对照组3只猪仅剖腹分离暴露SMV,并于上述时间点进行扫描,比较手术前后肠系膜血管、肠道、腹腔形态的动态变化,结果与病理对照.结果 9只实验组猪均显示急性肠缺血病理改变,随时间延长,缺血进行性加重.CTA可准确显示SMV主干、大属支及其远端小分支直至肠壁边缘的直小静脉,显示SMV分支各结扎点.静脉堵塞性肠缺血的早期CTA改变为肠系膜上动脉痉挛、充盈欠佳、显影延迟和延长;SMV显影淡、延迟;肠壁增厚,系膜水肿,腹水,肠壁强化高于正常;随时间推移,出现肠壁变薄,肠腔扩张、积液,系膜水肿,腹水加重,肠壁强化减弱.结论 CTA能清晰显示肠系膜血管解剖、堵塞的静脉、早期肠缺血改变及其动态演化规律,于病变早期可靠地诊断静脉堵塞性肠缺血.     

粘连性腹内疝及其合并肠缺血坏死的MSCT诊断

目的 探讨粘连性腹内疝及合并绞窄性肠坏死的MSCT特征.方法 回顾性分析21例经手术证实的粘连性腹内疝的CT资料,CT原始数据经多平面重建(MPR)及CT血管造影(CTA),以显示疝环、疝入肠系膜、疝内肠管的特征.结果 19例粘连性腹内疝均显示疝环,小肠扩张积液、聚集并移位,其中17例显示疝环处肠管狭窄与扩张肠管移行;17例显示疝入肠系膜水肿、增厚,肠系膜血管纠集、充血,其中11例显示疝环处肠管及其系膜扭转;15例显示腹水.根据疝入肠管影像表现将粘连性腹内疝分型:Ⅰ型为肠管扩张伴肠壁增厚(7例);Ⅱ型为肠管扩张不伴肠壁增厚(9例);Ⅲ型为肠管不扩张但肠壁增厚(5例).3型腹内疝肠管壁平扫CT值、动脉及门脉期肠壁强化值差异有统计学意义(P<0.05),Ⅰ和Ⅲ型小于Ⅱ型,Ⅰ、Ⅲ型之间的差异无统计学意义(P>0.05).8例粘连性腹内疝合并绞窄性肠坏死(5例为Ⅰ型,3例为Ⅲ型),CT显示肠扭转伴疝入小肠壁显著水肿增厚,肠壁模糊呈持续性低强化,其中4例显示肠系膜上静脉血栓栓塞,3例显示肠系膜上动脉主干或分支闭塞,8例均显示大量腹水.结论 粘连带形成的疝环,狭窄与扩张肠管移行以及小肠扩张、聚集并移位提示粘连性腹内疝的存在;疝入肠系膜水肿,血管纠集,充血,肠系膜血管闭塞,肠管壁显著水肿增厚并持续低强化,则是绞窄性肠坏死的影像特征.     

肠系膜上动、静脉病变64层螺旋CT血管成像探讨

目的探讨64层螺旋CT血管成像在肠系膜上动、静脉病变的诊断和临床应用价值。资料与方法回顾性分析经CT增强血管造影诊断肠系膜上动、静脉病变45例。采用Philips 64层螺旋CT容积扫描,增强扫描于注射对比剂后延迟25~30 s扫描动脉期、65~75 s扫描门静脉期。在工作站采用多平面重组(multi-planar reformat-ting,MPR)、最大密度投影(maximum intensity projection,MIP)及容积再现(volumetric rendering,VR)重组肠系膜上动、静脉图像,分析肠系膜上动、静脉血管成像对肠系膜血管病变的诊断价值。结果 45例患者均清晰显示肠系膜上动、静脉主干及其分支,共发现肠系膜上动、静脉病变49处,其中累及肠系膜上动脉23处,肠系膜上静脉13处,肠系膜上动、静脉同时累及13处。结论 64层螺旋CT血管成像能清楚显示肠系膜上动、静脉解剖结构,对肠系膜动、静脉病变有确诊价值,为临床诊断和治疗节省宝贵时间。     

A simultaneous superior mesenteric arterial and venous thrombosis in an elderly woman with a previous COVID-19 pneumonia: A suggestive case report diagnosed at computed tomography angiography

Superior mesenteric artery (SMA) and superior mesenteric vein (SMV) thrombotic occlusion is a rare but potentially fatal condition. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is very rare. We report the case of an 88-years-old woman with a combined superior mesenteric arterial and venous thrombotic occlusion with a previous COVID-19 pneumonia of about 15 days before, diagnosed at computed tomography angiography (CTA) scan. CTA had an important key-role for the diagnosis and evaluation of the severity of the mesenteric venous and arterious thrombosis.     

128层螺旋CTA对自发性孤立性肠系膜上动脉夹层的诊断

目的探讨64排128层螺旋CTA对自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesen-terric artery disection,SISMAD)的显示方法及诊断价值。方法回顾性分析64排128层螺旋CTA诊断SISMAD的患者资料8例,总结及优化扫描方案,采用多种后处理方法显示。结果共诊断SISMAD 8例,SISMAD起止的长度在10～75 mm之间;夹层发生的部位7例靠近于肠系膜上动脉(SMA)近段,其中3例发生于SMA近心端距SMA开口处约10～30 mm;1例起于发出胰十二指肠下动脉后。发现3处及以上破口的SISMAD 5例,发现2处破口1例,发现1处破口2例。部分假腔内可见血栓形成。结论 SISMAD涉及的多种病理改变64排128层螺旋CTA均可清楚显示,可作为诊断SISMAD的首选影像学检查手段。     

Anticlockwise swirl of mesenteric vessels: A normal CT appearance,retrospective analysis of 200 pediatric patients

Objective

The counterclockwise rotation of the SMV on SMA is a normal and non-specific finding, which results in an incomplete swirl formation on CT scans. However, it has a potential to be misinterpreted as ‘midgut volvulus’ resulting in serious clinical implications. The study was done to determine the frequency and degree of counterclockwise rotation of the SMV on SMA on CT in normal otherwise asymptomatic pediatric patients undergoing CT scan.

Methods

In this IRB approved study, we retrospectively analyzed abdominal CT scan examinations of 200 consecutive pediatric patients (age range of 11 days to 18 years), which were performed for different clinical indications over a period of 10 months. They were evaluated for the absence or presence and degree of counterclockwise rotation of the mesenteric vessels.

Results

Of the 200 patients, 128 (64%) patients showed no clockwise or anticlockwise rotation of mesenteric vessels. Counterclockwise rotation of SMV on SMA was seen in 72 (36%) patients. Further, the degree of rotation of vessels was also calculated, based on the criteria proposed by the authors.

Conclusions

The counterclockwise rotation of SMV on SMA gives an appearance of mesenteric whirlpool in otherwise normal mesenteric vessels and can be misinterpreted as midgut volvulus. It is a normal CT appearance and is due to a variation in branching pattern of mesenteric vessels. Awareness of this normal branching pattern of mesenteric vessels is important to avoid an inadvertent laparotomy.