多排螺旋CT在小肠梗阻诊断中的价值

小肠梗阻是最常见的急腹症之一,早期准确的诊断梗阻部位和病因可减少并发症和病死率.但是由于小肠走行迂曲,发生在小肠的梗阻定位、定性较为困难.近年来,随着多排螺旋CT(MSCT)和相关后处理技术的普及运用,其在小肠梗阻部位、病因、性质及梗阻程度的诊断中,发挥越来越重要的作用[1～3].本文回顾性分析经手术证实的小肠梗阻的CT表现,旨在探讨MSCT检查对小肠梗阻部位、病因、性质、程度的诊断价值,为临床及时选择合理的治疗方案提供影像学依据.     

多排螺旋CT横轴位结合MPR技术在老年肠梗阻诊断中的应用价值

目的 探讨多层螺旋CT(MSCT)横轴位结合多平面重建(MPR)技术在老年肠梗阻诊断中的应用价值.方法 45例老年肠梗阻患者,均施行CT横轴位扫描和对兴趣区MPR处理,分析MPR前后对肠梗阻部位诊断和病因诊断的准确率.结果 MPR前对梗阻部位的诊断准确率为80.0％(36/45),MPR后为88.9％ (40/45),P＞0.05.MPR前诊断信心(3.06±0.65)分,MPR后为(2.80±0.84)分,P＜0.01.MPR前对梗阻病因诊断准确率为75.6％ (34/45),MPR后为86.7％(39/45),P＜0.05.结论 MSCT横轴位结合MPR技术有助于老年肠梗阻的梗阻部位及梗阻原因的诊断.     

螺旋CT对肠梗阻临床诊断价值分析

目的探讨螺旋CT在肠梗阻临床诊断中的价值。方法选取我院2010年3月至2013年3月收治的62例肠梗阻患者为研究对象,将其行CT检查,并将CT诊断结果与手术结果及临床诊断病因进行比较。结果 CT诊断结肠梗阻22例,小肠低位梗阻33例,腹膜炎半麻痹性肠梗阻1例,高位梗阻6例。CT病因诊断:肿瘤22例,腹部疝3例,肠粘连11例,肠套叠5例,肠系膜血栓1例,炎性病变5例,肠扭转6例,粪便4例,先天性1例,原因不明4例,与临床病因诊断结果相符率为93.55%。结论螺旋CT对肠梗阻具有较高的临床诊断价值,在显示梗阻部位及梗阻原因上有着不可比拟的优势。     

多层螺旋CT对机械性肠梗阻的诊断价值

背景:传统影像学检查如X线透视和腹部平片对机械性肠梗阻的诊断价值有限,近年多层螺旋CT(MSCT)在机械性肠梗阻诊断中的应用日益广泛。目的:探讨MSCT在机械性肠梗阻诊断中的价值。方法:回顾性分析46例经手术和病理检查证实的机械性肠梗阻患者的MSCT资料。15例患者仅行MSCT,31例于MSCT后行多平面重建(MPR)或曲面重建(CPR),其中8例加行表面遮盖(SSD)重建、透明重建(ray sum)、CT仿真结肠镜(CTVC)。分析MSCT诊断机械性肠梗阻的准确率。结果:机械性肠梗阻的病因主要为肿瘤和肠黏连。MSCT的诊断敏感性为97.8%(45/46),定位和定性诊断准确率均为95.7%(44/46)。结论:MSCT轴位图像结合多种重建图像能有效判断机械性肠梗阻的病因,清晰显示梗阻部位和并发症,对临床诊断和治疗具有重要价值。     

多层螺旋CT对老年人小肠梗阻病因的诊断价值

目的 评价多层螺旋CT对老年人小肠梗阻病因的诊断价值. 方法 119例老年小肠梗阻病例进行了螺旋CT平扫,57例平扫加增强扫描,利用工作站获得重建图像,将CT结果与手术病理对照. 结果 多层螺旋CT正确诊断梗阻病因116例,其中良性病变98例(包括胆石性梗阻、腹斜疝、腹内疝、闭孔疝、黏连性肠梗阻、粪便纤维素性梗阻、肠套叠、小肠克罗恩病和局限性急性肠炎等),恶性病变18例(包括术后吻合口复发、原发性小肠恶性肿瘤和结肠回盲部恶性肿瘤等),误诊3例.74例小肠梗阻患者经手术证实.结论 多层螺旋CT是诊断老年人小肠梗阻病因有效且准确的方法.     

MSCT与MRCP对老年人胆道梗阻性疾病的应用价值

目前,胆道梗阻的诊断主要依赖于影像学检查.超声因其简便、快捷,主要用于疾病的筛查;内镜下逆行胰胆管造影术(ERCP),因有创、操作复杂、成功率低,难以广泛开展;多层螺旋CT(MSCT)薄层扫描及多期动态增强结合三维重建技术,可很好地显示胆道梗阻的部位、程度及原因,已广泛应用于胆道梗阻的诊断.磁共振胰胆管造影(MRCP)是一种全新的观察胰胆管系统解剖和病理形态的技术,展示胰胆管形态和组织结构为自然状态的表现,无造影剂压力的影响,图像质量更真实优良,可用于恶性肿瘤、结石、胆管先天性病变,狭窄和急慢性胰腺炎等的诊断.本文回顾性分析老年胆道梗阻病例MSCT与MRCP的影像学表现,探讨其临床应用价值.     

老年肺动脉栓塞多层螺旋CT血管造影的诊断价值

多层螺旋CT(MSCT)的临床应用使得肺动脉栓塞(pulmo-naryembolism,PE)的影像诊断研究进入一个新阶段.快速的容积扫描和较高的空间和时间分辨率,使肺动脉的显示更直观、准确[1].可以清楚显示血栓部位、形态、与血管关系及内腔受损情况,可以鉴别胸肺病变,及评价溶栓和手术效果,所以螺旋CT在老年PE的诊断中非常重要[2].本研究回顾性分析本院39例PE患者的临床资料及MSCT肺血管成像表现,并结合文献探讨MSCT血管成像对PE诊断价值.     

多层螺旋CT在诊断肠梗阻中的临床价值

目的研究多层螺旋CT在诊断肠梗阻中的应用价值,为临床治疗提供依据。方法调取2014年12月-2015年12月,我院收治的100例疑似肠梗阻患者资料,随机分为对照组与观察组,每组50例;观察组采用多层螺旋CT进行诊断,对照组采用常规X线平片进行诊断,结合检查结果对比2组患者的病症状态。结果多层螺旋CT结合三维动态呈现技术,对肠梗阻患者的病症状态,如:发病因素、梗阻位置、病症程度等具有更高的诊断价值。本次多层螺旋CT诊断48例,确诊率96%;常规X线平片诊断32例,确诊率64%;2组诊断结果差异显著(P0.01)。结论多层螺旋CT用于肠梗阻诊断价值更高,临床可为疾病治疗提供指导依据。     

多层螺旋CT与腹部X线在肠梗阻中的诊断价值

目的探讨多层螺旋CT及腹部X线检查在肠梗阻诊断中的价值。方法选取就诊于荆州市第一人民医院普通外科的100例肠梗阻患者,并对所有患者首先行多层螺旋CT检查,然后行腹部X线检查,然后以手术证实为肠梗阻作为金标准,最后比较多层螺旋CT检查与X线在肠梗阻中诊断的符合率及病因分析。结果多层螺旋CT在100例肠梗阻的患者中,诊断符合率为95.0%,X线在100例肠梗阻患者中的诊断符合率为72.0%,差异有统计学意义(P0.05);在病因分析方面,多层螺旋CT较X线在肠梗阻中更能发现肠粘连、肿瘤、炎症感染等病因,差异有统计学意义(P0.05)。结论多层螺旋CT较X线在肠梗阻的诊断中具有更高的诊断准确率及较低的误诊率,因此,对于肠梗阻患者,临床医师可以首选CT检查。     

多层螺旋CT多平面重组(MRP)及容积再现法(VRT)对脊柱爆裂性骨折的应用价值

目的分析探讨多层螺旋CT多平面重组(MRP)及容积再现法(VRT)成像及时的应用对脊柱爆裂性骨折的诊断价值。方法全面分析70例脊柱爆裂性骨折的临床及影像资料,术前行多层螺旋CT容积扫描,将CT原始图像进行多平面重组(MRP)、容积再现法(VRT)成像后处理,分析探讨后处理技术显示骨折情况的能力,并与手术结果对照。结果 MSCT多平面重组(MRP)及容积再现法(VRT)成像技术的联合应用能够准确显示脊柱爆裂性骨折的部位、类型、椎体压缩程度、椎体骨块移位情况、椎管狭窄程度及其三维空间关系。结论 MSCT多平面重组(MRP)及容积再现法(VRT)成像技术的联合应用,可全面、立体、多方位、直观地观察脊柱爆裂性骨折,为临床选择治疗方案、制定手术路经提供可靠依据。     

Comparison among preoperative single-slice CT and multi-slice CT in simple, closed loop and strangulating bowel obstruction

BACKGROUND/AIMS: The aim of this study is to compare preoperative single-slice CT (SSCT) and multislice-CT (MSCT) accuracy in the evaluation of patients with bowel obstruction and intestinal necrosis. METHODOLOGY: 64 patients were enrolled. We analyzed the SSCT scans of 30 patients and the MSCT scans of 34 patients with clinical and abdominal plain film evidence of bowel obstruction. Presence, site, kind, and cause of the obstruction were evaluated; specific signs of strangulating or closed loop obstruction and wall necrosis were also identified. Three radiologists interpreted the CT scans independently; a consensus review was obtained, indicating the need of emergency or delayed surgery. The results were assayed on the basis of surgical findings. RESULTS: SSCT and MSCT findings of bowel obstruction presented good correlation with the surgical report. Sensitivity, specificity, PPV and NPV were 86.1%; 89.3%; 91.1%; and 83.3% respectively. The k coefficient of interobserver agreement was significant (0.729; p<0.01). A major difference was observed between findings in SSCT and MSCT in detecting intestinal ischemia (p <0.05); a noteworthy statistical difference between these techniques was observed especially in the sensitivity and specificity of the edema, twisting and/or thickening of mesenteric vessels (p<0.05). CONCLUSIONS: The first objective of abdominal CT in patients with bowel obstruction is to evaluate the need for emergency surgery because delayed operations potentially result in high mortality. A CT presenting high correlation to surgical findings allows a correct surgical timing and planning thanks to the correct identification of site, kind, and causes of bowel obstruction. MSCT presents better results compared to SSCT in assessing intestinal necrosis.     

Dual-phase contrast-enhancement multislice computed tomography imaging for the assessment of elderly patients with acute myocardial infarction after primary percutaneous coronary intervention

Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography (MSCT) was implicated in porcine model. There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI), especially after primary percutaneous coronary intervention (PCI). In elderly patients with STEMI, the safety issues remain unknown. Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients (≥60 years old) with STEMI within one week after primary PCI. The presence, location and enhancement pattern on MSCT were evaluated. MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase (CK) release. Serum creatinine level was recorded before and after MSCT scan. Results MSCT scans were successfully performed in all the patients. Early myocardial perfusion defect (early defect, ED) was detected in all of the 11 patients (100%) in the early phase of the contrast bolus (subendocardial ED in 10 patients and transmural in 1 patient). Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium (46±17 HU vs 104 ± 17 HU; P < 0.01). Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients (100%). On delayed phase of MSCT scan, different enhancement patterns were observed: isolated subendocardial late enhancement (LE) in 6 patients, subendocardial residual perfusion defect (RD) and subepicardial LE in 1 patient, subendocardial RD in 4 patients. Infarct volume assessed by MSCT correlated well with area under the curve CK release (R=0.72, P < 0.01). Serum creatinine level after MSCT scan showed no difference with that before MSCT scan. Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI. Variable abnormal myocardial enhancement patterns were seen on dual phase MSCT in these patients with STEMI after primary PCI. Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion.     

Superior mesenteric artery syndrome following ileal J-pouch anal anastomosis

This is the first case report of the superior mesenteric artery syndrome developing in a patient following total proctocolectomy and ileal J-pouch anal anastomosis. In addition, this is the first demonstration of this syndrome using abdominal CT scan. A 22-year-old veteran underwent total proctocolectomy for left-sided ulcerative colitis because of failure of medical therapy. At operation an ileal J-pouch anal anastomosis was constructed. Following operation, the patient developed an intestinal obstruction. Abdominal CT scan demonstrated scant retroperitoneal fatty tissue, massive dilatation of the duodenum proximal to the midline, and tapered narrowing of the duodenum between the superior mesenteric artery and aorta. These findings indicated superior mesenteric artery syndrome: arteriomesenteric obstruction of the duodenum. Based on the experience of this case, the authors believe that compression of the duodenum by the superior mesenteric artery may be a common but unsuspected cause of prolonged postoperative ileus or early postoperative obstruction following ileal pouch anal anastomosis.     

MSCT在全面评估克罗恩病中的作用

目的 总结多层螺旋CT（MSCT）在诊断克罗恩病中的应用价值.方法 观察24例经临床、影像和病理3方面综合诊断为克罗恩病患者的MSCT表现,分析其影像学特点.结果 24例患者均表现为多节段肠壁增厚,其中直乙结肠受累2例,系膜缘增厚明显有13节段,肠壁均有不同程度强化.肠壁溃疡4例,瘘管2例,肠内瘘1例,肠梗阻8例,肠旁蜂窝织炎6例,炎性包块或腹腔脓肿6例.肠系膜淋巴结肿大13例,系膜密度增高12例,继发肠间距增宽8例,系膜血管增粗、密集12例,梳子征8例.结论 MSCT对克罗恩病肠壁的病变、肠外并发症及肠系膜、血管、淋巴结异常均有良好显示,并能判断病程,指导临床治疗,不失为一较好的影像检查方法.     

64层CT与血管内超声对冠状动脉粥样斑块的定性和定量评估的对照研究

目的 对照血管内超声（intravascular ultrasound,IVUS）评价64层CT对冠状动脉粥样斑块的定性检测和定量分析。方法 2005年7月至10月连续纳入12例拟行PCI的稳定性心绞痛患者进行研究。所有患者术前接受64层CT的冠状动脉成像,术中行三支冠状动脉（左前降支、回旋支和右冠状动脉）的IVUS检查。结果 共对31支血管（左前降支12支,回旋支10支,右冠状动脉9支）,88个节段进行了64层CT和IVUS的对比检查,其中64层CT可评价节段为68个。在IVUS检测到的51个有斑块节段中,64层CT检测出47个（敏感性92％）,在17个IVUS判断为无斑块的节段中,64层CT判断16个为无斑块（特异性94％）。64层CT测量的斑块面积和IVUS测量的斑块面积相关（r=0．53,P〈0．01）,但是高估了斑块面积[（9．09±3．89）mm。比（6．80±2．81）mm^2,P〈0．01]。64层CT在43个IVUS测定的低回声成分中检出30个为低密度成分,平均CT值67．39HU。结论 冠状动脉无严重钙化时,64层CT可准确检测冠状动脉近中段粥样斑块。64层CT测量的斑块面积虽然和IVUS测量结果相关,但准确测量受限。     

胸部孤立性纤维瘤的MSCT诊断分析

目的探讨胸部孤立性纤维瘤的多排螺旋CT(MSCT)影像表现,以提高对该疾病的认识和诊断。方法回顾性分析31例经手术、病理证实的胸部孤立性纤维瘤患者的MSCT表现及临床资料,4例行肺CT平扫,8例行肺CT一次性增强检查,19例行肺CT平扫+增强检查;结合后处理重建图像分析胸部孤立性纤维瘤的发病部位、形态、大小、密度、边缘、增强特点及与周围组织的关系。结果 31例胸部孤立性纤维瘤患者女性21例,男性10例,位于右侧胸腔16例,左侧胸腔13例,纵膈1例,肺内多发1例。27例病灶边界清晰,呈类圆形或长椭圆形,4例边界不清,呈大片状不规则形软组织密度块影,伴有胸腔积液及邻近肋骨破坏征象;增强扫描2例动脉期未见明显强化,延迟期轻度强化;11例动脉期呈中度不均匀强化,静脉期强化程度减低;14例动脉期轻中度不均匀强化,延迟期强化较动脉期更明显。31例患者良性27例,恶性4例。结论胸部孤立性纤维瘤的MSCT表现有一定的特征,大多呈边界清楚,血供丰富、呈中度以上不均匀强化的软组织密度结节或块影,MSCT可以清晰地显示病变特点,及时进行手术切除,可提高患者预后。     

磁共振成像和多层螺旋计算机成像在贲门癌术前T分期中的比较研究

目的　通过磁共振扫描 (MR)、多层螺旋CT(MSCT)检查对贲门癌术前T分期进行前瞻性比较 ,并与病理结果对照 ,探讨MR与MSCT在贲门癌术前T分期中的价值。方法　 2 8例经活检证实的贲门癌患者 ,于术前 1周内行MR和MSCT检查 ,术后将病理与两者结果相比较。MR扫描序列包括FSET1W ,FSET2W ,FSET1W加脂肪抑制以及动态FSPGR加脂肪抑制扫描 ,MSCT扫描为平扫后作动态三期增强。结果　MR、MSCT对胃癌浸润深度 (T)判断与手术病理比较的准确率分别为T188.8%和 11.1% ;T2 77.8%和 2 2 .2 % ;T383.3%和 32 .7% ;T4 10 0 .0 %和 5 0 .0 %。与MSCT相比较 ,MR动态增强加脂肪抑制以及延迟扫描对早期病变的显示、T2与T3、T3与T4的区分以及食管和主动脉侵犯方面均有优势 (P <0 .0 5 )。在平扫序列中 ,T1W加脂肪抑制能较好地显示肿瘤特征、溃疡存在以及周围淋巴结肿大。统计分析显示 ,MR在贲门癌T分期的诊断准确性明显高于MSCT。结论　MR在贲门癌T分期中有较大的优势 ,可用于指导选择正确的治疗方案 ,避免不必要的手术。     

多层螺旋CT对纵隔肿瘤的诊断评价

目的探讨多层螺旋CT对纵隔肿瘤的诊断价值。方法分析68例经穿刺活检或手术病理证实的纵隔肿瘤MSCT表现特点,重点观察肿瘤的部位、大小、形态、密度及其与周围组织结构的关系。结果68例纵隔肿瘤中,前纵隔肿瘤51例,其中胸腺瘤32例,生殖细胞肿瘤15例,淋巴瘤4例;中纵隔肿瘤10例,包括淋巴瘤9例,胸腺瘤1例;后纵隔肿瘤7例,均为神经源性肿瘤;其中CT定位准确率100%(68/68),定性准确率93%(63/68)。结论 MSCT对纵隔肿瘤具有较高的诊断价值。     

肺黏膜相关淋巴组织淋巴瘤MSCT表现与病理学基础

目的探讨肺黏膜相关淋巴组织(MALT)淋巴瘤的多层螺旋CT(MSCT)表现特征与病理学表现的关系,提高本病的影像诊断准确性。 方法收集我院17例经病理证实的肺MALT淋巴瘤患者的MSCT及病理资料,15例患者行肺部CT平扫及增强扫描,2例患者仅行肺部CT平扫,结合病理学基础分析其影像学表现特征。 结果17例肺MALT淋巴瘤中,多发5例(5/17),单发12例(12/17),病灶主要分布在支气管血管旁或胸膜下。影像表现为实变形6例(6/17,35%),肿块或结节形7例(7/17,41%),支气管血管束型2例(2/17,12%)混合型2例(2/17,12%)。其中,15例见充气支气管征,10例见血管造影征,9例伴胸腔积液,5例伴支气管扩张,4例伴纵膈淋巴结肿大,2例可见钙化灶,伴肺脓肿、空洞各1例。 结论肺MALT淋巴瘤CT表现以肺实变影、肿块影伴充气支气管征及血管造影征为主要特征,对本病的诊断及鉴别诊断具有重要的提示作用,但确诊需依靠病理活检。