多层螺旋CT多期扫描对闭袢性小肠梗阻肠壁缺血判断的实验研究

目的 探讨多层螺旋CT(MSCT)多期增强扫描对实验性闭袢性小肠梗阻肠壁缺血的诊断价值.方法 大白兔24只,分为3组,每组8只;打开腹腔后,取距回肠末端30 em处,选择10～15 cm长的小肠结扎远近两端成闭袢,同时缝扎闭袢的引流静脉,制造模型A组(1～1.5 h)、B组(2～2.5 h)和C组(5～6 h组)行MSCT多期扫描,采用对比分析CT表现与肠壁组织病理改变.结果 A组8只、B组5只闭袢肠壁增强扫描出现持续强化,C组闭袢肠壁均无强化.CT值测量:增强前、增强后动脉期、静脉期和延佑迟期的CT值,A组分别为(37.38±6.16)HU、(91.03±10.48)HU、(104.00±4.04)HU和(69.50±7.70)HU;B组分别为(38.53±6.64)HU、(64.25±16.07)HU、(86.19±24.80)Hu和(84.13±18.99)HU;C组分别为(45.43±10.11)HU、(48.99±10.53)HU、(51.03±12.19)HU和(50.22 ±11.39)HU.A组、B组、c组闭袢肠壁之间的CT值在平扫时差异无统计学意义(P>0.05);在增强后的同一时期内差异有统计学意义(P<0.05).在增强前、增强后各期内,A组、B组、C组闭袢肠壁与对照肠袢之间的CT值差异有统计学意义(P<0.05).与病理学对照,肠壁无坏死组(11/13)出现持续强化征象明显高于肠壁坏死组(2/11)(P<0.05).结论 MSCT多期增强扫描可评价不同时间下肠壁缺血状态,持续强化主要见于肠壁缺血的早期阶段,而坏死的肠壁在增强各期无明显强化.     

螺旋CT多期扫描判断闭袢性肠梗阻肠壁缺血的实验研究

目的探讨螺旋CT增强多期扫描对实验性闭袢性肠梗阻肠壁缺血的诊断价值.方法新西兰大白兔24只,分为3组,每组8只;取10～15 cm长小肠结扎两端成闭袢,同时结扎闭袢肠段的引流静脉;于模型制成后0.5 h(A组)、1～2 h(B组)和3～5 h(C组)行螺旋CT多期扫描.采用盲法对比分析CT表现与肠壁组织病理改变的关系.结果 A组 7只及B组 4只兔闭袢肠壁增强扫描出现持续强化,C组8只的闭袢肠壁均无明显持续强化.CT值测量在增强前、增强后的动脉期、静脉期和延迟期A组闭胖肠壁的CT值分别为 (56.3±4.3)HU,(139.5±17.9)HU,(145.1±12.6)HU和 (124.9±10.5)HU;B组分别为 (58.8±5.6)HU,(82.5±13.7)HU,(101.0±20.3)HU和 (95.0±16.4)HU;C组分别为 (62.1±7.8)HU,(63.9±6.6)HU,(59.5±4.40)HU和 (59.6±6.9) HU.在平扫时,A组、B组、C组闭袢肠壁之间的CT值差异无统计学意义(P>0.05).在增强后的同一时期内,无论是在动脉期、静脉期或是延迟期,A组闭袢肠壁的CT值最大,B组次之,C组最小,而且差意有统计学意义(P<0.05).在平扫、增强后各期内,A组、B组和C组对照肠袢的CT值差异无统计学意义(P>0.05).与病理组织学对照,肠壁无坏死组出现持续强化征象的发生率(11/13)明显高于肠壁坏死组 (1/11)(P<0.05).结论螺旋CT多期增强扫描可评价肠壁不同时间的缺血,持续强化主要见于肠壁缺血的早期阶段,而已坏死的肠壁在增强各期均无强化.     

实验性小肠闭袢性肠梗阻肠壁缺血程度与时间相关性的CT分析

目的:建立兔小肠闭袢性肠梗阻模型,通过螺旋CT多期扫描,观察小肠闭袢性肠梗阻肠壁缺血程度与时间的相关性。方法:新西兰大白兔54只,随机分为A、B、C三组。A组9只,结扎长约10~15cm的小肠两端,形成单纯性闭袢;B组30只,除按A组形成单纯性闭袢外,同时结扎闭袢肠段的引流静脉;C组15只,在B组的基础上,同时结扎闭袢肠段的供血动脉。术后在不同的时间点行螺旋CT多期扫描。根据小肠梗阻肠壁缺血程度的CT标准,回顾性分析不同程度肠壁缺血所对应的缺血时间。结果:A组在随机的各时间内均表现为轻度肠缺血,缺血时间(107.11±71.65)min;B组表现为轻度、中度和重度肠缺血,其对应的缺血时间分别为(36.11±9.56)min、(98.77±39.12)min和(250.75±52.00)min;C组在随机的各时间内表现为中度肠缺血和重度肠缺血,其对应的缺血时间分别为(30.50±11.91)min和(150.11±71.62)min。结论:根据小肠梗阻的类型,结合螺旋CT多期扫描,可估计小肠肠壁的缺血程度所对应的缺血时间。缺血程度和缺血时间的确定,可为临床治疗方案的选择提供参考。     

超声造影引导下联合止血剂注射治疗肾挫裂伤的实验研究

目的 探讨超声造影引导下联合止血剂注射治疗肾挫裂伤的可行性.方法 18只新西兰大白兔开腹建立Ⅲ～Ⅳ级模拟钝性挫裂伤,随机数字表法分成三组:在超声造影引导下分别注射血凝酶(A组)、血凝酶联合α-氰基丙烯酸酯止血(B组)和等渗盐水(C组),观察止血时间、止血效果、肾周血肿等情况.结果 治疗后1 h,A、B、C组的肾周积液宽度分别为(0.200±0.012)cm,(0.050±0.002)cm和(0.400±0.009)cm,A、B组与C组比较,差异有统计学意义(P＜0.05).治疗后7,14 d复查,A组病灶长径分别为(1.107±0.143)cm和(0.433±0.163)cm,B组分别为(0.567±0.082)cm和(0.160±0.078)cm,C组分别为(0.980±0.203)cm和(0.686±0.157)cm,治疗后14 d,A、B组与C组间比较,差异有统计学意义(P＜0.01).A组病灶较B组大(P＜0.01).但B组治疗1个月后出现轻度肾积水的情况.结论 单纯注射血凝酶与联合注射血凝酶和α-氰基丙烯酸酯均能够达到止血效果,但后者的止血效果更加迅速、可靠.     

多层螺旋CT灌注成像评价伊达拉奉防治肺栓塞缺血-再灌注损伤疗效的实验研究

目的 探讨多层螺旋CT灌注成像用于评价伊达拉奉防治肺柃塞缺血-再灌注损伤(PTE-IRI)疗效的价值.方法 杂种犬20只,用球囊栓塞犬的右肺下叶动脉4 h,然后再撤除球囊,使血流再灌注4 h,制备PTE-IRI模型.根据实验动物是否用伊达拉奉和应用的时间,用数字表法将实验动物随机分为4组,每组5只,即A组:缺血时和再灌注时均不用伊达拉奉;B组:缺血时用伊达拉奉,再灌注时不用;C组:缺血时和再灌注时均用伊达拉奉;D组:缺血时不用伊达拉奉,再灌注时用.每组又分为缺血前、缺血4 h和冉灌注4 h 3个时间点,分别在这些时间点进行肺部CT平扫及CT灌注扫描.测量右肺下叶局部肺实质的血流量(BF)、血容量(BV)和平均通过时间(MTT),并采用方差分析的方法对其进行比较.结果 实验动物再灌注4 h CT检查主要表现为右肺下叶的肺水肿.(1)右肺CT灌注扫描组间比较:再灌注4 h A、B、C、D组的BF分别是(259.4±15.7)、(293.7±7.9)、(379.4±14.5)、(382.5±16.6)ml·min-1·100 g-1,MTT分别是(3.1±0.2)、(2.6±0.2)、(2.2±0.1)、(1.9±0.2)s;除C组和D组间的BF和MTT差异无统计学意义外(P值均＞0.05),其他各组间BF和MTY差异均有统计学意义(P值均＜0.01);各组间BV差异均无统计学意义(P值均＞0.05).(2)组内比较:A组和B组缺血前和再灌注4 h间的BF[缺血前A组为(397.2±19.2)ml·min-1·100 g-1,B组为(393.2±16.1)ml·min-1·100 g-1]和MTT[缺血前A组为(1.8±0.1)s,B组为(1.8±0.2)s]差异均有统计学意义(P值均＜0.01);缺血前和再灌注4 h A组BV分别为(12.0±0.9)、(12.2±1.0)ml/100 g,B组分别为(11.9±1.5)、(12.2±1.3)ml/100 g,差异均尤统计学意义(P值均＞0.05);C和D组缺血前和再灌注4 h间的BF、MTT、BV差异均无统计学意义(P值均＞0.05).结论 伊达拉奉可减轻肺栓塞缺血.再灌注损伤的程度,多层螺旋CT灌注成像可用于其效果的评价.     

小肠Crohn病的MRI诊断

目的　探讨小肠Crohn病的MRI诊断价值。方法　回顾性分析经手术和病理证实的 13例小肠Crohn病的MRI表现 ,其中男 12例 ,女 1例 ,年龄最大 6 4岁 ,最小 17岁。分析病变肠管的数量、部位、肠壁的厚度和静脉注射钆喷替酸葡甲胺 (Gd DTPA)增强后病变肠壁与正常肠壁的信号强度比或病变肠壁的增强百分比及并发症 (蜂窝组织炎、炎性肿块、脓肿和瘘管 )。其中 6例行MR注气小肠灌肠 (MRenteroclysis) ,即经小肠导管向肠腔注入空气约 10 0 0ml直接行冠状面和横断面带脂肪饱和(fatsaturation)的增强扫描 ;另 7例行小肠MR水成像 ,即扫描前 4 5min间断口服 2 5 %等渗甘露醇共15 0 0ml后行带脂肪饱和的冠状面平扫及冠状面和横断面增强扫描。扫描前均静脉注射山莨菪碱 2 0mg以抑制肠蠕动。结果　MRI均显示了每例小肠Crohn病的病变肠段 ,敏感性为 10 0 % ,13例 }共显示 36段炎症肠壁 ,平均每例 2 8个病变肠段。小肠Crohn病的MRI表现为增强后病变肠壁强化明显增加 ,注气灌肠组增强后的病变肠壁与正常肠壁的信号强度比为 1 9～ 2 5 (平均 2 1) ,水成像组增强后的病变肠壁与正常肠壁的信号强度比为 1 3～ 2 9(平均 1 9) ,病变肠壁的增强百分比为 96 %～2 2 3% (平均 133% ) ,而正常肠壁增强百分比为 31%～ 78% (平均 5     

正常成人小肠各节段多时相多体位MSCTE分析

目的探讨正常成人小肠各节段小肠壁的形态学变化规律、增强扫描后不同时相的CT值动态变化曲线以及扫描体位对图像质量的影响。方法回顾性分析60例MSCTE影像资料,并运用多平面重建、最大密度投影、容积再现技术、曲面重建法等进行后处理。由两名以上精通胃肠道影像诊断的主治医师进行双盲读片,对各节段不同时相小肠的肠壁厚度、肠管充盈直径和肠壁CT值进行测量,观察小肠黏膜在各节段的显示率,并对数据进行统计学分析。结果本组正常成人小肠MSCTE的肠壁平均厚度为(2.14±0.22)mm、平均充盈直径为(19.63±1.71)mm,不同组段肠壁厚度、肠管充盈直径有差异(P0.05);同组段不同扫描体位肠壁厚度、肠管充盈直径无差异(P0.05),但俯卧位小肠充盈较好分布更符合自然走向,十二指肠及空肠在不同体位的充盈度评分有差异(P0.05)。本组小肠平扫、动脉期、静脉期、延迟期CT值分别为(29.25±2.80)HU、(58.46±2.56)HU、(78.23±4.12)HU、(65.53±3.86)HU,同一时相各组段肠管之间CT值无差异(P0.05),而同一组段不同时相小肠CT值有差异(P0.05)。结论 MSCT小肠造影能提供高质量的小肠内外结构图,小肠肠壁强化曲线呈"速升缓降"型,强化峰值出现在静脉期,俯卧位扫描可以提高小肠的充盈满意度。     

射频消融联合肝动脉栓塞治疗肝癌疗效的实验研究

目的 研究射频消融(RFA)与肝动脉栓塞(TAE)联合治疗VX2兔肝移植瘤的疗效.材料与方法将VX2肿瘤块植入实验兔的肝脏内,建立36只兔肝癌模型,随机分为4组,每组9只.A组行单纯RFA治疗,B、C、D组分别在TAE治疗后1、4、7天行RFA治疗.各组在治疗后1、4、7天取标本,观察疗效.结果 毁损范围:A组(2.99±0.18)cm2与B组(3.67±0.32)cm2、C组(3.65±0.29)cm2、D组(3.53±0.16)cm2比较差异有统计学意义(P＜0.05),B、C、D组之间比较筹异无统计学意义(P＞0.05).结论 在一定时间内TAE与RFA联合治疗可以明显增加肝脏肿瘤的坏死范围,提高坏死率.     

动态和延迟增强MRI诊断早期股骨头骨骺软骨缺血的实验研究

目的:研究动态和延迟增强MRI诊断乳猪早期股骨头骨骺软骨缺血的价值。材料和方法:24例2~3周龄乳猪随机分为正常组10例,缺血组14例。缺血模型制作采用双髋关节蛙式位固定1h~12h,MRI扫描序列包括SET1WI、FSET2WI、动态和延迟增强MRI扫描。扫描完成后解除固定,并于1d和1周后行MRI复查。采用时间-信号强度曲线观察股骨头骨骺二次骨化中心首过灌注状态并测量相对强化比率,采用延迟增强MRI信号变化观察骨骺软骨的造影剂弥散情况,并与组织学检查行对照研究。结果:正常组10例双侧股骨头骨骺二次骨化中心动态增强扫描呈早期快速强化,相对强化比率平均值为1.51±0.46。延迟扫描骨骺软骨强化均匀。缺血组14例,固定3h和6h者各5例,固定1h和12h者各2例。14例共28个股骨头中,MRI平扫均未见异常。动态MRI增强扫描显示24个股骨头骨骺二次骨化中心呈低灌注状态,相对强化比率平均值为0.34±0.13,与正常组比较有显著统计学差异。延迟MRI扫描20个股骨头骨骺呈片状不强化或强化减低区。其中,4个股骨头可见灌注异常而延迟增强MRI扫描呈正常强化。1d后复查,13个股骨头恢复正常强化,另7个股骨头1周后复查也恢复正常强化。组织学检查显示所有28个股骨头骨骺均未见缺血坏死征象。结论:动态MRI增强扫描能敏感地发现乳猪蛙式位固定后股骨头骨骺二次骨化中心的早期缺血性改变,延迟增强MRI能很好地显示骨骺软骨的缺血,两者结合使用能较好地评价股骨头骨骺软骨早期缺血及其恢复。     

MR小肠造影多模态检查序列分析

目的分析比较MR小肠造影多模态检查各序列的优势与特点。方法回顾我院2012年1月～2017年1月期间所做的551例MR小肠造影检查。所有病例的MR检查均包含HASTE/T2SSFE,TURE-TISP/FIESTA, DWI,VIBE-T_1/LAVA-T_1及3D-T_1增强扫描,87例进行Function Cine MRI检查。结果 HASTE/T2SSFE可清晰显示肠壁结构及肠壁厚度;TURE-TISP/FIESTA可清晰显示肠系膜结构;DWI可显示肠壁的炎症表现;VIBE-T_1/LAVA-T_1及3D-T_1增强扫描可显示病变有无异常强化;Function Cine MRI可显示肠粘连及肠道蠕动的情况。结论 MR小肠造影检查各序列各有优势及特点,依据患者的实际情况分析、选择合适的序列进行多模态扫描有助于小肠疾病的正确诊断。     

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.     

Closed-loop and strangulating intestinal obstruction: CT signs.

In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation.     

Magnetic resonance imaging of bowel ischemia induced by ligation of superior mesenteric artery and vein in a cat model

OBJECTIVE: To assess the usefulness of magnetic resonance (MR) imaging for detecting bowel ischemia with strangulation compared with histopathologic findings in an experimental cat model. MATERIALS AND METHODS: Fourteen cats were assigned to the normal control group (n = 3), acute ischemic group (induced by ligation of superior mesenteric vessels for 3 hours, n = 7), and subacute ischemic group (induced by ligation of superior mesenteric vessels for 10 hours, n = 4). Using a 4.7-T MR scanner, contrast-enhanced T1-weighted images were obtained at 0, 10, 20, 30, and 60 minutes after bolus injection of contrast media. T1- and T2-weighted images were obtained from the extracted bowel wall and compared with histopathologic findings. RESULTS: On contrast-enhanced MR images, the target-like bowel wall layers were clearly demonstrated and the submucosal layer showed the most prominent enhancement. At 10 minutes after administration of contrast media, the subacute ischemic group showed significantly lower enhancement of the submucosal layer than the normal or acute ischemic group (P <0.05). On T1-weighted images, there were not significant differences between the normal and ischemic bowel groups (P >0.05). On T2-weighted images, the signal intensity of all layers of acute ischemic bowel wall was significantly higher than that of the normal control or subacute ischemic group (P <0.05). CONCLUSION: Delayed contrast-enhanced MR images and T2-weighted images were helpful for detecting subacute and acute bowel ischemia with strangulation, respectively.     

Helical CT diagnosis of small bowel obstruction in the acute clinical setting

Definite confirmation or exclusion closed loop obstruction (CLO) is one of the most difficult tasks the radiologist has to face in the clinical practice. Aim of this retrospective work was to study the value of spiral computed tomography (CT) in the diagnosis of closed loop obstruction complicated by intestinal ischemia. The state of the art CT signs of closed loop obstruction were taken into consideration. Serrated beaks with poor or no contrast enhancement of the bowel walls, ascites or engorgement of the mesenteric vasculature allowed the CT diagnosis of CLO complicated by ischaemia. U or C-sharped of dilated loops, radial distribution of the mesenteric vessels, beaks and whirls suggested CLO, but did not help differentiate CLO from strangulation. CLO is a dynamic entity which may regress or need laparotomy depending on the time and degree of rotation of the incarcerated loops. CT is a reliable imaging modality able to differentiate CLO from strangulation, which is rarely simple and obvious. Detection of ischemic changes in the bowel walls and/or attached mesentery on CT scans imply strangulation highlighting the need for laparotomy; if only signs of CLO are detected, the existence and/or development of strangulation cannot be predicted.     

Angiographic patterns in experimental obstruction of the small bowel.

Mechanical obstruction of the small intestine was induced in 79 rabbits. Ligation and/or fixation of an intestinal loop with sutures was performed in order to produce simple obstruction, strangulation, intussusception and volvulus. The obstructed loop and the adjacent segments of the bowel were examined with microscopic, microangiographic and angiographic methods at fixed time intervals of 6, 12, 24 and 48 hours. Dynamics of arterial changes in the intestinal wall and mesentery were investigated. Angiographic patterns of obstruction in the exteriorized loop of a living animal are described. These findings may be of value in evaluating clinical cases.     

Sonographic findings in a model of ischemia-induced necrotizing enterocolitis with pathological correlations

PURPOSE: To evaluate sonographic findings in ischemic enterocolitis (IEC) and correlate with pathologic findings in an experimental study. MATERIALS AND METHODS: Ischemic enterocolitis was induced with ligation of the superior mesenteric artery in 20 rabbits. Plain radiography and ultrasonography (US) were performed. US was done hourly after the ligation using 10 MHz linear probe. US findings were categorized into 2 groups according to the bowel wall echogenicity; the echogenic dots (ED) group and the circumferential granular echogenicity (CGE) group. US findings were compared with the specimen radiography and the histopathology. RESULTS: On US, ED were seen in the bowel of all rabbits after SMA ligation (2.2 +/- 1.3 hours [standard deviation]) and CGE in 16 rabbits (4.1 +/- 0.9 hours). On the specimen radiographs, multiple radiolucent air bubbles were present. Comparing the ED and CGE group, histopathological findings revealed the CGE group had severer injury of the bowel wall than the ED group. On plain radiography, there was progressive bowel distention, but pneumatosis intestinalis (PI) was not evident. CONCLUSION: ED or CGE are the sonographic findings of ischemic enterocolitis, and bowel wall echogenicity might reflect the degree of ischemic injury.     

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.     

Radiologic features of closed loop obstruction: analysis of 25 confirmed cases

The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.     

Small Bowel Volvulus Complicated by Bowel Infarction

Teaching Point: Torsion of a segment of the small bowel and its mesentery, together with closed loop obstruction and absent enhancement of paper-thin small bowel walls, is an alarm sign for small bowel volvulus complicated by acute bowel infarction.