口服等渗甘露醇SCT小肠造影诊断小肠肿瘤的临床研究

目的 探讨口服大剂量5.07％等渗甘露醇螺旋CT小肠造影(spiral CT enterography,SCTE)在小肠肿瘤诊断中的临床应用价值.方法 研究对象包括2004年1月～2008年10月间临床怀疑有小肠肿瘤性病变而行SCTE检查者60例、正常志愿者10例,动物实验(8只大鼠).分析各种小肠肿瘤的SCTE表现,并比较了82例传统CT扫描与SCTE检查结果,分别计算出两种不同检查方法的敏感度、特异度、阳性预测值、阴性预测值.结果 70例SCTE检查者除2例回盲部充盈欠佳外,余病例十二指肠、空肠及回肠肠腔充盈良好,对肿瘤的显示、衬托满意.动物试验显示50min大鼠小肠充盈最佳.SCTE检查的敏感度97.22％(35/36)、特异度95.83％(23/24)、阳性预测值97.22％(35/36)、阴性预测值95.83％(23/24),高于传统法CT扫描之敏感度76.19 ％(32/42)、特异度75％(30/40)、阳性预测值76.19 ％(32/42)、阴性预测值75％(30/40),两种方法比较其敏感度、阳性预测值差异有统计学意义(x2=5.45,x2=5.45,P＜0.05).结论 ①口服等渗甘露醇SCTE是一种简便、安全、非侵袭性、有效评价小肠肿瘤的方法,能明显提高肿瘤的检出率；②口服等渗甘露醇SCTE双期增强扫描结合重建技术对小肠肿瘤定位、定性及肿瘤分期有较高临床价值.

Clinical study of spiral CT enterography with isosmotic mannitoi as oral contrast in diagnosis of small intestine tumors

Objective To study the clinical application value of spiral CT enterography （SCTE） with orally administered isosmotic mannitol （5.07%） as negative contrast in diagnosis of small intestine tumors. Methods The study group in- cluded 60 patients who were suspected of small disease, 10 healthy volunteers and 8 rats from january, 2004 to October, 2008. Demonstration features of various kinds of small bowel tumors was analyzed by comparing with the results of con- ventional CT scan in 82 patients, and the diagnostic efficacy of SCTE was evaluated. The sensitivity, specificity, positive predictive value and negative predictive value in conventional CT scan and SCTE were calculated. Results Only two cases did not, treceive satisfactory in filling ileocecal junction, all the other cases in SCTE reeeiced satisfactory result in filling the duodenum, jejunum, ileum and in demonstrating the bowel tumors. Animal experiments showed that the best filling time of the small intestinal in rats was 50 minutes. The sensitivity, specificity, positive predictive value and negative pre- dictive value in SCTE were 97.22%, 95.83%, 97.22%, 95.83%, which was higher than by conventional CT （76.19%, 75 %, 76.19%, 75 %）. The difference between two modalities in sensitivity and positive predictive value were significant （X2 = 5.45 ,X2 = 5.45, P d0.05）. Conclusion OSpiral CT enterography with isosmotic mannitol as oral contrast is a sim- ple, rapid, safe, noninvasive, and effective method for evaluating small bowel tumor, which obviously increases the de- tectability of small intestine tumors;（2） Spiral CT enterography with isosmotic mannitol as oral contrast using biphasic en- hencing and 3D-imaging reconstruction techniques have an important clinical vale in localize, characterize and staging of in- terstinal neoplasms.