小肠腺癌的螺旋CT诊断

目的评价多层螺旋CT三期增强扫描对小肠腺癌诊断的价值。方法对27例经手术或内镜活检证实的小肠腺癌(十二指肠14例,空肠8例,回肠5例)的CT资料进行回顾性分析,图像MPR重建在GE ADW4.3工作站进行。结果 18/27例病灶表现为肠管息肉状或菜花状软组织密度影;9/23例腺癌表现为肠壁增厚。其他表现包括:肝内胆管明显扩张1例,肝内外胆管不同程度扩张4例,不完全性肠梗阻7例,;淋巴结肿大8例,病灶侵犯胰腺2例,累及肠系膜、大网膜7例,表现为密度增高,呈并可见结节状影;1例病灶合并肠套叠;血管包绕3例。三期增强扫描动脉期较平扫强化CT值平均增加22HU,门脉期进一步强化CT值平均增加34HU,延迟强化强化稍下降但仍强于动脉期,CT值平均增加29HU。结论螺旋CT扫描可有效显示小肠腺癌的直接征象和合并征象。多平面重建有助于显示病变与周围结构的关系及远处转移的情况。

MDCT Features of Small Bowel Adenocarcinoma

Objective To evaluation of multi-slice CT scan in the diagnosis of small bowel adenocarcinoma. Methods 27 cases after surgery or endoscopic biopsy confirmed the intestine （duodenum, jejunum in 14 cases, 8 cases of 5 patients with ileal） CT data： a retrospective analysis, image reconstruction in MPR GE ADW4.3 workstation. Result 18/27 cases lesions characterized by intestinal polyps or cauliflower-shaped soft tissue density; 9/23 patients with adenocarcinoma of the bowel wall thickening performance. Other manifestations include： intrahepatic bile duct dilatation of 1 cases of obvious, intrahepatic and extrahepatic bile duct dilatation of the 4 cases to varying degrees, incomplete bowel obstruction, 7 cases;lymph 8 cases, the lesions of 2 cases of violations of the pancreas （Figure 3）, involving the mesenteric, omentum 7 cases, performance for high density, and visible Nodular lesions; 1 cases; merge intussusception in 3 cases. Three- phase artery with unenhanced CT value increase by an average of enhanced 22HU, portal and further strengthen the CT values during an average increase of strengthening reinforced 34HU, delayed slightly decline but is still stronger than the CT values for arterial phase, an average increase of 29HU. Conclusion spiral CT scan can show direct signs of intestine and merge features. MPR can help show lesions and surrounding structures and distant metastases.