肠结核的影像学诊断

目的 探讨肠结核的CT与肠道X线造影的诊断价值及局限性，优化影像学组合检查。方法 收集经病理证实的肠结核22例，所有病例均经CT及肠道X线检查包括胃肠钡餐造影（GI）18例、十二指肠低张造影2例、小肠双对比造影3例、结肠双对比造影8例，分析两种检查的影像学表现。结果 CT对肠结核病灶检出的敏感性和定性论断如肠道X线检查，不易判断十二指肠水平段及空回肠病灶，但易于检出合并腹内肠外结核（特别是对诊断有帮助的特征性淋巴结结核）及侵犯肠道的肠外结核灶。肠道X线检查对肠结核的肠粘膜破坏和溃疡形成情况、肠道的累及范围、肠腔的狭窄程度及瘘管的显示有重要诊断价值。结论 各种影像学检查均有其优点及不足之处，根据肠结核不同部位行局部腹部CT扫描加相应的肠道X线检查中明显提高该病的诊断准确性。

Imaging diagnosis of intestinal tuberculosis

Objective To assess significance and limitation of CT and radiological gastrointestinal examination in the diagnosis of the intestinal tuberculosis. Methods 22 cases of intestinal tuberculosis proven pathologically were analyzed CT scans and radiological examination were performed (barium meal examination in 18 cases, intestinal or colonic double contrast examination in 10 cases and hypotonic duodenography in 3 cases). Results Sensitivity and specificity of diagnosing the intestinal tuberculosis with CT were inferior than that with radiological examination Lesions in small intestine (not including ileocecal region) were not easily identified by CT scan. However, CT scan was more preferable in identifying abdominal tuberculosis other than intestinal tuberculosis, especially typical tuberculous lymphadenopathy Intestinal radiological examination was of great significance for the assessment of the status of intestinal tuberculosis by demonstrating mucosal alterations, morphologic appearance of ulcer, bowel deformation, and the involvement of lesion and fissures. Conclusions Gastrointestinal radiological examination and CT scans possess their diagnostic value, but have limitation in diagnosis of intestinal tuberculosis CT scans combined with gastrointestinal radiological examination further improve the accuracy of diagnosis.