全腹部64层螺旋 CT 增强扫描对腹部实质脏器损伤的诊断价值

目的回顾性分析全腹部64层螺旋CT(MSCT)增强扫描对创伤所致腹部脏器损伤的诊断价值。方法对2008～2011年到我院就诊的63例有外伤史的患者进行全腹部MSCT增强扫描。患者先行平扫,再经肘正中静脉团注对比剂,延迟25S扫描,得到动脉期图像,再延迟50S得到静脉期图像,扫描范围为肺下部到耻骨联合下缘。结果 63例中腹部脏器损伤共83个。MSCT平扫发现损伤脏器表现为低密度影21例,混杂密度影35例,等密度影25例,高密度影2例。25例等密度影表现者MSCT平扫漏诊,在增强扫描后,其损伤部位和范围均得到明确显示;其余58例增强扫描后损伤部位的轮廓更加清晰,范围更加明确。脏器的其他损伤表现包括:脏器增大或增粗(6例)、包膜不光整(5例)、包膜下血肿(等密度7例、高密度7例、低密度2例、混杂密度1例)、造影剂外漏4例。63例中,45例为单个腹部实质脏器损伤,其中有41例行手术治疗;18例为复合脏器损伤,其中有14例行手术治疗,其术前CT诊断与手术符合率均达100%。结论全腹部MSCT增强扫描对创伤所致腹部脏器损伤的诊断具有显著优势,是腹部实质脏器损伤CT平扫的有效补充,可以作为腹部损伤的常规检查方法使用。

Diagnostic value of abdominal 64-slices spiral enhanced scanning in the traumatized patients with abdominal parenchymal organ injury

Objective To retrospectively analyze the diagnostic value of the abdominal 64-slices computed tomography scanning in traumatized patients with abdominal organ injury. Methods Abdominal 64 slices spiral CT scanning was performed in 63 traumatized patients. After plain scanning, bolus injection contrast agent was applied through cubital intravenous way, arterial phase images were obtained （25-second delay） , venous phase images was obtained （ 50-second delay）. The scanning range are from the lower part of the lung to the lower edge of pubic sym- physis. Results In 63 cases of patients, there were a total of 83 organ damages in plain scanning, including 21 cases of low density,35 cases of mixed density ,25 cases of isodensity and 2 cases of high density. Totally 25 cases of isodensity who received plain scanning were miss-diagnosed, but their injury site and range were clearly displayed after enhanced scanning;for the rest 58 cases after enhanced scanning,the contours of the injury site were more dear, the range more explicit. There were 6 cases of organ increase or thickening ,5 cases of irregular capsule, 17 cases of subcapsular hematoma（7 isodensity,7 high density,2 low density, and 1 mixed density） ,4 eases of contrast agent leakage. Among the 63 patients, there were 45 cases of single abdominal parenchymal organ injury ,41 of whom were treated with surgery;18 cases of composite organ damage, 14 of whom underwent surgery, with preoperative CT diagnosis and surgical coincidence rate 100%. Conclusion The whole abdominal 64-slices spiral CT enhanced scan- ning in the diagnosis of traumatic patients with abdominal organs injury has a significant advantage which is an effective complementary inspection method of abdominal parenehymal organs injury, and can be used as a routine examination of abdominal trauma.