成人肠套叠的MDCT诊断价值

目的分析成人肠套叠的的MDCT影像特征。方法回顾分析手术证实为成人肠套叠的CT影像资料共48例。观察内容主要包括肠套叠部位、数目、套叠类型及CT征象、套叠处肠壁是否增厚或肿块形成、肠壁是否水肿与坏死等。结果本组48例50处肠套叠均为顺行套入,单处肠套叠46例(位于回盲部22例、回肠10例、空肠8例、升结肠4例、十二指肠空肠交界处、降结肠型及直肠各2例),多处肠套叠2例。MDCT示肠套叠3层肠壁结构及肠管内脂肪48例50处、杯口征及靶形征42例44处,彗星尾征32例34处,漩涡征24例26处。肠壁均匀增厚并水肿12例,其中考虑合并肠壁坏死4例;肠壁不均匀增厚或和肿块形成、不均匀强化14例;肠壁均匀增厚并轻中度均匀强化6例。套叠处见多发囊状低密度灶并囊壁均匀强化4例;套入远端圆形脂肪瘤合并肠壁坏死2例;小肠冗长2例;肠壁正常8例;其中合并肠梗阻12例,合并腹壁疝2例。结论成人肠套叠MDCT影像表现有一定特征,三期增强扫描结合多平面重组技术,对其诊断及选择治疗方法具有重要价值。

The Diagnostic Value of MDCT for Adult Intussusceotion

Objective To analyze the imaging features of MDCT for adult intussusception. Methods A retrospective analysis was performed to assess the MDCT imaging appearances of 48 cases of adult intussusception contains the intussusceptions＇ site, number, confirmed by operation. Evaluative content type and direct CT signs, bowel wall thickening or mass formation, bowel wall edema and necrosis and so on. Results CT demonstrated all 50 intussusceptions in 48 cases were anterograde, of which single lesion in 46 cases （22 cases located in ileocecal junction, 10 cases in ileum, 8 cases iq jejunum, 4 cases in ascending colon, 2 case in duodenum-jejunum junction, descending colon and rectum respectively）, multiple intussusceptions in 2 case. CT showed three bowel walls structure and intraluminal tat sign in all 50 intussusceptions of 48 cases, cup mouth sign and ring sign in 44 intussusceptions of 42 cases, comet sail sign in 34 intussusceptions of 32 cases, whirl pool sign 26 intussusceptions of 24 cases. Homogeneous thickening with edema of bowel wall was found in 12 cases, of which necrosis was considered in 4 cases, heterogeneous thickening of bowel wall or mass formation with heterogeneous enhancement in 14 cases, homogeneous thickening of bowel wall with slightly homogeneous enhancement in 6 cases. Multiple cystic low density lesions with capsule wall uniform enhancement were found in 4 cases, round lipoma in the distal with bowel wall necrosis in 2 case, too long small intestine in 2 case and non＇hal bowel wall in 8 cases. Intestinal obstruction in ~2 cases and abdominal hernia in 2 case were combined with. Conclusion The MDCT findings of adult intussusception are relatively specific, and three-phase CT combined with three dimensional reconstruction shows high clinical value for its diagnosis and the choice of treatment methods.