能谱CT等渗甘露醇胃肠低张造影诊断消化道疾病的价值

目的评价口服等渗甘露醇胃肠低张造影结合能谱成像在消化道疾病诊断中的临床价值。方法回顾性分析56例经手术与病理证实消化道病变患者的资料，所有患者均行口服复方聚乙二醇电解质散清洁肠道，检查当日口服2．5％甘露醇等渗溶液行肠道充盈并低张。采用双能CT宝石能谱成像技术行平扫及双期增强扫描，将原始数据应用能谱分析软件，获得组织最佳对比噪声比（CNR）的单能图像，结合水一碘分离图及能谱曲线分析，并在ADW4．5工作站上进行MPR、MIP和VRT。结果56例患者均能顺利完成检查，胃肠道适度扩张、充盈密度均匀，气粪影干扰少，胃壁及肠壁与低密度的胃腔和肠腔形成鲜明的对比。清楚显示胃肿瘤15例，小肠肿瘤9例，小肠Crohn病2例，小肠过敏性紫癜1例，小肠血管畸形2例，结肠肿瘤13例，结肠息肉8例，直肠肿瘤6例，直肠息肉2例，降结肠及乙状结肠缺血3例。结论口服等渗甘露醇胃肠低张造影可以提供良好的胃肠道显示背景，是一种安全、方便、高效的胃肠检查方法，同时结合能谱成像，可突显小病灶，优化血管成像，判断病灶同源性等方面具有一定的价值，且可真正达到胃肠道一站式检查。

Value of spectrum CT with isotonic mannitol gastrointestinal hypotonic radiography in the diagnosis of gastrointestinal tract diseases

Objective To evaluate the clinical value of spectral imaging combined with oral isotonic mannitol gastrointes tinal hypotonic radiography in the diagnosis of digestive tract diseases. Methods A retrospective data analysis of 56 cases confirmed by both surgery and pathology as gastrointestinal lesions was conducted. After oral complex polyethylene glycol electrolyte powder for bowel cleansing, all patients were encouraged to drink up 2.5 % isotonic mannitol to improve the quality of bowel filling and low distension. The original data from plain and dual-phase enhanced scan by dual energy CT with gems spectroscopy imaging techniques was applied by spectrum analysis software to obtain mono-energetic image of issue best contrast-to-noise ratio （CNR）, and then made a analysis with water-iodine separation diagram and energy spec trum curve, and operated on ADW 4.5 workstation for multi-planar reconstruction （MPR）, maximum intensity projection （MIP） and volume rendering technique （VRT）. Results 56 patients were able to successfully finish the examination the moderate distention of gastrointestinal tract, with uniform density less interference of gas dung shadow, as well as a dis tinct contrast on stomach wall and intestine wall from gastric cavity and enteric cavity with low density. It was clearly shown 15 cases of stomach neoplasms, 9 cases of small intestinal tumor, 2 cases of Crohn＇s-afflicted small bowels, 1 case of small bowel allergic purpura, 2 case of small bowel vascular malformation, 13 cases of colon tumor, 3 cases of colon polyps, 6 cases of rectal tumor, 2 cases of rectal polyps, 3 cases of descending colon and sigmoid colon ischemia. Conclu sion Oral isotonic mannitol gastrointestinal hypotonic radiography can provide a good gastrointestinal background. It is a safe, convenient and efficient method for gastrointestinal examination. Combination with spectrum imaging, it can high light small lesions, optimize vascular imaging, judge the lesion homology to some extent, so it can truly achieve a gastroin testinal one-stop examination.