螺旋CT三维重建技术在肠系膜缺血性肠病中的应用

目的：探讨多层螺旋CT后处理技术对肠系膜缺血性疾病的早期诊断。方法：2007年7月至2010年7月在本院行CT检查并经临床及病理证实的急性肠缺血患者21例，采用SIMENSHispeed16层螺旋CT扫描仪，进行全腹CT平扫及增强扫描。运用容积成像（VR），多平面重组（MPR），最大密度投影（MIP）后处理技术，结合横断面CT图像进行评价。结果：21例急性肠缺血患者，肠系膜动脉栓塞1例，肠系膜静脉栓塞19例，1例同时有肠系膜动脉及静脉栓塞。CT增强扫描肠系膜上动脉、肠系膜上静脉和或门静脉管腔内见充盈缺损。8例合并肠管积气积液扩张，肠壁水肿，增强后呈“面包圈征”：4例呈“脂肪混浊征”；6例呈“漩涡征”；3例合并气腹；8例合并腹腔和／或盆腔积液；3倒合并有肝硬化；3例肝脏灌注异常。结论：螺旋CT三维重建技术可以提高肠系膜缺血性肠病的早期诊断准确率。

The use of 3-dimensional reconstruction of spiral CT in diagnosis of the mesenteric ischemia enteropathy

Objective ：To explore the value of muhi-slice spiral CT （MSCT） post-processing technique in early diagnosis of mesenteric ischemia enteropathy. Methods： Between July 2007 and July 2010, 21 cases clinically and pathologically confirmed with acute intestinal ischemia underwent total abdominal CT scan and contrast-enhanced scan by SIMENS Hispeed 16-slice Spiral CT. The results were then evaluated with post- processing techniques including volume rendering （VR）, multiplanar reformation （MPR） and maximum intensity projection （MIP） in combination of transverse plane CT images. Results： Of 21 patients with acute intestinal ischemia,mesenterie artery embolism was found in 1 patient, mesenteric vein embolism inl9, and both two embolisms inl. The contrast-enhanced CT scan demonstrated filling defects in the superior mesenteric artery, superior mesenteric vein and/or portal vein. Pneumatosis and effusion in distended intestine and intestinal wall edema, as presented with doughnut sign after enhancement, could be seen in 8 cases. Fat opacity sign was shown in 4 cases,and Vortex sign in 6 cases. Three cases were with pneumoperitoneum, 8 withabdominal and/or pelvic effusion,3 withhepatic cirrhosis and 3 with perfusion abnormality of the liver. Conclusion： The 3-dimensional reconstruction of spiral CT may increase the accuracy in early diagnosis of mesenteric ischemia enteropatby.