肠系膜上静脉血栓形成的CT诊断

目的探讨螺旋CT对肠系膜上静脉血栓形成的诊断价值。方法回顾性分析临床证实的13例肠系膜上静脉血栓形成的CT表现特点。13例均行CT平扫及多期增强扫描,其中4例行口服对比剂后延迟扫描。部分图像数据行多平面最大密度投影等后处理。结果所有病例均表现有肠系膜充血水肿,8例于增强扫描后显示有肠系膜上静脉内圆形充盈缺损。其余5例发生于末梢血管的病变。CT未能直接显示血栓,扫描显示了肠管扩张、肠壁增厚、靶征、肠壁强化程度减低、缺失或肠间小气泡影等反映继发肠缺血表现的CT征象。后两者对肠缺血坏死的判断,有较高的特异性。而肠坏死的发生与血栓是否位于主干并无直接关系。结论螺旋CT是诊断肠系膜上静脉血栓形成的重要的检查方法。

CT Diagnosis of Superior Mesenteric Vein Thrombosis

Objective To explore the diagnostic value of helical CT in superior mesenteric vein(SMV) thrombosis.Methods Characteristic CT appearances of SMV thrombosis verified by clinic in 13 patients were retrospectively analysed.Precontrast and postcontrast CT scan were performed in all patients.After the data were acquired,they were transferred to workstation for maximum intensity projection of muti-plane.Results Hyperaemia and edema of the mesentery could be seen in all patients.After administration of contrast material,the filling defects of SMV could be showed in 8 cases,and the distal SMV was occluded in other patients.The thrombi could be directively showed by CT,but distended bowel loops,bowel wall thicking with or without the target sign,absent or poor enhancement of the bowel wall,and the pneumatosis at interbowel were showed by CT,the later two findings were more important and specific signs of ischemic bowel.There was not directively relation between bowel necrosis and the thrombus was whether or not localized at main SMV.Conclusion Helical CT is a important modality for the diagnosis of SMV thrombosis.