乙状结肠扭转的CT诊断(附23例分析)

目的:探讨乙状结肠扭转的多排螺旋C T表现特征。方法:回顾手术中证实为乙状结肠扭转的23例,分析腹部C T扫描图和横断面扫描特征,总结乙状结肠扭转的C T影像学特征。结果:在C T定位像上,最敏感的表现是扩张的乙状结肠倒U征(21/23,91%),不成比例乙状结肠扩张(19/23,83%),其次为咖啡豆征(17/23,74%),Y征(12/23,52%)。在横断面扫描上,最敏感的是不成比例的乙状结肠扩张(21/23,91%)和圆腹征(20/23,87%),其次为近端结肠扩张(15/23,65%),漩涡征(15/23,65%),鸟嘴征(13/23,57%)。在C T定位像和横断面扫描上,典型的乙状结肠扭转影像表现分别占57%(13/23)和83%(19/23)。在定位像上,咖啡豆征与Y征在显著相关(P0.05)。横断面扫描上肠管损害的C T征象与临床肠管损害显著相关(P0.05)。结论:多排螺旋C T对乙状结肠扭转的诊断具有重要价值。在定位像上,乙状结肠扭转的主要影像学表现为倒U征,特征性表现为Y征;在横断面扫描上,主要影像学表现为不成比例的乙状结肠扩张,特征性表现为漩涡征和鸟嘴征。

CT diagnosis of sigmoid colon volvulus

Objective： To discuss the manifestation characteristics of sigmoid colon volvulus on Multi-detector CT. Methods： CT scanograms and cross-sectional images in 23 cases of sigmoid colon volvulus proved by operation were retrospectively analyzed and summarized. Results： The most sensitive scanogram findings were inverted-U sign of expansive sigmoid colon（21 of 23 cases,91%）and disproportionate sigmoid colon expansion（19 of 23 cases, 83%）, followed by coffee bean sign（17 of 23 cases, 74%）and Y sign（12 of 23 cases, 52%）. The most sensitive cross-sectional find-ings were disproportionate sigmoid colon expansion（21 of 23 cases, 91%）and round belly sign（20of 23 cases, 87%）, followed by proximal colonic dilatation（15 of 23 cases, 65%）, whirl sign（15 of 23 cases, 65%）and beak sign（13 of 23 cases, 57%）. The typical findings of sigmoid colon volvulus on scanogram and cross-section scanning respectively accounted for 57%（13 of 23 cases）and 83%（19of 23 cases）. Coffee bean sign significantly correlated with Y sign on scanograms（P〈0.05）. Imaging signs suggesting bowel compromise on the cross-section scanning correlated significantly with the clinical bowel wall compromise（P〈0.05）. Conclusion： Multi-slice spiral CT is of great value for diagnosis of sigmoid colon volvulus. The main manifestation of sigmoid colon volvulus on scanograms are inverted-U sign and the characteristics of Y sign. And those on cross-sectional images are disproportionate sigmoid colon expansion and whirl sign and beak sign as characteristic.