急诊CT中肠系膜漩涡征的临床意义

The value of mesenteric vessel whirl sign with acute abdominal pain on abdominal multislice spiral CT images

目的探讨急性腹痛患者肠系膜漩涡征的临床意义。方法回顾性分析30例急性腹痛而全盆腹腔CT平扫病例。以肠系膜血管伴或不伴肠管绕轴旋转角度至少大于90°作为漩涡征的判断标准,分别观察漩涡征角度、位置、方向以及伴随征象,并比较肠扭转及非肠扭转病例组中漩涡征各项特征的差异性。结果①肠扭转组漩涡征角度为(494.00±123.58)°,非肠扭转组漩涡征角度为(160.91±63.16)°,两者存在统计学差异(t=5.30,P<0.05);②肠系膜漩涡征作为肠扭转诊断标准的准确度为35.48%,当漩涡征旋转角度大于和等于300°时,诊断肠扭转敏感性为83.35%,特异性为90%,准确度为71.43%;③小肠扭转漩涡征多位于中线或偏右侧中上腹部,乙状结肠扭转位于左下腹。而非肠扭转病例的漩涡征可出现在下腹部、腹腔边缘等不典型区域。结论肠系膜漩涡征大部分并不指向肠扭转,当漩涡征旋转角度越大越倾向于肠扭转,小肠扭转多位于中腹部或右上腹部,下腹部出现漩涡征需想到阑尾炎的可能。

Objective To evaluate the value of the mesenteric vessel whirl sign with acute abdominal pain on abdominal multisliee spiral CT images. Methods Thirty patients with acute abdominal pain underwent abdominopelvic emergency uncnhanced CT without oral contrast material using a mubislice spiral CT scanner initially. A mesemeric rotation angle a- round＇the axis〉 90°was used as the diagnostic standard for whirl sign. To evaluate the mescneric vessel whirl sign and its morphological characteristics （including its rotation angle, site, rotation direction） and associated signs. The difference of whirl sign was compared between volvulus and non-volvulus patients. Results ①The rotation angles of volvulus and non-volvulus patients were respectively （494.00±123.58）° and （160.91±63. 16）°, a difference was found between the two groups （ P〈0.05） ; ②The accuracy while whirl signwas confirmed as volvulus was 35.48%, while the rotation an- gle≥300° was confirmed as volvulus the sensitivity was 83.35%, the specificity was 90% and the accuracy was 71.43% ③The site of whirl sign in small intestine volvulus group was middle or right upper abdomen and the sigmoid volvulus ca- ses was left lower abdomen, while the site of non-volvulus group was not only typical area but also untypical area such as lower abdomen or the edge of abdomen. Conclusion The most part of mesenteric vessel whirl sign was not direcdy point- ed to volvulus. The more the rotation angle value was large, the more it was prefer to volvulus. The site of whirl sign in small intestine volvulus group was middle or right upper abdomen. As whirl sign was in lower abdomen, it might to be ap- pendicitis.