肠系膜上动脉MSCTA对小肠疾病的诊断价值

The Evaluation of Superior Mesenteric artery CT Angiography in Diagnosis of Small Intestinal Disease

目的探讨肠系膜上动脉MSCTA对小肠疾病的定位诊断价值;并观察肠系膜血管的改变对部分小肠疾病的定性诊断价值。方法搜集2008年1月至2010年12月,因腹痛、腹泻、呕吐、黑便等临床症状行MSCT双期增强扫描的患者362例。采用动脉期、静脉期双期增强扫描,原始图像0.625mm重组传入ADW4.3工作站。利用动脉期图像采用最大密度投影(maximum intensity projection,MIP)、容积再现(volume rendering,VR)等技术得到肠系膜上动脉MSCTA图像,比较MSCT薄层轴位图像与结合MSCTA图像定位诊断空、回肠疾病的正确率。使用SPSS 13.0软件对数据进行统计分析。结果经确诊空、回肠疾病者101例,其中肿瘤29例,炎性病变25例,小肠憩室12例,动静脉畸形5例,肠扭转7例,小肠内疝3例,肠石性小肠梗阻6例,粘连性肠梗阻6例,肠套叠4例,术后吻合口狭窄3例,腹股沟斜疝1例。MSCT薄层轴位图像诊断正确64例,结合MSCTA图像诊断正确94例。两者之间差异具有统计学意义。结论 MSCT薄层轴位图像结合MSCTA,有助于提高小肠疾病的定性、定位诊断正确率,并能与腹腔、盆腔其他部位病变相鉴别,有助于临床制定合适的治疗方案。

Objective To evaluate the value of superior mesenteric artery CTA in diagnosis of small intestinal disease from the change of SMA and superior mesenteric vein（SMV）.Methods 362 patients clinically suspected intestinal disease were collected from January 2008 to December 2010.Dual phase MSCT scan was performed and source images of a 0.625 mm thickness were used for image reconstruction.The reconstruction technique of MPR（Multiplanar Reconstruction）,MIP（Maximal intensity projection） and VR（volume rendering） were used.The diagnostic accuracy of reconstruction imaging was compared with the source images.Results A total of 101 cases with intestinal disease were proved by operation or pathology,which included intestinal tumor（29 cases）,inflammatory process（25 cases）,intestinal diverticulum（12 cases）,arteriovenous malformation（AVM,5 cases）,intestinal volvulus（7 cases）,intestinal entocele（3 cases）,enterolith intestinal obstruction（6 cases）,adhesion intestinal obstruction（6 cases）,stomal stenosis after surgery（3 cases）,intussusception（4 cases）,oblique inguinal hernia（1 cases）.In the 101 cases of intestinal disease proved by operation or pathology,64 cases were diagnosed correctly with source image,and 94 cases were diagnosed correctly with reconstruction MSCTA image.There was significant difference between source image and reconstruction MSCTA image in diagnostic accuracy.Conclusion MSCT source image with reconstruction techniques are helpful for evaluation of small intestinal disease,and also helpful to differential diagnosis and decide treatment planning.