新生儿环状胰腺的多层螺旋CT表现及诊断价值

Multi-slice CT features of annular pancreas in neonates

目的探讨新生儿环状胰腺的MSCT表现及诊断价值。方法回顾性分析27例经手术证实的新生儿环状胰腺临床及CT资料，其中20例行CT平扫及增强检查。2名高年资医师分析阅片，确定十二指肠梗阻部位及梗阻程度、胰头与梗阻端关系及周围组织结构的变化。结果直接征象：CT显示胰头部中间含气或对比剂肠管影4例；增强后17例十二指肠降部周围软组织与正常胰腺组织强化一致，梗阻端肠壁与环状胰腺问脂肪间隙消失17例。间接征象：20例显示十二指肠梗阻，其中“单泡征”2例，“双泡征”18例，18例“双泡征”中12例十二指肠泡直径（Dd）／胃泡直径（Ds）〉1．0；5例远端肠管无充气，15例远端肠管少量充气；梗阻部位：20例梗阻部均位于十二指肠降部；梗阻部形态：“乳头征”15例，“鼠尾征”5例；合并其他畸形：胰头中含气肠管异常扩张1例，胰管内积气1例，“漩涡征”2例。结论MSCT结合三维重组技术可以清楚显示环状胰腺形态、判定梗阻部位和程度及发现其他并发畸形，为指导临床治疗方案的选择提供重要依据。

Objective To investigate the MSCT manifestations and their values in the diagnosis of annular pancreas in neonates. Methods Retrospective analysis of clinical and CT findings in 27 cases with surgery-proved annular pancreas in neonates was made. The unenhanced and contrast-enhanced CT images were obtained in 20 patients. Two experienced radiologists determined the site and degree of obstruction, the relationship between the head of the pancreas and the obstruction point, and the surrounding tissue structure. Results The direct signs included the fluid-filled or gas-filled bowel in the head of pancreas in 4 cases,the enhancement of surrounding soft tissue as enhanced pancreas in 17 cases, disappearance of the fat gap between the intestinal wall and the annular pancreas in 17 cases. The indirect signs included intestinal obstruction in 20 cases,＂ single-bubble sign＂ in 2 cases,＂ double-bubble sign＂ in 18 cases, the distal bowel without gas in 5 cases, small amount of gas in the distal bowel in 15 cases. In 12 of 18 cases showing ＂double-bubble sign＂, the ratio of duodenal bubble diameter（Dd） to stomach bubble diameter （Ds）was over 1.0. The site of obstruction was located in the descending duodenum in 20 cases. The form of obstructed point presented with ＂nipple sign＂ in 15 cases,with ＂the mouse tail＂ in 5 cases. The expansion bowel was located in the head of pancreas in 1 case. Gas was found in the pancreatic duct in 1 case, and ＂swirl sign＂ was shown in 2 cases. Conclusions MSCT combined with three-dimensional reconstruction techniques can clearly demonstrate the annular pancreas＇ s shape, the site and degree of obstruction and other malformations. It can provide important information for clinical treatment.