MSCT及图像后处理技术对胆石性肠梗阻的诊断价值

Value of MSCT and image post-processing techniques in diagnosis of gallstone ileus

目的探讨MSCT检查及图像后处理技术对胆石性肠梗阻的诊断价值。方法回顾性分析15例经手术或临床证实的胆石性肠梗阻患者的资料,所有病例均接受MSCT平扫及增强检查,对图像行MPR、滑动薄层最大密度投影(STS-MIP)及CPR,并将影像学表现与手术结果进行比较。结果所有病例MSCT均表现出肠梗阻征象,其中胆管积气13例、胆囊积气6例、合并肠缺血4例、明确显示胆肠瘘5例;发现异位结石共20枚,15枚位于回肠,5枚位于空肠,其中3例为多发结石;MSCT后处理图像可清晰显示结石大小、数目、位置、梗阻点及周围并发症,与术中所见一致。结论 MSCT及图像后处理在胆石性肠梗阻的定位和定性诊断中具有重要价值,可为临床治疗提供丰富全面的影像学信息。

Objective To explore the value of MSCT and image post-processing techniques in diagnosis of gallstone ileus. Methods Fifteen patients with gallstone ileus confirmed surgically or clinically were retrospectively reviewed. All patients underwent abdominal plain and contrast enhanced MSCT scan. Volume data were reconstructed with MPR, slab thin slice maximum intensity projection （STS MIP） and CPR. MSCT findings were compared with surgical results. ~Results Intesti- nal obstruction were detected in all 15 patients, with pneumobilia in 13, pneumo-gallbladder in 6, and intestinal ischemia in 4 cases. There were 5 patients showing biliary-enteric fistula definitely in enhanced MSCT scan. Totally 20 ectopic stones were found, 15 located in the ileum and 5 in the jejunum. Multiple stones occurred in 3 patients. Post-processing image of MSCT clearly displayed the size, the number and the location of ectopic stones, as well as the obstructive site and sur- rounding complication, which were identical to surgical results. Conclusion MSCT and image post-processing techniques have an important clinical value in diagnosis of gallstone ileus and can provide rich and comprehensive information for clini- cal therapy