16层螺旋CT诊断缺血性结肠炎的临床价值

Value of 16-slice spiral CT in diagnosing ischemic colitis

目的评价16层螺旋CT在诊断缺血性结肠炎及判断缺血病因中的价值。方法回顾性分析26例确诊为缺血性结肠炎患者的CT资料及临床资料。采用16层螺旋CT扫描,2例急诊CT平扫,24例均行平扫加双期增强扫描,获得图像采用多种后处理技术,15例行CT血管成像(CT angiography,CTA)。结果 23例肠壁增厚,其中可逆性缺血20例,不可逆缺血3例。3例肠壁变薄者为不可逆缺血。21例肠壁密度减低,5例肠壁密度增高。增强扫描,可逆性缺血中有7例肠壁强化增加,不可逆性缺血中4例肠壁强化减弱或不强化,2例非阻塞性肠缺血表现为部分强化。6例肠壁积气和4例肠管扩张均见于不可逆性肠缺血;门静脉积气2例,7例出现肠梗阻;SMA/IMA主干和/或分支硬化性狭窄7例,其中4例出现肠系膜小血管广泛钙化;缆绳征21例;漩涡征3例。肠系膜静脉栓塞4例;5例为肠系膜动脉血栓形成,23例患者找到结肠肠缺血之病因。结论 16层螺旋CT在诊断缺血性结肠炎及判断缺血病因上具有重要价值。

Objective To evaluate the capacity of 16-slice spiral computed tomography in diagnosing ischemic colitis and determining its extent and etiology. Methods CT manifestations of 26 patients with clinically confirmed isehemic colitis were retrospectively analyzed. Plain CT scans were performed in all 26 patients and two-phase contrast-enhanced CT scans were performed in 24 patients. VR, MIP, MPR, CPR of the source images were followed. CT angiography （CTA） was performed in 15 cases. Results 23 cases were revealed having bowel wall thickening, of which 20 cases were reversible bowel ischemia and 3 cases were irreversible ones. 3 cases with thin bowel wall were irreversible ischemia exclusively. The bowel walls were enhanced in 7 cases in reversible ischemia. The bowel wails were no or decreased enhanced in 4 cases in irreversible ischemia after contrast enhanced, and partial enhancement was seen in 2 cases with non-occlusive ischemia. 6 cases with pneumatosis and 4 cases with luminal dilation were irreversible ones exclusively. Portal venous gas was found in 2 ones, Intestinal obstruction in 7 cases, narrowing of the proximal superior mesenterie arteries （SMA）/ IMA in 7 cases, strand sign in 21 ones, thrombus of lower density in mesenteric veins in 4 cases, and whirl sign in 3 cases. The mesenteric venous and the mesenteric arterial thrombi were respectively discovered in 4 and in 5 cases. The etiology of ischemic colitis was determined in 23 cases. Conclusion 16-SCT is quite helpful in accurately diagnosing ischemic colitis and determining its extent and etiology.