肠缺血坏死的特征性CT征象

Study the characteristic CT signs of intestinal ischemic necrosis

目的总结肠缺血坏死的特征性CT征象。方法回顾性分析2008年1月至2012年12月广东省江门市中心医院30例经手术病理确诊为肠缺血坏死的CT检查资料。所有患者均行CT平扫、动脉期和静脉期增强扫描,所得图像进行三维重建。结果本组30例患者均出现肠壁强化减弱或肠壁不强化征;28例(93%,28/30)患者出现肠壁内或肠壁下小气泡征;13例(43%,13/30)患者出现高密度肠液征或高密度腹腔积液征;8例(27%,8/30)患者出现肠系膜血管栓塞征,其中肠系膜上动脉栓塞5例,肠系膜上静脉栓塞3例;8例(27%,8/30)患者出现门静脉积气征或气腹征。结论肠系膜血管栓塞和肠壁强化减弱或肠壁不强化征是肠缺血坏死的直接CT征象。肠壁内或肠壁下小气泡征、高密度肠液征或高密度腹腔积液征和门静脉积气征或气腹征是肠缺血坏死的间接CT征象。

Objective To explore the typical CT signs of intestinal ischemic necrosis .Methods CT imaging findings of 30 patients diagnosed as intestinal ischemic necrosis in Jiangmen Central Hospital of Guangdong Province between January 2008 and December 2012 were retrospectively analyzed .Every patient received CT non-enhanced and contrast-enhanced scanning （ arterial and venous phases ） , and the images were reformatted on workstation .Results CT imaging showed that the decreased enhancement or unforcement of intestinal wall in all the 30 patients, small bubbles under intramural or intestinal wall in 28 patients （93%, 28/30）, high density intestinal juice or high density ascites in 13 patients （43%, 13/30）, mesenteric vascular embolism in 8 patients （27%, 8/30）, 5 cases of superior mesenteric artery embolus and 3 cases of superior mesenteric vein embolus ） , and portal vein pneumatosis or pneumoperitoneum in another 8 patients （ 27%, 8/30 ） .Conclusions Intestinal ischemic necrosis can be diagnosed accurately by mesenteric vascular embolism and decreased enhancement （ or unforcement ） of intestinal wall . Other symptoms including small bubbles under intramural or intestinal wall , high density intestinal juice , high density ascites , portal vein pneumatosis and pneumoperitoneum are indirect CT images for the diagnosis of intestinal ischemic necrosis .