多层螺旋CT诊断成人肠套叠的价值

Significance of Multi-slice CT in Diagnosis of Adult Intussusception

目的成人肠套叠较少见,且临床症状不典型,较易误诊,本研究旨在探讨成人肠套叠的多层螺旋CT(MSCT)征象,以提高该病的诊断水平。资料与方法回顾性分析经手术病理确诊为成人肠套叠的60例患者的临床和影像资料,观察肠套叠套头部病变、套鞘部肠管、折返部肠管、套入部肠管及卷入的肠系膜脂肪、血管等的CT表现。结果直接征象:套叠头部区肿块的靶征60例,其中单靶征44例、双靶征16例,外形呈肾形征39例、不规则状肿块21例;体部出现双肠管征22例;尾部出现彗星尾征15例,不同方向的"山"字征25例。间接征象:60例均有不同程度的套叠区域肠壁增厚,肠腔内见肠系膜脂肪及血管影45例。伴有肿块旁肠系膜及腹膜后有淋巴结肿大12例,腹水5例,转移瘤7例,其中肝脏转移4例,骨盆成骨性转移2例,多脏器转移1例。合并肾结石1例、输尿管结石3例。结论成人肠套叠具有特征性CT表现,尾部呈现不同方向的"山"字征为特征之一,CT检查对成人肠套叠的临床诊断、治疗有重要指导作用。

Purpose Adult intussusception is rare, and clinical symptoms are atypical and tend to be misdiagnosed. This study aims to explore the imaging features of intussusception on multi-slice CT（MSCT） and to improve the diagnosis of this disease. Materials and Methods Sixty cases with intussusception confirmed by pathology were recruited and imaging findings including sleeve head lesions, set sheath canal, exhumation of intestine, involved mesenteric fat, and blood vessels were retrospectively analyzed. Results The direct sings included 60 cases with target signs, 44 of them with single target signs and 16 of them with double target signs; the shape was ＂kidney＂ like in 39 cases and irregular in 21 cases; 22 cases showed double intestinal signs, 15 cases showed comet tail signs, and 25 cases showed mountain like with different direction. The indirect signs included 60 cases with thickened intestinal wall and 45 cases with mesenterium fat and vessel in enteric cavity, 12 cases with adjacent mesenteric mass and enlarged retroperitoneal lymph nodes, 15 cases with ascites, 7 cases with metastatic tumors, including 4 cases of liver metastasis, 2 of pelvic ossification metastasis, and 1 of multiple organ metastasis, 1 case combined with renal calculus and 3 case with ureteral caluli. Conclusion There are some special CT manifestations of adult intussusception. Mountain like sign with different direction at the tail is one of the characteristics. CT plays an important role in clinical procedure.