小肠肠壁增厚的多层螺旋CT小肠造影征象分析和诊断价值

Multiple-Slice CT Enterography Findings of Small Bowel Wall Thickness:Analysis of the Signe and Their Values of Differential Diagnosis

目的探讨小肠肠壁增厚的MSCT小肠造影(MSCTE)征象在不同类型小肠疾病诊断中的价值。方法搜集MSCTE发现小肠壁增厚并经手术、病理或临床证实为小肠肿瘤、小肠梗阻、小肠炎性或感染性疾病、低蛋白血症和小肠扩张症的患者共32例,由两名有经验的放射科医师共同阅片,分析增厚肠壁的受累肠段、受累长度、对称与否、强化方式、程度以及肠周异常在不同类型疾病中出现的情况。结果肠壁增厚累及十二指肠2例,空肠近段7例,空肠远段4例,回肠近段1例,回肠远段14例,弥漫性4例。不均匀强化和不对称性的局限性肠壁增厚多见于小肠腺癌、间质瘤和转移瘤,均匀强化和对称性的节段性肠壁增厚多见于炎性或感染性疾病、小肠梗阻。节段性或弥漫性肠壁增厚除淋巴瘤外,主要见于良性病变,增厚肠壁分层状强化多见于炎性或感染性疾病,强化减弱多见于肠缺血,均匀强化和不均匀强化多见于肿瘤;增厚肠壁邻近淋巴结增大多见于小肠恶性肿瘤、Crohn氏病和结核,邻近肠系膜血管异常多见于小肠梗阻、炎性或感染性疾病。结论小肠肠壁增厚的长度、对称性、强化方式及肠周异常的不同有助于小肠肿瘤、小肠梗阻、小肠炎性或感染性疾病的诊断和鉴别诊断。

Objective To investigate the multiple-slice CT enterography （MSCTE） signs of small bowel wall thickness in various kinds of small bowl diseases and the role of signs in diagnosis. Methods Thirty-two patients with thickened small bowel wall founded by MSCTE were collected in the study. The patients were proved by surgery, pathology, or clini- cally and included small bowel tumors, small bowel obstruction, inflammatory or infectious diseases, hypoproteinemia, in- testinal lymphangiectasia. The MSCTE data were studied by two experienced radiologists and described as follows： location in loops of intestine, length of involvement, symmetry of wall thickening, pattern of contrast enhancement, degree of wall thickening, associated abnormality in the adjacent mesentery or vessels or lymph nodes. Results The location of thick- ened small bowel wall were as following： 2 cases of duodenum, 7 cases of proximal jejunum, 4 cases of distal jejunum, 1 case of proximal jejunum, lg cases of distal ileum and 4 cases of diffuse involvement. Heterogeneous, asymmetric focal thickening is more frequently due to adenocarcinoma, gastrointestinal stromal tumors（GIST） and metastases. Homogeneous , symmetric segmental thickening is more frequently due to inflammatory or infectious conditions and small bowel obstruc- tion. Segmental or diffuse bowel wall thickening is usually caused by benign conditions, except for lymphoma. Stratification of the layers of the small bowel wall is usually caused by inflammatory or infectious conditions and decreased enhancement is more frequently due to bowel ischaemia. Homogeneous or heterogeneous enhancement is usually caused by tumors. The adjacent lymphadenopathy is usually associated with malignant tumors, crohn~ disease or tuberculosis. The adjacent abnor- mal vessels is usually associated with small bowel obstruction, inflammatory or infectious conditions. Conclusion The various ways of the signs in MSCTE such as length of involvement, symmetry of wall thickening, pattern of contrast enhancement and perienteric abnormality were helpful to diagnosis and differential diagnosis in small bowel tumors, small bowel obstruction, inflammatory and infectious diseases.