64层螺旋CT对小肠间质瘤性小肠出血的诊断价值

Diagnostic Value of 64 MSCT on Intestinal Hemorrhage Induced by Gastrointestinal Tract Tumor of Small Intestine

目的：探讨64层螺旋CT（MSCT）对小肠间质瘤导致小肠出血的诊断价值。方法：回顾性分析25例经手术病理证实的小肠间质瘤导致小肠出血的CT影像资料,结合多平面重组（MPR）、最大密度投影（MIP）综合分析。结果：17例小肠间质瘤位于空肠,8例位于回肠,24例平扫表现为腔内型软组织肿瘤,大小约1-3.8 cm,平均1.7 cm,动脉期明显强化,静脉期持续强化,坏死囊变不强化。1例平扫表现腔内外软组织肿块,大小约5.6 cm×4.8cm×3.4 cm,明显不均匀强化,其内片状未见强化低密度影。12例显示肿瘤血供,8例肿瘤血管来自于肠系膜上动脉空肠支,4例来自于回肠支。1例显示空肠近端间质瘤动脉破裂,动脉期肿瘤边缘片状造影剂,静脉期范围扩大。结论：多层螺旋CT对小肠间质瘤动脉破裂出血的直接征象有所欠缺,但能分析小肠出血的原因,并准确判断肿瘤的位置,为指导临床治疗提供帮助。

Objective To explore the diagnostic value of 64 slice spiral CT（ MSCT） in intestinal hemorrhage induced by gastrointestinal tract tumor of small intestine.Methods The CT image of 25 patients with intestinal hemorrhage induced by gastrointestinal tract tumor confirmed by surgical pathology were retrospectively analyzed. The general analysis is combining multi-level plane reconstruction（ MPR） and maximum intensity projection（ MIP）.Results In all 25 patients,the tumors of17 cases located in jejunum,8 cases in ileum,24 cases of plain scan showed soft tissue tumor in the cavity,the size was about 1 to 3.8 cm with an average of 1.7 cm,apparent arterial enhanceed,venous phase continued strengthen,necrosis in capsule had no improvement.One case of plain scan showed soft tissue tumor in both internal and external cavity,the size was about 5.6 cm×4.8 cm×3.4 cm,inhomogeneous enhanced obviously,in the interior showed a piece of low density without enhancement.The CT image of 12 cases showed the supply of blood to tumors,and 8 cases showed that the supply of blood came from the branch of mesenterica superior artery of jejunum,4 cases came from the branch of ileum.One case showed artery rupture of gastrointestinal tract tumors which located at the proximal jejunum,the tumor＇s edge was seen contrast-medium in arterial phase,and the range was expanded in venous phase.Conclusion Multi-slice spiral CT may be not sufficient to show the direct signs of small intestinal hemorrhage,but could be used to analyze the cause of hemorrhage and location of tumor for clinical treatment.