MDCT小肠造影技术在小肠疾病中的临床应用研究

Application of Muti-detector Row Computed Tomography Enterography in Small Bowel Diseases

目的:探讨多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。方法:对181例临床怀疑小肠病变患者术前行MDCTE平扫及多期增强扫描,图像行后处理,并与手术结果相对照。结果:本组181例患者中,58例MDCTE诊断为小肠病变,并与最终临床诊断相符。123例患者MDCTE诊断为阴性,108例符合,9例漏诊,6例误诊。MDCTE诊断小肠疾病的敏感性为79.45%,特异性为100%,诊断正确率为91.71%,阳性预测值为100%,阴性预测值为87.80%。本组资料中小肠肿瘤15例,其中腺癌5例,间质瘤3例,淋巴瘤1例,平滑肌瘤1例,肠系膜转移5例。小肠炎症性病变27例,其中克罗恩病16例,溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例。肠梗阻22例,其中腹内外疝9例,小肠扭转6例,小肠粘连性梗阻2例,幽门梗阻2例,胆石症2例,因克罗恩病肠壁增厚引起不全性小肠梗阻1例。小肠憩室2例,其中Meckel憩室1例,盲肠憩室伴慢性阑尾炎、阑尾结石1例。血管性病变3例,其中肠系膜上动脉栓塞1例,肠系膜上静脉血栓形成1例,肠道血管畸形1例。其他病变包括腹茧症2例,肠息肉1例,过敏性紫癜(腹型)1例。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠疾病的诊断具有重要价值。

Purpose： To discuss the utility of multi-detector row computed tomography enterography （MDCTE） for evaluating diseases of the small bowel. Methods： One hundred and eighty-one patients with suspected small bowel diseases underwent MDCTE. The MDCTE and histopathology results were reviewed. The CT characteristic features of small-bowel tumor, inflammatory bowel disease and other conditions affecting the small bowel were described and illustrated in detail. Associated complications and extra-enteric manifestations were also described. Results： Of 181 patients, the sensitivity, specificity, positive and negative predictive values and accuracy of MDCTE for small bowel disease were 76.71%, 100%,100%, 91.271%, and 87.80%, respectively. There were 15 cases of small intestinal tumor, which including 5 cases of adenocareinoma, 3 cases of GIST, 1 case of lymphoma, 1 case of leiomyoma and 5 cases of mesenteric metastasis. There were 27 cases of small bowel inflammation, which including 16 cases of Crohn＇s disease,2 cases of ulcerative colitis, 1 intestinal tuberculosis,1 case of viral gastroenteritis and 7 cases of generalized small bowel enteritis. There were 22 cases of small bowel obstruction and 3 cases of small bowel vascular lesions. Some other rare small-bowel cases were also presented in our study. Conclusion： Our results demonstrated that MDCTE with oral and intravenous contrast media is useful in assessing small bowel diseases; however, further studies are needed to determine and validate the full diagnostic and clinical potential of bowel imaging with MDCTE..