多排螺旋CT征象及轴位联合后处理图像对急性肠系膜缺血的诊断价值

Diagnostic value of multi-detector row CT imaging and axial post-processing images for acute mesenteric ischemia

目的 探讨多排螺旋CT征象及轴位联合后处理图像对急性肠缺血（AMI）的诊断价值。方法 选取2014年1月至2016年2月于清华大学第一附属医院初诊时疑似AMI患者33例。分析所有患者多排螺旋CT征象及轴位联合后处理图像影像资料，评价多排螺旋CT征象及轴位联合后处理图像对AMI的诊断效能。结果 多排螺旋CT诊断AMI的敏感度、特异度、准确率、阴性预测值和阳性预测值分别为100.00%、94.12%、96.97%、100.00%和94.12%。多排螺旋CT征象中肠壁增厚、增强扫描增厚肠壁分层强化和肠系膜充血水肿、呈缆绳征诊断AMI的敏感度较高，分别为93.75%、81.25%和81.25%；门静脉肠系膜静脉血栓形成、平扫肠壁密度增高、增强扫描肠壁无明显强化、肠壁间积气诊断AMI的特异度较高，分别为94.12%、94.12%、94.12%、100.00%。轴位联合后处理图像可以更清晰地观察AMI患者血管和肠道病变范围。结论 多排螺旋CT是诊断AMI的一种有效无创的检查方法，轴位联合后处理图像在明确AMI病因和血管及肠管病变范围，识别早期肠缺血方面有重要临床价值。

Objective To explore the diagnostic value of multi-detector row CT（MDCT） imaging and axial post-processing images for acute mesenteric ischemia（AMI）. Methods A total of 33 patients with undiagnosed AMI from January 2014 to February 2016 in the First Hospital of Tsinghua University were enrolled. All patients had MDCT; the diagnostic value of MDCT signs combined with axial union post-processing images for AMI was analyzed. Results The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of MDCT in diagnosis of AMI were 100.00%, 94.12%, 96.97%, 100.00% and 94.12%, respectively. The sensitivities of intestinal wall thickening, intestinal wall hierarchical intensification, mesenteric edema＋stranding sign in MDCT signs in diagnosis of AMI were 93.75%, 81.25% and 81.25%, respectively. The specificities of portal vein/mesenteric vein thrombosis, intestinal wall density increasing, intestinal wall no significant intensification and intestinal wall pneumatosis in diagnosis of AMI were 94.12%, 94.12%, 94.12% and 100.00%, respectively. Axial post-processing images showed extents of blood vessel and intestinal tract lesions more clearly. Conclusion MDCT signs and axial post-processing images have important significance for etiological analysis and extent definition of AMI.