多排螺旋CT对腹腔脓肿的诊断价值

Diagnostic value of multi-slice spiral CT in celiac abscess

目的探讨多排螺旋CT(MSCT)对腹腔脓肿病因的诊断价值及临床意义。方法回顾性分析亳州市人民医院2013年7月至2016年8月21例经手术、穿刺及临床治疗随访等证实的腹腔脓肿患者影像学资料,结合MSCT多平面重建(MPR),观察分析不同病因腹腔脓肿的分布特点及MSCT表现。结果 MSCT结合MPR,21例腹腔脓肿MSCT定位诊断正确率达100.0%,定性诊断正确率达95.2%(20/21)。其中阑尾炎脓肿12例,MSCT显示脓肿主要位于回盲部周围,脓肿内可见气体或气-液平面形成;消化道穿孔6例,MSCT表现为消化道穿孔部位区渗出性改变及脓肿形成,增强扫描可见均匀光整的环形脓肿壁强化,部分邻近脓肿周围可发现游离气体影;胆囊结石、胆囊炎穿孔1例,MSCT显示胆囊壁水肿增厚,缺损处胆囊壁连续性中断,其旁可见多发游离胆囊结石影;异物包裹脓肿2例,MSCT清晰显示高密度异物周围脓肿形成,脓肿壁强化、异物不强化。结论 MSCT平扫及增强扫描结合MPR能早期发现腹腔脓肿,分析腹腔脓肿原因,为临床治疗提供重要的参考依据。

Objective To explore diagnostic value and clinical significance of multi -slice spiral CT （MSCT） in the pathogeny of celiac abscess.Methods Twenty-one patients with celiac abscess undergoing surgery ,puncture and clinical follow -up from July 2014 to July 2016 in People＇s Hospital of Bozhou were retrospectively analyzed .Combined with multi-planar reconstruction （MPR） of MSCT,the distribution characteristics and MSCT manifestations of abdominal abscess of different etiology were observed and analyzed .Results The diagnostic accuracy of celiac abscesses was 100% and the accuracy of qualitative diagnosis was 95.2% （20 /21） by using MSCT combined with MPR.Among them,12 cases were appendicitis abscess .MSCT showed that the abscess was mainly located around the il -eocecal region,and gas or gas-liquid plane was formed in the abscess .6 cases were caused by perforation of alimentary tract .MSCT showed perforation changes in the perforation area of the digestive tract and abscess formation .Enhanced CT showed uniform smooth ring abscess wall enhancement ,and some parts of the surrounding abscess can be found around the free gas shadow .One case was caused by gallstone and cholecystitis perforation .MSCT displayed thickening and hydrops of gallbladder -wall.Interruption of gallblad-der-wall could be shown in the defect .Two cases were caused by encapsulated abscesses .MSCT manifested abscesses around high den -sity foreign body,the walls of abscess obviously enhanced ,and the foreign body did not strengthen .Conclusions MSCT plain scan and enhanced scan combined with MPR can find early celiac abscess ,and analyze the cause of celiac abscess ,which provides a significant reference for clinical treatment.