多排CT对急性及慢性肠系膜静脉血栓的诊断价值

Diagnostic value of multidetector CT in acute and chronic mesenteric venous thrombosis

目的·分析肠系膜静脉血栓(mesenteric venous thrombosis,MVT)患者的多排CT(multidetector CT,MDCT)表现,探讨MDCT对评价急性及慢性MVT的价值。方法·回顾性分析上海交通大学附属第六人民医院及新疆喀什地区第二人民医院2012年1月至2018年10月共47例经临床证实的MVT患者的MDCT表现。测量并计算急性及慢性MVT的MDCT平扫时轴位图像上血栓平均CT值,根据CT值及各CT表现统计分析2组间差异。结果·47例患者中,46例CT表现为肠系膜静脉及其分支充盈缺损(97.87%),34例表现为血栓处血管扩张(72.34%),肠壁增厚30例(63.82%),增强后肠壁分层强化(靶征)9例(19.15%),肠腔扩张11例(23.40%),腹腔积液21例(44.68%),肠系膜水肿25例(53.19%)。急性组MVT血栓平均CT值[(42.88±17.77) HU]大于慢性组[(31.80±6.18) HU](P<0.05);急性组MVT出现血栓处血管扩张、增强后肠壁分层强化征象的比例高于慢性组(P<0.05),2组间其余征象的比例未见差异。结论·MVT患者的MDCT表现具有特征性,测量血栓的CT值、观察血栓处血管扩张及肠壁的分层样强化等征象对评价急慢性MVT有一定价值。

Objective · To analyze the multidetector CT (MDCT) manifestations of mesenteric venous thrombosis (MVT) and further explore the diagnostic value of MDCT in acute and chronic MVT. Methods · MDCT findings of 47 MVT patients clinically confirmed in Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University and Second People's Hospital in Kashgar from January 2012 to October 2018 were retrospectively analyzed. The mean CT value of thrombus on CT axial images of acute and chronic MVT was measured and calculated. According to CT values and CT manifestations, differences between the two groups were statistically analyzed. Results · Among 47 patients with MVT, there were 46 (97.87%) with filling defect of mesenteric vein and its branches, 34 (72.34%) with dilatation of blood vessels at the thrombosis site, 30 (63.82%) with intestinal wall thickening, 9 (19.15%) with enhanced delamination of intestinal wall, 11 (23.40%) with intestinal dilatation, 21 (44.68%) with ascites, and 25 (53.19%) with mesenteric edema. The mean CT value of MVT thrombus in acute group [(42.88±17.77) HU] was higher than that in chronic group [(31.80±6.18) HU](P<0.05). The proportion of MVT with vasodilation and target sign in acute group was higher than that in chronic group (P<0.05). There was no difference in the ratio of other signs between the two groups. Conclusion · The MDCT findings of MVT patients are characteristic. CT value of thrombus, vasodilation and target sign are valuable in evaluating acute and chronic MVT.