胆石性肠梗阻CT与MRI影像学特征及其诊断价值分析

CT and MRI Imaging Features of Gallstone Ileus and Their Diagnostic Value

目的分析胆石性肠梗阻计算机断层扫描(CT)与磁共振成像(MRI)影像学特征及其诊断价值。方法对27例胆石性肠梗阻患者临床资料进行回顾性分析。术前均行CT或MRI检查,观察胆石性肠梗阻的CT与MRI影像特征,比较二者对该疾病诊断价值差异。结果27例胆石性肠梗阻患者经术前CT诊断准确率100%,肠腔异位结石31枚,其中位于回肠16枚,空肠9枚,3例胆囊及十二指肠内均可见结石;合并胆囊积气26例(96.30%),肝内胆管积气20例(74.07%),腹腔少量积液4例(14.81%)。13例胆石性肠梗阻患者经术前MRI诊断准确率100%;其对结石部位、大小、形态显示情况与CT相近,但胆管积气易与结石混淆;MRI检查瘘口直接显示率100%,高于CT的52.38%(P<0.05)。结论CT可快速良好显示肠腔异位结石、机械性肠梗阻及胆道积气情况,可作为肠梗阻的首选检查方法,MRI对异位结石显示效果与CT相当,对胆管积气与结石易混淆,但其对瘘口的显示优于CT,可作为补充性检查。

Objective To analyze the imaging features and diagnostic value of CT and MRI of gallstone ileus.Methods The clinical data of 27 patients with gallstone ileus were retrospectively analyzed.Imaging examinations (CT or MRI) were performed before operation,and the imaging features of CT and MRI of gallstone ileus were observed, and the diagnostic value on disease between the two was compared.Results Among 27 patients with gallstone ileus,the accuracy rate of preoperative CT diagnosis was 100%,and there were 31 ectopic stones in the intestine (including 16 stones in the ileum,9 stones in the jejunum,and 3 stones in the gallbladder and duodenum).There were 26 cases (96.30%) of combined pneu-gallbladder,20 cases (74.07%) of pneumobilia and 4 cases (14.81%) of a small amount of effusion in abdominal cavity.The accuracy rate of preoperative MRI diagnosis was 100% in 13 patients with gallstone ileus.The location,size and morphology of the stones by MRI were similar to those of CT,but the pneumobilia was easy to be mixed up with stones.The direct display rate of orificium fistulae by MRI was higher than that by CT (100% vs 52.38%)(P<0.05).Conclusion CT can quickly display the ectopic stone of intestine,mechanical intestinal obstruction and biliary tract pneumatosis, and it can be used as the first choice for intestinal obstruction.MRI has the same display effects on ectopic stones with CT,and it is easy to be confused with pneumobilia and stones.However,its display on orificium fistulae is better than CT,and can be used as a supplementary check.