ESGAR和ESPR肠道MR成像肠道充盈规范在胃肠道肿瘤术后患者中的应用研究

Application of intestinal filling specifications of ESGAR and ESPR MR enterography recommendation in patients undergoing gastrointestinal tumor surgery

目的探讨欧洲胃肠和腹部放射学会(European Society of Gastrointestinal and Abdominal Radiology,ESGAR)和欧洲儿科放射学会(European Society of Paediatric Radiology,ESPR)肠道MR技术推荐中,肠道充盈规范在胃肠道肿瘤术后患者中应用的可行性,并初步分析胃肠道手术对小肠充盈扩张的影响。材料与方法回顾性分析2017年3月至2019年3月行小肠MR成像检查的胃肠道肿瘤术后随访患者的连续资料,肠道准备参照ESGAR及ESPR技术推荐执行,记录摄入对比剂体积。根据患者的手术史,将完成1500 mL推荐剂量摄取的受试者分为胃肿瘤术后组、小肠肿瘤术后组、结直肠肿瘤术后组。由两位医师分别在冠状位T2图像上测量十二指肠、空肠(近端及远端)、回肠(近端及远端)肠道直径,并按4分法评分,图像质量按3分法评分。采用Kruskal-Wallis H检验比较胃肿瘤术后组、小肠肿瘤术后组、结直肠肿瘤术后组的各肠段评分及图像质量评分。结果十二指肠、远端空肠、近端回肠、远端回肠的肠道充盈评分在胃肿瘤术后组、小肠肿瘤术后组和结直肠肿瘤术后组之间差异均无统计学意义(P>0.05);胃肿瘤术后组的近端空肠肠道充盈评分优于小肠肿瘤术后组,两组差异有统计学意义(调整后P<0.05);结直肠肿瘤术后组的近端空肠肠道充盈评分优于小肠肿瘤术后组(调整后P<0.05)。结论采用ESGAR和ESPR技术推荐对胃肠道肿瘤术后患者进行小肠MR成像随访,可以得到有良好图像质量且满足临床诊断要求的MR图像。除近端空肠外,胃肠道手术对于小肠充盈扩张无显著影响。

Objective:To investigate the feasibility of intestinal filling specifications of European Society of Gastrointestinal and Abdominal Radiology(ESGAR)and European Society of Paediatric Radiology(ESPR)recommendation of MR enterography in patients undergoing gastrointestinal tumor surgery and to analyze the effect of gastrointestinal surgery on bowel distention.Materials and Methods:A retrospective study was performed between Mar.2017 and Mar.2019,the consecutive patients who underwent gastrointestinal tumor surgery were included.Small bowel preparation was performed in accordance with the recommendation.The volume of the contrast agent was recorded.The patients who ingested 1500 mL of contrast agent were divided into the stomach tumor group,the small bowel tumor group and the colorectal tumor group according to the history of surgery.The diameters of the duodenum,jejunum(proximal and distal)and ileum(proximal and distal)were measured by two physicians and scored by 4 points and the image quality was assessed by 3 points.K-W test was used to compare the small bowel distension scores and the image quality of different groups.Results:There was no significant difference in the distension scores of duodenum,distal jejunum and proximal and distal ileum between each group(P>0.05).There was significantly better distention of the proximal jejunum(adjusted honestly significant difference,P<0.05)in stomach tumor group compared with the small bowel tumor group.There was significantly better distention of the proximal jejunum(adjusted honestly significant difference,P<0.05)in colorectal tumor group compared with the small bowel tumor group.Conclusions:ESGAR and ESPR techniques are recommended for people who need response assessment of post-operative gastrointestinal tumor evaluation.Gastrointestinal tumor surgery has no significant effect on the bowel distension with the exception of proximal jejunum.