MSCT增强扫描在消化道穿孔的定位诊断价值

The Value of MSCT Enhancement Scanning in Localization Diagnosis of Gastrointestinal Perforation

目的探讨多层螺旋CT(MSCT)增强扫描在消化道穿孔的定位诊断价值。方法回顾性分析2015年1月至2019年5月42例经手术证实消化道穿孔患者的CT图像,患者术前均行全腹部CT平扫和以肝脏扫描计划设定的三期增强扫描,由两位高年资医师采用双盲法阅片分析患者的平扫及动脉期、门静脉期及平衡期图像,查找穿孔的位置,分析各期扫描检出破口的差异。结果上消化道(胃、十二指肠)穿孔22例,下消化道(空肠、回肠、阑尾、结肠和直肠)20例,对照手术结果,平扫和增强扫描动脉期、门静脉期及平衡期对穿孔破口位置检出符合率分别为52.4%、73.4%、90.5%、85.7%。增强扫描各期对比平扫对破口位置显示的差异均具有显著性(P<0.05),门静脉期检出率最高。结论全腹部MSCT增强扫描能提高消化道穿孔检出率,以门静脉期显示最佳,对提高消化道穿孔的定位诊断水平具有重要价值。

Objective To discuss the value of MSCT enhancement scanning in localization diagnosis of gastrointestinal perforation.Methods CT images of 42 patients with pneumoperitoneum and confirmed as gastrointestinal perforation by surgery from January 2015 to May 2019 were retrospectively analyzed.All patients underwent plain and triphasic enhanced abdominal CT scan set by the liver scan plan before operation.All images include plain scan,arterial phase,portal phase and equilibrium phase were analyzed by two senior radiologist using double-blind method,to find the location of the perfora-tion.The difference of accuracy in detecting perforation between four-phase scanning was investigated.Results 22 cases were located in the upper GI(stomach and duodenum),20 cases were located in the lower GI(include jejunum,ileum,ap-pendix,colon and rectum).Comparing with the results of operation,the coincidence rates of plain scan and enhanced scan at arterial phase,portal phase and equilibrium phase were 52.4%,73.4%,90.5%and 85.7%,There were significant differences in the location of the perforation between plain scan and four-phase enhanced scan(P<0.05).Conclusion The contrast-enhanced MSCT scan with arterial phase,portal phase and equilibrium phase can improve the detection rate of gastrointestinal perforation,especially in the portal phase.It is of good value for improving the accuracy in localization of gastrointestinal perforation.