胆石性肠梗阻的CT和MRI影像学特征

Application Value of Multi-slice Spiral CT and MRI in the Diagnosis of Gallstone Ileus

目的探讨多层螺旋计算机体层成像(MSCT)及磁共振成像(MRI)在胆石性肠梗阻中的诊断价值。方法回顾性分析28例经手术证实的胆石性肠梗阻患者的病例资料,其中20例行MSCT检查,另8例行MRI检查,评估MSCT和MRI的表现结果(肠梗阻程度,异位结石位置、大小、数目,肠道积气、胆肠瘘及并发症发生情况)。结果MSCT表现显示肠梗阻20例,不完全性肠梗阻12例,完全性肠梗阻8例,异位结石32枚(回肠18枚、空肠9枚,胃内4枚,十二指肠球部1枚),胆囊积气15例,胆管积气8例,合并肠缺血5例。8例患者经MRI表现的肠梗阻程度、结石情况与MSCT结果相似。28例中5例合并胆肠瘘,16例MSCT显示瘘口,8例经MRI显示瘘口。结论MSCT及MRI均可用于胆石性肠梗阻的诊断,其中MRI在胆囊与十二指肠瘘口的显示上较MSCT清晰。

Objective To explore the application value of multi-slice spiral computed tomography(MSCT)and magnetic resonance imaging(MRI)in the diagnosis of gallstone ileus.Methods Retrospective analysis was performed on the data of 28 cases with cholelithiolic ileus which confirmed by surgery,among which 20 cases underwent MSCT examination and the other 8 cases underwent MRI examination,to evaluate the performance results of MSCT and MRI(the degree of gallstone ileus,the location,size and number of ectopic stones,intestinal gas accumulation,biliary intestinal fistula and the occurrence of complications).Results MSCT showed 20 cases of intestinal obstruction,12 cases of incomplete intestinal obstruction,8 cases of complete intestinal obstruction,32 cases of ectopic stones(18 in ileum,9 in jejunum,4 in stomach,1 in duodenal bulb),15 cases of gallbladder pneumatosis,8 cases of bile duct pneumatosis,and 5 cases of combined intestinal ischemia.The intestinal obstruction degree and stone situation in 8 patients by MRI were similar to those by MSCT.Among the 28 patients,there were 5 cases of biliary intestinal fistula,and 16 cases showed orificium fistulae by MSCT and 8 cases showed orificium fistulae by MRI.Conclusion Both MSCT and MRI can be used for the diagnosis of gallstone ileus,and MRI is clearer than MSCT in the display of gallbladder and duodenal fistula.