MSCT对静脉硬化性结肠炎的影像诊断及临床价值

The Role of Radiological Findings in Patients Diagnosed with Phlebosclerotic Colitis

目的探讨多层螺旋CT(MSCT)对静脉硬化性结肠炎诊断与鉴别诊断的临床价值。方法回顾性分析7例静脉硬化性结肠炎患者的病例资料及其随访图像。全部病例均进行CT平扫,其中4例同时进行了对比剂增强扫描,所有CT图像通过最大密度投影(MIP)、多平面重组(MPR)影像后处理技术进行三维成像。结果7例中病变累及升结肠、横结肠近段2例,累及升结肠、全部横结肠1例,累及升结肠、横结肠及降结肠2例,累及升结肠、横结肠、降结肠及乙状结肠2例,CT平扫影像表现均为结肠旁或结肠壁内不规则细线状或树枝状钙化影。5例有不同程度肠梗阻及结肠周围炎症,表现为小肠及结肠扩张积液,内见多发液平,结肠壁不同程度增厚,约7~14 mm,结肠周围渗出,见缆绳征;4例少量腹腔积液;全部病例未合并穿孔、脓肿。其中手术治疗3例,保守支持治疗2例。另外2例无任何症状。结论MSCT对特发性肠系膜静脉钙化性结肠炎的诊断及鉴别诊断有较高的临床价值。

Objective To evaluate the value of MSCT in diagnosis of the Phlebosclerotic colitis.Methods A retrospective analysis phlebosclerotic colitis was conducted on 7 cases of phlebosclerotic colitis,including their follow-up images.MSCT scans were performed on all cases,with contrast-enhanced scans in 4 cases.Three-dimensional imaging using maximum density projection(MIP)and multiple planar reformation(MPR)post-processing techniques were applied to all CT images.Results Among the 7 cases,the lesions involved the ascending colon,the proximal segment of the transverse colon in 2 cases,the ascending colon and the entire transverse colon in 1 case,the ascending colon,the transverse colon and the descending colon in 2 cases,and the entire colon in 2 cases.All patients had pathognomonic imaging finding,consisting of multiple curvilinear calcifications distributed on the colonic and mesenteric vessels or associated with colonic wall thickening and adjacent fat stranding in the computed tomography images.Five cases presented with varying degrees bowel obstruction,dilation of the small intestine and colon with wall thickening of the colonic ranging from approximately 7-14 mm and pericolic inflammation(fat stranding),Small amount of ascites in four cases;and no perforation or abscess.Surgical intervention was performed on three patients while conservative support was provided for two others.The remaining two cases were asymptomatic.Conclusion MSCT play a crucial role in diagnosis and different diagnosis and management of phlebosclerotic colitis,and is the most useful diagnostic tool for evaluating the severity of mesenteric venous calcification and for its follow-up.