Computed tomography enterography-based radiomics for assessing mucosal healing in patients with small bowel Crohn's disease

BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.

Comparison of pancreatic acinar cell carcinoma and adenocarcinoma using multidetector-row computed tomography

AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy specimens.The preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were compared.The scan delay times were 40,70,and 120 s for each contrast-enhanced phase.The visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U test.RESULTS:The adenocarcinomas tended to be hypodense in all 4 phases.The acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were higher.Further,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast phase.The time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed phase.The time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 cases.None of the 6 acinar cell carcinomas showed peak enhancement during the delayed phase.CONCLUSION:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.

Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.

Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography:Now and in future

Multidetector-row computed tomography(MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years.In selected patients,MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography.Chiou et al reported a delicate infarcted myocardium at-risk score.According to their results,the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score(r = 0.841,P < 0.001).They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk.In this commentary,we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect,detecting reversible myocardial ischemia,assessing myocardial viability,estimating target lesion restenosis,and calculating of fractional flow reserve from MDCT.

Small intestinal lipomas:Diagnostic value of multi-slice CT enterography

AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed.The location,size,clinical and radiological aspects were discussed.RESULTS:Twelve patients presented with abdominal pain,of whom three complained of paroxysmal colic.Melena or bloody stools was mentioned in five cases.One lesion was detected incidentally during routine physical examination.One lesion was found unexpectedly during the preoperational evaluation for cholecystitis.Examination of the abdomen revealed palpable masses in four cases.Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from-130 HU to-60 HU.On contrast enhancement CT scan,no striking enhancement was seen.CONCLUSION:The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations,while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.

Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis

Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis.Clinically,patients present with early satiety,abdominal fullness,nausea,epigastric discomfort and eructation.Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases,in the absence of an organic gastric outlet obstruction.This case presents the longest video capsule retention in the medical literature to date.It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan.Finally,an unusual"plugging"of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient’s symptoms.

Differentiation of Lymphoma Presenting as Retroperitoneal Mass and Retroperitoneal Fibrosis： Evaluation with Multidetector-row Computed Tomography

Background： Retroperitoneal fibrosis （RPF） and lymphoma presenting as retroperitoneal mass may closely resemble each other and misdiagnosis may occur. This study investigated the differential imaging features of RPF and lymphoma which presented as a retroperitoneal soft tissue using multidetector-row computed tomography （MDCT）. Methods： The 42 consecutive patients were included in this retrospective review, including 19 RPF patients （45.2%; including 13 males and 6 females; mean age： 56.7 ± 6.2 years） and 23 patients with lymphoma （54.8%： including 14 males and 9 females： mean age： 57.4 ± 12.3 years）. An array of qualitative computed tomography （CT） features of lesions in 42 consecutive patients with newly diagnosed untreated RPF and lymphoma were retrospectively analyzed. The quantitative size of the lesion at the para-aortic region and attenuation in the precontrast, arterial, and portal phases were calculated in regions of interest and compared between the patients with newly diagnosed untreated RPF and with lymphoma. Receiver operating characteristic curve analysis was used to assess the potential diagnostic value of each quantitative parameter. Inter-reader concordance was also calculated. Results： Mean ages between patients with RPF and lymphoma were not significantly different （56.7 ±6.2 years vs. 57.4 ± 12.3 years P = 0.595）. Compared to those in patients with lymphoma, homogeneous enhancement （65.2% vs. 94.7%, P = 0.027） and pelvic extension （52.2% vs. 89.5%, P= 0.017） were significantly more common while the involvement of additional nodes （78.3% vs. 5.3%, P 〈 0.001）, suprarenal extension （60.9% vs. 15.8%, P = 0.004）, and aortic displacement （43.5% vs. 5.3%, P 0.006） were significantly less common in patients with RPF. Lesion size at the para-aorta was significantly greater in patients with lymphoma, compared with RPF patients （3.9 ± 1.2 cm vs. 1.8 ± 0.6 cm; P 〈 0.001 ）. The attenuation values in three phases were not significantly different between patients with RPF and lymphoma. Inter-reader concordance for subjective features ranged from very good to excellent （range： 85.7 100.0%）. Conclusions： This study showed that MDCT can help differentiate between untreated RPF and lymphonla on the basis of qualitative CT features and lesion sizes. Differentiating RPF from lymphoma on the basis of attenuation values in the precontrast, arterial, and portal phases was difficult to accomplish.

小肠CT造影对儿童克罗恩病临床活动分期的评价

目的 探讨小肠CT造影(CTE)对儿童克罗恩病临床活动分期的应用。资料与方法 回顾性收集2019年1月—2022年10月首都儿科研究所附属儿童医院收治的83例临床确诊儿童克罗恩病的临床及CTE影像学资料,依据儿童克罗恩病活动指数分为4组(缓解期11例、轻度活动期47例、中度活动期14例、重度活动期11例),收集CTE的各项参数指标,并分析CTE评估与儿童克罗恩病活动度分期的相关性。结果 4组CTE影像表现中,病变肠管范围(χ^(2)=49.934)、肠壁强化方式(χ^(2)=56.561)、肠管狭窄程度(χ^(2)=31.932)、肠壁厚度(χ^(2)=46.535)、肠周淋巴结肿大(χ^(2)=17.330)差异有统计学意义(P<0.05)。儿童克罗恩病活动指数活动期病变(轻-重度活动期)CTE影像表现为受累肠管范围大(>50 mm)(31例,37.3%)、肠壁分层强化多见(27例,32.5%)、肠腔狭窄(<5 mm)(19例,22.9%)及肠壁明显增厚(>5.0 mm)(54例,65.1%)、肠周淋巴结肿大(>7 mm)(16例,19.3%)出现比例高。其中病变肠管范围(r=0.500)、病变肠壁强化方式(r=0.574)、肠腔狭窄(r=0.316)、肠壁增厚(r=0.533)与儿童克罗恩病临床活动分期呈正相关(P均<0.01)。结论 随着病变肠管范围增加、病变肠壁强化方式(均匀-分层)、肠腔狭窄及肠壁增厚程度加重,临床活动分期也逐渐加重,以上4项指标可作为反映儿童克罗恩病活动分期的特征性指标。

CT小肠造影对活动性克罗恩病的诊断价值

目的：本研究的目的是确定CT小肠造影（CT enterography,CTE）检查对活动性克罗恩病诊断价值。方法：回顾性分析58例确诊克罗恩病患者。男性47例,女性11例,平均年龄53.5岁。所有病例行小肠CTE检查。扫描范围从膈顶至盆腔。由2位不知道病理结果的放射科医生共同观察确定有无病变,病灶部位,累积肠段数目,肠壁厚度,肠壁强化,肠腔狭窄,肠外淋巴结,肠系膜水肿及血管改变,肠外炎症,瘘管及瘘道等,判断病变是否具有活动性。并将CTE检查结果与临床症状及内镜检查比较。结果：58例克罗恩病以回肠末端为最常见受累部位（54/58）,小肠单独受累（48/58）,小肠-结肠受累（10/58）。肠壁增厚（51/58）。累积肠段数目（107段）、肠壁厚度（3.2~21.5）mm,动脉期肠壁强化（56.2~89.4）HU静脉期（87.6~103.8）HU、肠腔狭窄（55/58）、肠外淋巴结（32/58）、肠系膜水肿及血管改变（50/58）、肠外炎症、瘘管及瘘道等（3/58）。临床症状及内镜检查证实的活动期患者51例,稳定期患者7例。2位医生诊断活动性克罗恩病阳性48例,3例稳定期病例误认为活动期。CTE诊断克罗恩病活动期的敏感度、特异度、阳性预测值及阴性预测值分别为（94%,48/51）、（40%,2/5）、（96%,48/50）、（38%,3/8）。结论：CT小肠造影对活动期克罗恩病诊断具有较高的价值,确诊还应结合临床及肠镜检查。CT小肠造影对早期克罗恩病诊断作用还有待研究。

口服等渗甘露醇SCT小肠造影诊断小肠肿瘤的临床研究

目的探讨口服大剂量5.07%等渗甘露醇螺旋CT小肠造影(spiral CT enterography,SCTE)在小肠肿瘤诊断中的临床应用价值。方法研究对象包括2004年1月～2008年10月间临床怀疑有小肠肿瘤性病变而行SCTE检查者60例、正常志愿者10例,动物实验(8只大鼠)。分析各种小肠肿瘤的SCTE表现,并比较了82例传统CT扫描与SCTE检查结果,分别计算出两种不同检查方法的敏感度、特异度、阳性预测值、阴性预测值。结果 70例SCTE检查者除2例回盲部充盈欠佳外,余病例十二指肠、空肠及回肠肠腔充盈良好,对肿瘤的显示、衬托满意。动物试验显示50min大鼠小肠充盈最佳。SCTE检查的敏感度97.22%(35/36)、特异度95.83%(23/24)、阳性预测值97.22%(35/36)、阴性预测值95.83%(23/24),高于传统法CT扫描之敏感度76.19%(32/42)、特异度75%(30/40)、阳性预测值76.19%(32/42)、阴性预测值75%(30/40),两种方法比较其敏感度、阳性预测值差异有统计学意义(2=5.45,2=5.45,P<0.05)。结论①口服等渗甘露醇SCTE是一种简便、安全、非侵袭性、有效评价小肠肿瘤的方法,能明显提高肿瘤的检出率;②口服等渗甘露醇SCTE双期增强扫描结合重建技术对小肠肿瘤定位、定性及肿瘤分期有较高临床价值。

多层螺旋CT小肠成像诊断肠道炎性病变的临床应用

目的探讨多层螺旋CT小肠成像(CTE)诊断肠道炎性病变的临床应用价值。方法怀疑肠道疾病行CTE检查的患者74例,以临床病理结果为标准,两位医生采用盲法分别对其CTE表现进行分析。结果两位医生通过CTE诊断肠道炎性病变的准确度分别为93.2%和94.6%。肠道炎性病变段肠壁增厚,与相邻正常肠壁之间的差别有统计学意义;病变段肠壁强化后的CT值较相邻正常肠壁CT值高,但差别未显示有统计学意义。结论 CTE检查能够多方位显示肠腔、肠壁、肠系膜和腹腔内淋巴结的异常情况,可以作为诊断肠道炎性病变的重要检查方法。

MSCT小肠造影联合胶囊内镜对小肠肿瘤的诊断价值

目的探讨多层螺旋CT小肠造影(MSCTE)及与胶囊内镜(CE)联合检查对小肠肿瘤的诊断价值。方法回顾性分析经手术病理证实的41例小肠肿瘤患者的MSCTE及CE资料,对比两种检查方法及联合应用对小肠肿瘤的检出率。结果 41例小肠肿瘤中:间质瘤(GIST)25例,脂肪瘤3例,腺癌9例,淋巴瘤4例;MSCTE与CE联合应用诊断小肠肿瘤的检出率为95.12%,明显高于单一检查方法(P<0.05)。结论 MSCTE联合CE可提高对小肠肿瘤的检出率,且对小肠肿瘤的临床术前诊断及治疗方案的制定具有重要的指导意义。

多层螺旋CT小肠造影对Crohn病的诊断价值评价

目的:探讨多层螺旋CT小肠造影对Crohn病的诊断价值。方法:回顾性分析经内镜、手术、病理证实的60例Crohn病的多层螺旋CT小肠造影影像学表现。结果:60例中多节段病变43例(72%),单独小肠受累21例(35%)、小肠和大肠同时受累35例(58%)、单独大肠受累4例(7%)。小肠累及的56例(93%)中,累及回肠末端39例(70%)。MSCTE所见包括:肠壁增厚60例(100%)、强化增加58例(97%)、肠壁分层39例(65%)、肠腔狭窄32例(53%)、肠壁脓肿5例(8%)、肠系膜血管增多("梳征")39例(65%)、病变肠管周围纤维脂肪增多19例(32%)、蜂窝织炎40例(67%)、腹腔脓肿和炎性肿块13例(22%)、窦道/瘘管15例(25%)、假憩室12例(20%)、多发淋巴结肿42例(70%)、肛周病变4例(7%)。肠管增厚、肠管分层、强化增加、肠壁内脓肿、病变肠管周围蜂窝织炎、血管增多(梳征)等可反应病变的活动性。动脉期与静脉期比较,未提供肠壁、肠管外病变的更多信息。结论:CT小肠造影可同时显示Crohn病的小肠和结肠病变,对肠壁病变及肠腔外并发症的显示以及在判断病变活动性方面有独特的优越性,可作为首选的影像学检查方法。

MDCT小肠造影技术在小肠疾病中的临床应用研究

目的:探讨多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。方法:对181例临床怀疑小肠病变患者术前行MDCTE平扫及多期增强扫描,图像行后处理,并与手术结果相对照。结果:本组181例患者中,58例MDCTE诊断为小肠病变,并与最终临床诊断相符。123例患者MDCTE诊断为阴性,108例符合,9例漏诊,6例误诊。MDCTE诊断小肠疾病的敏感性为79.45%,特异性为100%,诊断正确率为91.71%,阳性预测值为100%,阴性预测值为87.80%。本组资料中小肠肿瘤15例,其中腺癌5例,间质瘤3例,淋巴瘤1例,平滑肌瘤1例,肠系膜转移5例。小肠炎症性病变27例,其中克罗恩病16例,溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例。肠梗阻22例,其中腹内外疝9例,小肠扭转6例,小肠粘连性梗阻2例,幽门梗阻2例,胆石症2例,因克罗恩病肠壁增厚引起不全性小肠梗阻1例。小肠憩室2例,其中Meckel憩室1例,盲肠憩室伴慢性阑尾炎、阑尾结石1例。血管性病变3例,其中肠系膜上动脉栓塞1例,肠系膜上静脉血栓形成1例,肠道血管畸形1例。其他病变包括腹茧症2例,肠息肉1例,过敏性紫癜(腹型)1例。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠疾病的诊断具有重要价值。

胶囊内镜及小肠CT成像联合检查对小肠疾病的诊断价值

目的探讨胶囊内镜(CE)以及小肠CT成像(CTE)联合检查对小肠疾病的诊断价值。方法回顾性研究2011年9月-2016年4月在玉溪市人民医院诊治怀疑小肠疾病的患者198例,将患者分为3组,分别行CE、CTE检查、CE及CTE联合检查,对3组病例的病变检出率及病因诊断符合率进行对比,探讨CE及CTE联合检查在小肠疾病的应用价值。结果 CE患者72例,检出病变43例,漏诊4例,误诊2例,病变检出率59.7%(43/72),病因诊断符合率87.2%(41/47)。CTE患者86例,检出病变48例,漏诊7例,误诊3例,病变检出率55.8%(48/86),病因诊断符合率81.8%(45/55)。联合检查患者40例,检出病变32例,漏诊2例,病变检出率80.0%(32/40),病因诊断符合率94.1%(32/34),联合检查的病变检出率高于另外两组,其差异有统计学意义(P<0.05),病因诊断符合率与另外两组差异无统计学意义。结论 CE及CTE联合检查可提高小肠疾病的病变检出率,具有较好的临床价值。

多模态MR与CT小肠造影诊断小肠肿瘤性疾病的对比观察

目的:比较多模态MR小肠口服造影法与CT小肠造影在诊断小肠肿瘤性疾病中的价值。方法:对本院2012年2月至2014年8月对怀疑有小肠肿瘤的65例患者行CT和多模态MR小肠造影检查。由两位腹部影像学医师分别对CT及MR图像进行分析,记录十二指肠、近段空肠、远段空肠、近段回肠以及远段回肠肠管的病变累及情况,并与手术以及内镜活检病理结果进行对照。结果:经手术及内镜病理证实,65例中共37例患者有38个小肠肿瘤病灶(腺癌6例,淋巴瘤7例,间质瘤18例,神经内分泌肿瘤3例,海绵状血管瘤2例,脂肪瘤2例)。CT及MRI对小肠肿瘤性病变的检出率分别为97.4%(37/38)和94.7%(36/38);McNemar检验结果显示,CT小肠显像与多模态小肠MR口服造影法对于多部位侵犯的小肠肿瘤性病变的诊断敏感度和特异度的差异无统计学意义(P>0.05)。两例黏膜海绵状血管瘤伴出血仅在CT图像上显示。结论:多模态MR小肠口服造影法与CT小肠造影均是诊断小肠肿瘤性疾病的有效手段。

联合运用CTC和CTE诊断肠道疾病

目的探讨联合运用CTC和CTE诊断肠道疾病的价值。方法20例临床高度怀疑肠道疾病的患者(病变的确切部位不明),其中男12例,女8例。常规准备肠道后,运用GELightSpeed64层螺旋CT对所有患者行CTC和CTE联合检查,将结果与肠镜或手术病理结果对照。结果①9例消化道出血的患者中,7例CTC或CTE结果与病理结果吻合;1例CTE诊断与病理结果不符,1例无明显阳性发现。②6例因各种原因导致肠镜检查失败的患者中,3例CTE或CTC诊断发现有病变;3例无明显阳性结果。③5例肠道术后随访患者中,CTC和CTE均未发现明显异常征象。结论当临床高度怀疑肠道疾病但又不能明确病变部位、或因种种原因造成肠镜检查失败时,联合运用CTC和CTE在明确诊断方面有重要的临床意义。

多层CT小肠造影与单气囊小肠镜对小肠梗阻的诊断价值

目的探讨多层CT小肠造影(MSCTE)与单气囊小肠镜(SBE)在小肠梗阻性病变的诊断价值。方法收集2009年6月-2013年2月临床和/或腹部X线平片疑为小肠梗阻的患者30例。所有患者先行MSCTE检查,根据检查结果选择经口或经肛SBE检查。分析两种检查方法对小肠梗阻性病变的诊断率。结果①MSCTE检查诊断小肠梗阻的灵敏度为85.19%,特异度为66.67%,阳性预测值为95.83%,阴性预测值为33.33%。SBE检查分别为81.48%、100%、100%和37.50%。②MSCTE和SBE检出病变一致性为53.33%(16/30)。③根据MSCTE检查结果选择经口或经肛SBE检查,MSCTE检查阳性指导SBE选择进镜方式正确率高于MSCTE检查阴性(95.83%vs33.33%,P<0.05)。结论 MSCTE和SBE对小肠梗阻的诊断率相当,二者联合应用可提高对小肠梗阻性病变的诊断率。MSCTE检查结果可以指导SBE选择进镜方式。

256层多排螺旋CT小肠成像(MDCTE)对小肠疾病的诊断价值

目的:探讨256层多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。材料和方法:对118例临床怀疑小肠疾病患者,男53例,女65例,平均年龄48.5岁。行256-MDCTE平扫及增强扫描,通过横断面及多平面重建,观察病变部位、大小、形态、周围侵犯及转移情况,结果与最终临床诊断对照分析。结果:本组118例患者中,56例MDCTE诊断为小肠病变,并与最终临床诊断相符。另外62例MDCTE诊断为阴性,其中47例符合,9例漏诊,6例误诊。并且通过统计分析得出MDCTE对小肠疾病诊断的灵敏度为78.87%(56/71),特异度为100%(47/47),正确率为87.29%((56+47)/118),阳性预测值为100%(56/56),阴性预测值为75.80%(47/62)。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE对小肠疾病的临床诊治具有重要价值。

256层多排螺旋CT小肠成像对小肠炎症性病变的临床应用研究

目的:探讨256层多排螺旋CT小肠造影(MDCTE)扫描技术在小肠炎症性病变诊断中的临床应用价值。材料和方法:对118例临床怀疑小肠疾病患者(男53例,女65例,平均年龄48.5岁)行256-MDCTE平扫及增强扫描,通过横断面及多平面重建,观察病变部位、大小、形态、周围情况等与病理结果对照分析。结果:本组118例患者中,小肠炎症性病变25例(男13例,女12例,平均年龄45.5岁),其中Crohn病12例(因克隆恩病肠壁增厚引起不全性小肠梗阻1例),溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例,另外2例临床无法确诊。MDCTE诊断21例,4例漏诊者均为一般炎症。结论:小肠炎症性病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠炎症性疾病的诊断具有重要价值。