【摘要】：目的 探討CT在缺血性結腸炎(Ischemic Colitis, IC)的診斷及分期中的價值。 資料與方法 回顧性分析31例經(jīng)腸鏡證實的缺血性結腸炎患者的CT資料,所有病例行全腹CT平掃及增強掃描,并經(jīng)多平面重建(MPR)及CTA后處理,分析IC急性期、非急性期病變的影像學特征,并與結腸鏡檢查比較。 結果 病變較多累及左半結腸,較少累及直腸。主要表現(xiàn)為腸壁均勻對稱性增厚、腸壁分層、拇紋征、腸周脂肪間隙模糊或清晰。病變腸段黏膜連續(xù),呈節(jié)段性分布,管腔狹窄,腹腔積液。31例結腸鏡檢查及病理證實的IC患者中,CT檢查發(fā)現(xiàn)IC的符合率為77.42%(24/31)；其中急性期符合率為90.90%(10/11),非急性期為70.00%(14/20)。急性期與非急性期病變CT在腸壁厚度、拇紋征、腸周脂肪間隙清晰度、腸壁分層、黏膜下強化程度有統(tǒng)計學差異(P0.05)。CTA顯示腸系膜上下動脈主干存在異常陽性率為12.90%(4/31),MPR重建顯示病變腸段邊緣動脈增多改變。 結論 螺旋CT增強掃描及MPR檢查對缺血性結腸炎具有較高的診斷及鑒別診斷價值,對分期有較大的幫助,能指導臨床早期治療從而獲取較好療效。而CTA顯示腸系膜上下動脈主干多無栓塞,MPR重建顯示邊緣動脈增多改變提示IC非血管栓塞所致,可以與急性腸系膜缺血(acute mesenteric ischemia, AMI)相鑒別以避免盲目溶栓治療。
[Abstract]:objective
Objective to investigate the value of CT in the diagnosis and staging of Ischemic Colitis (IC).
Data and methods
CT data of 31 patients with ischemic colitis confirmed by enteroscopy were analyzed retrospectively. All patients underwent plain and enhanced CT scan of the whole abdomen. The imaging features of acute and non-acute lesions in IC were analyzed and compared with colonoscopy.
Result
The main manifestations were symmetrical thickening of the intestinal wall, stratification of the intestinal wall, thumbprint sign, blurred or clear periintestinal fat space. The lesions were continuous and segmental mucosa with narrow lumen and peritoneal effusion. In 31 patients with IC confirmed by colonoscopy and pathology, CT showed the coincidence rate of IC. The coincidence rate was 90.90% (10/11) in the acute phase and 70.00% (14/20) in the non-acute phase. There were significant differences in the intestinal wall thickness, thumbprint sign, intestinal fat clearance, intestinal wall stratification and submucosal enhancement between the acute phase and the non-acute phase (P 0.05). 0% (4/31), MPR reconstruction showed a change in the marginal artery of the lesion.
conclusion
Enhanced spiral CT scan and MPR examination have higher diagnostic and differential diagnostic value for ischemic colitis, and are helpful for staging and guiding early clinical treatment to obtain better curative effect. It can be differentiated from acute mesenteric ischemia (AMI) to avoid blind thrombolytic therapy.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R574.62

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