多層螺旋CT口服低張小腸造影的臨床應(yīng)用研究
發(fā)布時間：2018-08-17 09:03
【摘要】：第一部分三種不同中性對比劑MSCTE小腸擴張效果的對比研究目的:分析比較臨床懷疑小腸疾病患者口服三種不同中性對比劑小腸擴張程度的差異性,為臨床口服低張小腸造影選擇合適的對比劑提供依據(jù)。方法:收集我院2014年1月至3月期間臨床懷疑小腸疾病且無明確腸梗阻患者共60例,隨機分為三組并口服三種不同的中性對比劑,即2.5%等滲甘露醇組、純牛奶組、純凈水組各20例。60例患者均行CT增強雙期掃描,所有數(shù)據(jù)建薄后導(dǎo)入后臺獨立工作站進行圖像三維后重組,然后采用盲法原則經(jīng)過兩位具有豐富經(jīng)驗的放射科醫(yī)生分析重組圖像,判斷全組小腸及各段小腸擴張程度,最后對所測量數(shù)據(jù)進行統(tǒng)計學(xué)分析。結(jié)果:全組小腸整體擴張程度比較:三組差異有統(tǒng)計學(xué)意義,等滲甘露醇組擴張程度最好,與純牛奶組及純水組比較差異均有統(tǒng)計學(xué)意義(P0.05),純牛奶組與純凈水組比較差異無統(tǒng)計學(xué)意義(P0.05);組內(nèi)各段小腸比較:回腸擴張效果最好,空腸其次,十二指腸擴張效果稍差。結(jié)論:2.5%等滲甘露醇擴張小腸腸管效果最好,更利于發(fā)現(xiàn)小腸病變,可推薦臨床對懷疑小腸疾病患者口服2.5%等滲甘露醇行多層螺旋CT檢查。第二部分MSCTE對小腸疾病的診斷價值研究目的:探討多層螺旋CT口服低張小腸造影(MSCTE)對小腸疾病的臨床診斷價值。方法:收集我院2014年4月至2015年2月期間消化內(nèi)科及胃腸外科臨床診斷懷疑小腸疾病并符合本研究納入條件的患者共98例,CT掃描前按要求口服2.5%等滲甘露醇溶液1000～1500ml,所有患者均行多層螺旋CT軸位連續(xù)增強雙期掃描,通過橫斷位、冠矢狀位重建及曲面重組、血管成像技術(shù)觀察是否有小腸病變,若有小腸病變應(yīng)進一步觀察病變部位、大小、形態(tài)、強化特點、與周圍組織關(guān)系及遠處轉(zhuǎn)移情況,最后將MSCTE診斷結(jié)果與最終臨床診斷作對照分析。結(jié)果:本研究98例患者中,53例患者MSCTE診斷發(fā)現(xiàn)有小腸疾病,沒有發(fā)現(xiàn)小腸病變者共45例,而最終臨床診斷共58例有小腸病變,40例無小腸病變。MSCTE診斷共漏診5例,其中包括空腸腺癌1例、腹型過敏性紫癜1例、腸結(jié)石1例、小腸血管畸形2例,誤診2例,包括空腸腺癌誤診為淋巴瘤1例、腹型過敏性紫癜誤診為腸結(jié)核1例。本研究中MSCTE診斷小腸疾病的靈敏度為91.38%(53/58),特異度為100%(40/40),陽性預(yù)測值為100%(53/53),陰性預(yù)測值為88.89%(40/45),診斷正確率為92.86%((51+40)/98)。58例小腸病變中,腫瘤性病變共26例,其中腺癌13例,發(fā)生于十二指腸3例,2例表現(xiàn)為十二指腸降段及水平段起始部管壁環(huán)形增厚,增強輕中度強化,腸腔輕度狹窄,1例表現(xiàn)為十二指腸降段突向腔內(nèi)的軟組織結(jié)節(jié)影,增強明顯均勻強化,3例均未引起近段腸梗阻征象;發(fā)生于空腸5例,位于空腸近端2例,1例表現(xiàn)為腔內(nèi)類圓形軟組織腫塊影,增強明顯均勻強化,1例表現(xiàn)為腸壁明顯增厚伴異常強化,2例均引起十二指腸梗阻擴張,位于空腸中遠段2例,1例為絨毛狀腺瘤惡變?yōu)檎骋合侔?表現(xiàn)為空腸遠段腔內(nèi)較大分葉狀腫塊影,同時可見近段腸管內(nèi)膠囊內(nèi)鏡滯留,1例表現(xiàn)為空腸壁不規(guī)則增厚伴腸腔擴張,MSCTE誤診為小腸淋巴瘤,1例MSCTE漏診;發(fā)生于回腸(包括回盲部)共5例,2例表現(xiàn)為回腸壁局限性環(huán)形增厚,3例為回盲部腫塊影,其中1例侵犯升結(jié)腸并引起低位小腸梗阻。小腸淋巴瘤4例,均表現(xiàn)為較長范圍的腸壁環(huán)形增厚、腸腔不狹窄,2例可見腹腔腹膜后多發(fā)淋巴結(jié)增大。小腸間質(zhì)瘤6例,其中3例表現(xiàn)為腔內(nèi)均勻明顯強化的軟組織腫塊影(最大徑5cm),邊界較清晰,動脈期病灶內(nèi)可見多發(fā)血管影,3例表現(xiàn)為較大囊實性腫塊影,其內(nèi)見較多液化壞死及氣體影。小腸脂肪瘤3例,均表現(xiàn)為小腸內(nèi)多發(fā)結(jié)節(jié)狀脂肪密度影。小腸炎癥性病變共24例,其中克羅恩病4例,均表現(xiàn)為空回腸多節(jié)段性腸壁增厚伴腸壁強化,一例伴有腹腔膿腫形成并侵犯右腹直肌,一例伴有腸系膜多發(fā)小膿腫及肛周膿腫形成;潰瘍性結(jié)腸炎3例,2例表現(xiàn)為降結(jié)腸、乙狀結(jié)腸及直腸黏膜異常強化,肌層水腫,漿膜層模糊不清,1例表現(xiàn)為全結(jié)腸連續(xù)性腸壁增厚并異常強化,腸系膜增厚且明顯強化;腸結(jié)核7例,3例表現(xiàn)為廣泛腹膜、系膜增厚呈"腹繭癥",小腸被聚集且腸壁彌漫性增厚,腹腔多發(fā)淋巴結(jié)增大,環(huán)形強化,4例表現(xiàn)為回腸末端、回盲部腸壁增厚、異常強化,腹腔積液,腹膜增厚;腹型過敏性紫癜5例,3例表現(xiàn)為小腸節(jié)段性腸粘膜增粗、明顯強化,腸腔未見狹窄,其中1例合并盆腔積液,1例表現(xiàn)為回盲部及回腸末端腸壁增厚,腹腔腹膜后多發(fā)淋巴結(jié)增大,腹膜增厚,MSCTE誤診為腸結(jié)核,1例MSCTE漏診。一般炎癥性疾病5例。腸結(jié)石1例,MSCTE漏診。腸系膜血管病變7例,包括腸系膜扭轉(zhuǎn)2例,均不伴有腸壁缺血壞死,腸系膜上靜脈及門靜脈血栓2例,較長范圍小腸壁缺血壞死,腸系膜上動脈栓塞1例,節(jié)段性小腸壁水腫增厚,小腸血管畸形2例,MSCTE漏診。結(jié)論:小腸腫瘤性病變、炎癥性病變及血管性病變等在MSCTE上具有相對特征性的表現(xiàn),MSCTE能全面展示小腸腔內(nèi)外病變、腸系膜、系膜血管及其他臟器情況,對小腸疾病的診斷具有重要價值。
[Abstract]:Objective: To compare the effects of three different neutral contrast agents (MSCTE) on small intestinal dilatation in patients with suspected small intestinal diseases, and to provide evidence for the selection of suitable contrast agents for oral hypotonic enterography. Sixty patients with suspected small intestinal disease and no definite intestinal obstruction were randomly divided into three groups and treated with three different neutral contrast agents, namely, 2.5% isotonic mannitol group, pure milk group and pure water group, 20 patients in each group. Then the reconstructed images were analyzed by two experienced radiologists to judge the degree of dilatation of the whole small intestine and each segment of the small intestine. There was no significant difference between pure milk group and pure water group (P 0.05). Compared with pure water group, ileal dilatation was the best, jejunum was the second, and duodenal dilatation was slightly worse. Multislice spiral CT examination of 2.5% isotonic mannitol is recommended for patients suspected of small intestinal diseases. Part 2: The diagnostic value of MSCTE in small intestinal diseases. Objective: To investigate the clinical diagnostic value of MSCTE in small intestinal diseases. A total of 98 patients with suspected small intestinal diseases and eligible for inclusion in this study were diagnosed by gastrointestinal surgery and gastrointestinal surgery. Before CT scan, 2.5% isotonic mannitol solution was taken orally for 1000-1500 ml. All patients underwent axial continuous enhanced dual-phase multi-slice spiral CT scanning. Through transection, coronary-sagittal reconstruction and curved surface reconstruction, vascular imaging techniques were performed. If there are small intestinal lesions, we should further observe the location, size, shape, enhancement characteristics, relationship with surrounding tissues and distant metastasis. Finally, the MSCTE diagnosis results were compared with the final clinical diagnosis. Results: Among the 98 patients in this study, 53 patients were diagnosed with small intestinal diseases by MSCTE, without any occurrence. There were 45 cases of small intestinal lesions and 58 cases of small intestinal lesions and 40 cases of non-small intestinal lesions. 5 cases were missed by MSCTE, including 1 case of jejunal adenocarcinoma, 1 case of abdominal allergic purpura, 1 case of enterolithiasis, 2 cases of small intestinal vascular malformation, 2 cases of misdiagnosis, including 1 case of jejunal adenocarcinoma misdiagnosed as lymphoma, 1 case of abdominal allergic Pura misdiagnosed as intestinal nodules. The sensitivity, specificity, positive predictive value and negative predictive value of MSCTE were 91.38% (53/58), 100% (40/40), 100% (53/53), 88.89% (40/45) and 92.86% ((51+40)/98). Among 58 cases of small intestinal lesions, 26 were malignant, including 13 adenocarcinoma, 3 duodenum and 2 duodenum. The wall of the descending and horizontal segments of the duodenum was thickened circularly, slightly and moderately enhanced, and the intestinal cavity was narrowed slightly. One case showed soft tissue nodules protruding from the descending segment of the duodenum. The enhancement was uniformly enhanced. No proximal intestinal obstruction was found in 3 cases. Soft tissue mass showed marked homogeneous enhancement. One case showed marked thickening of intestinal wall with abnormal enhancement. Two cases had duodenal obstruction and dilatation. Two cases were located in the middle and distal part of the jejunum. One case was malignant transformation of villous adenoma into mucinous adenocarcinoma. Large lobular mass was seen in the distal part of the jejunum. There were 5 cases of irregular thickening of jejunal wall with dilatation of intestinal cavity, 1 case of misdiagnosis of small intestinal lymphoma by MSCTE, 1 case of missed diagnosis by MSCTE, 2 cases of localized circular thickening of ileocecal wall, 3 cases of ileocecal mass, and 1 case of ascending colon with low intestinal obstruction. There were 6 cases of small intestinal stromal tumors, 3 of which showed homogeneous and markedly enhanced soft tissue mass (maximum diameter 5 cm), clear boundary, multiple vascular shadow in arterial phase, 3 of which showed large cystic and solid mass, and more in them. Liquefied necrosis and gas shadow. 3 cases of small intestinal lipoma showed multiple nodular fat density shadows in the small intestine. 24 cases of small intestinal inflammatory lesions, including 4 cases of Crohn's disease, were manifested as multiple segmental thickening of jejuno-ileal intestinal wall with intestinal wall enhancement, one case with abdominal abscess formation and invasion of right rectus abdominis, one case with multiple mesenteric abscesses. 3 cases of ulcerative colitis, 2 cases of descending colon, abnormal enhancement of sigmoid and rectal mucosa, myoedema, vague serosa, 1 case of total colon continuous intestinal wall thickening and abnormal enhancement, mesentery thickening and obvious enhancement; 7 cases of intestinal tuberculosis, 3 cases of extensive peritoneum, mesenteric thickening was "abdominal cocoon disease" The small intestine was gathered and diffuse thickening of the intestinal wall, multiple lymph node enlargement and circular enhancement of the abdominal cavity. 4 cases showed thickening and abnormal enhancement of the ileocecal intestinal wall at the end of the ileum, peritoneal effusion, peritoneal thickening; 5 cases of abdominal allergic purpura, 3 cases showed segmental thickening of the intestinal mucosa, obvious enhancement, and no stricture of the intestine, including 1 case with pelvic effusion. One case was misdiagnosed as intestinal tuberculosis by MSCTE, and the other was misdiagnosed as intestinal tuberculosis by MSCTE. There were 5 cases of general inflammatory diseases, 1 case of intestinal calculi, 1 case of MSCTE misdiagnosis. There were 2 cases of portal vein thrombosis, 1 case of ischemic necrosis of small intestinal wall, 1 case of superior mesenteric artery embolism, 2 cases of segmental small intestinal wall edema, 2 cases of small intestinal vascular malformation, and MSCTE missed diagnosis. Mesentery, mesangial vessels and other organs are of great value in the diagnosis of small bowel diseases.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R816.5;R574
本文編號：2187133
[Abstract]:Objective: To compare the effects of three different neutral contrast agents (MSCTE) on small intestinal dilatation in patients with suspected small intestinal diseases, and to provide evidence for the selection of suitable contrast agents for oral hypotonic enterography. Sixty patients with suspected small intestinal disease and no definite intestinal obstruction were randomly divided into three groups and treated with three different neutral contrast agents, namely, 2.5% isotonic mannitol group, pure milk group and pure water group, 20 patients in each group. Then the reconstructed images were analyzed by two experienced radiologists to judge the degree of dilatation of the whole small intestine and each segment of the small intestine. There was no significant difference between pure milk group and pure water group (P 0.05). Compared with pure water group, ileal dilatation was the best, jejunum was the second, and duodenal dilatation was slightly worse. Multislice spiral CT examination of 2.5% isotonic mannitol is recommended for patients suspected of small intestinal diseases. Part 2: The diagnostic value of MSCTE in small intestinal diseases. Objective: To investigate the clinical diagnostic value of MSCTE in small intestinal diseases. A total of 98 patients with suspected small intestinal diseases and eligible for inclusion in this study were diagnosed by gastrointestinal surgery and gastrointestinal surgery. Before CT scan, 2.5% isotonic mannitol solution was taken orally for 1000-1500 ml. All patients underwent axial continuous enhanced dual-phase multi-slice spiral CT scanning. Through transection, coronary-sagittal reconstruction and curved surface reconstruction, vascular imaging techniques were performed. If there are small intestinal lesions, we should further observe the location, size, shape, enhancement characteristics, relationship with surrounding tissues and distant metastasis. Finally, the MSCTE diagnosis results were compared with the final clinical diagnosis. Results: Among the 98 patients in this study, 53 patients were diagnosed with small intestinal diseases by MSCTE, without any occurrence. There were 45 cases of small intestinal lesions and 58 cases of small intestinal lesions and 40 cases of non-small intestinal lesions. 5 cases were missed by MSCTE, including 1 case of jejunal adenocarcinoma, 1 case of abdominal allergic purpura, 1 case of enterolithiasis, 2 cases of small intestinal vascular malformation, 2 cases of misdiagnosis, including 1 case of jejunal adenocarcinoma misdiagnosed as lymphoma, 1 case of abdominal allergic Pura misdiagnosed as intestinal nodules. The sensitivity, specificity, positive predictive value and negative predictive value of MSCTE were 91.38% (53/58), 100% (40/40), 100% (53/53), 88.89% (40/45) and 92.86% ((51+40)/98). Among 58 cases of small intestinal lesions, 26 were malignant, including 13 adenocarcinoma, 3 duodenum and 2 duodenum. The wall of the descending and horizontal segments of the duodenum was thickened circularly, slightly and moderately enhanced, and the intestinal cavity was narrowed slightly. One case showed soft tissue nodules protruding from the descending segment of the duodenum. The enhancement was uniformly enhanced. No proximal intestinal obstruction was found in 3 cases. Soft tissue mass showed marked homogeneous enhancement. One case showed marked thickening of intestinal wall with abnormal enhancement. Two cases had duodenal obstruction and dilatation. Two cases were located in the middle and distal part of the jejunum. One case was malignant transformation of villous adenoma into mucinous adenocarcinoma. Large lobular mass was seen in the distal part of the jejunum. There were 5 cases of irregular thickening of jejunal wall with dilatation of intestinal cavity, 1 case of misdiagnosis of small intestinal lymphoma by MSCTE, 1 case of missed diagnosis by MSCTE, 2 cases of localized circular thickening of ileocecal wall, 3 cases of ileocecal mass, and 1 case of ascending colon with low intestinal obstruction. There were 6 cases of small intestinal stromal tumors, 3 of which showed homogeneous and markedly enhanced soft tissue mass (maximum diameter 5 cm), clear boundary, multiple vascular shadow in arterial phase, 3 of which showed large cystic and solid mass, and more in them. Liquefied necrosis and gas shadow. 3 cases of small intestinal lipoma showed multiple nodular fat density shadows in the small intestine. 24 cases of small intestinal inflammatory lesions, including 4 cases of Crohn's disease, were manifested as multiple segmental thickening of jejuno-ileal intestinal wall with intestinal wall enhancement, one case with abdominal abscess formation and invasion of right rectus abdominis, one case with multiple mesenteric abscesses. 3 cases of ulcerative colitis, 2 cases of descending colon, abnormal enhancement of sigmoid and rectal mucosa, myoedema, vague serosa, 1 case of total colon continuous intestinal wall thickening and abnormal enhancement, mesentery thickening and obvious enhancement; 7 cases of intestinal tuberculosis, 3 cases of extensive peritoneum, mesenteric thickening was "abdominal cocoon disease" The small intestine was gathered and diffuse thickening of the intestinal wall, multiple lymph node enlargement and circular enhancement of the abdominal cavity. 4 cases showed thickening and abnormal enhancement of the ileocecal intestinal wall at the end of the ileum, peritoneal effusion, peritoneal thickening; 5 cases of abdominal allergic purpura, 3 cases showed segmental thickening of the intestinal mucosa, obvious enhancement, and no stricture of the intestine, including 1 case with pelvic effusion. One case was misdiagnosed as intestinal tuberculosis by MSCTE, and the other was misdiagnosed as intestinal tuberculosis by MSCTE. There were 5 cases of general inflammatory diseases, 1 case of intestinal calculi, 1 case of MSCTE misdiagnosis. There were 2 cases of portal vein thrombosis, 1 case of ischemic necrosis of small intestinal wall, 1 case of superior mesenteric artery embolism, 2 cases of segmental small intestinal wall edema, 2 cases of small intestinal vascular malformation, and MSCTE missed diagnosis. Mesentery, mesangial vessels and other organs are of great value in the diagnosis of small bowel diseases.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R816.5;R574
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9 鄧燕勇;磁共振小腸造影對Crohn病的診斷價值[D];浙江大學(xué);2004年
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