【摘要】：目的：通過回顧性分析一組經(jīng)手術(shù)或結(jié)腸鏡病理證實及經(jīng)保守治療追蹤觀察臨床最終診斷的71例腸梗阻病例的CT資料：（1）分析腸梗阻的MSCT影像特征；（2）比較觀察單純橫斷面圖像和結(jié)合多平面重建圖像對腸梗阻的診斷價值；（3）分析52例增強病例MSCT診斷結(jié)果與平掃MSCT診斷結(jié)果對比，觀察CT平掃和CT增強對腸梗阻的部位診斷和病因診斷符合率比較，評估CT增強對腸梗阻的臨床應(yīng)用價值。 方法：使用GE light speed16排螺旋CT，71例腸梗阻病人均接受MSCT全腹部平掃，掃描結(jié)束后容積掃描信息送至GE圖像工作站進行圖像減薄及MPR處理，分析單純橫斷面圖像和結(jié)合MPR圖像對腸梗阻的部位和原因的影像表現(xiàn)特征和顯示能力，，評估MPR對腸梗阻診斷價值。分析52例CT增強組與71例CT平掃組比較觀察，評價增強MSCT對腸梗阻的臨床診斷價值。 結(jié)果：71例腸梗阻包括腸道腫瘤26例，結(jié)腸及回盲部炎癥9例，粘連性腸梗阻24例，腸外疝5例，膽石性腸梗阻2例，小腸克隆病、乙狀結(jié)腸扭轉(zhuǎn)、腹繭癥、術(shù)后腹腔內(nèi)紗布包塊粘連及腸管內(nèi)糞塊各1例。（1）16排螺旋CT對腸梗阻部位診斷符合率單純橫斷面組為78.9%（56/71），橫斷面圖像結(jié)合MPR組后為92.9％（66/71）（P0.05），但是運用MPR后更加直觀顯示移行帶位置及形態(tài)，掌握更多的診斷證據(jù)，使不同閱片者雙盲法診斷的一致性得到提高，分別為0.556，0.577。提高閱片者的信心（P0.01）。對病因診斷符合率單純橫斷面組為73.2%（52/71），橫斷面結(jié)合MPR組后為90.1%（64/71）（P0.05），（2）CT平掃組對梗阻部位診斷準確率為83.1%（59/71），CT增強組為90.4%（47/52）（P0.05）；對病因診斷準確率CT平掃組64.8%（46/71），CT增強組為90.4%（47/52）（P0.05）。 結(jié)論：1.MSCT單純橫斷面圖像結(jié)合MPR處理后圖像觀察，可提高腸梗阻的部位診斷及病因診斷符合率。雖然腸梗阻的部位診斷無統(tǒng)計學意義，但是運用MPR后使不同閱片者雙盲法診斷的一致性得到提高，并提高閱片者的信心。2.增強CT較平掃CT，對梗阻部位的診斷符合率無統(tǒng)計學意義，但對梗阻病因的診斷符合率有統(tǒng)計學意義。
[Abstract]:Objective: to analyze retrospectively the CT data of 71 cases of intestinal obstruction confirmed by operation or colonoscopy and followed up by conservative treatment: (1) to analyze the characteristics of MSCT images of intestinal obstruction; (2) to compare and observe the diagnostic value of simple cross-sectional images and multiplanar reconstruction images in intestinal obstruction, (3) to analyze the diagnostic results of MSCT and plain scan MSCT in 52 cases. To evaluate the clinical value of CT enhancement in the diagnosis of intestinal obstruction and to evaluate the clinical value of CT enhancement in the diagnosis of intestinal obstruction by observing the coincidence rate of CT plain scan and CT enhancement in the diagnosis of intestinal obstruction. Methods: GE light speed16 spiral CT,71 was used in all patients with intestinal obstruction. The information of volume scan was sent to the GE image workstation for image thinning and MPR processing at the end of the scan. To evaluate the diagnostic value of MPR in the diagnosis of intestinal obstruction, the imaging features and display ability of the location and cause of intestinal obstruction were analyzed by simple cross-sectional images and combined with MPR images. The clinical diagnostic value of enhanced MSCT in intestinal obstruction was evaluated by comparing 52 cases of CT enhancement group with 71 cases of CT plain scan group. Results 71 cases of intestinal obstruction included intestinal tumor in 26 cases, colonic and ileocecal inflammation in 9 cases, adhesive intestinal obstruction in 24 cases, intestinal hernia in 5 cases, cholelithiasis intestinal obstruction in 2 cases, intestinal clonosis, sigmoid volvulus, abdominal cocoon. Postoperative intraperitoneal gauze mass adhesion and intestinal fecal mass in 1 case. (1) 16-row spiral CT for the diagnosis of intestinal obstruction in the simple cross-section group was 78.9% (56 / 71), cross-sectional image combined with MPR group was 92.9% (66 / 71) (P0.05), but the use of MPR is more visual display. The position and shape of the transition zone, With more diagnostic evidence, the consistency of double blind diagnosis of different film readers was improved, which was 0.556n0.577. Improve the confidence of readers (P0.01). The coincidence rate for etiological diagnosis was 73.2% (52 / 71) in the cross-sectional group and 90.1% (64 / 71) in the cross-section combined with MPR group (P0.05), (2). The accuracy of diagnosis of obstructive site in CT plain scan group was 83.1% (59 / 71). The accuracy rate of CT plain scan group was 90.4% (47 / 52) (P0.05), and that of CT plain scan group was 90.4% (47r52) (P0.05). Conclusion 1. The coincidence rate of site diagnosis and etiological diagnosis of intestinal obstruction can be improved by simple cross-sectional images combined with MPR images. Although there was no statistical significance in the diagnosis of intestinal obstruction, the consistency of double blind diagnosis of different film readers was improved after MPR, and the confidence of film readers was improved. 2. The coincidence rate of enhanced CT in diagnosis of obstructive site was not statistically significant compared with that of plain scan CT, but the diagnostic coincidence rate of obstructive etiology was statistically significant.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.5;R574.2

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