本文選題：小腸 + CT小腸造影�。� 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:總結(jié)口服等滲甘露醇后正常小腸的MSCT表現(xiàn)及能譜曲線特點(diǎn),為小腸疾病的診斷提供對比依據(jù)。方法:本研究搜集我院自2015年2月-2016年12月期間經(jīng)臨床確診的無消化系統(tǒng)疾病的患者31例,其中男性14例,女性17例。所有病例均在口服等滲甘露醇后行CT檢查,其中6例行雙源CT雙能量掃描,本研究將小腸分為十二指腸、空腸及回腸三組,觀察并分析三組腸管腸腔充盈寬度、腸壁厚度、腸壁分層、腸壁平掃及增強(qiáng)雙期CT值、腸系膜脂肪密度及40-160keV單能量CT值。對各組段小腸腸腔充盈寬度、腸壁厚度、平掃及增強(qiáng)雙期CT值等指標(biāo)進(jìn)行單因素方差分析,方差一致時,采用One-way ANOVA檢驗,用LSD進(jìn)行兩兩比較;方差不一致時,采用Brown-Forsythe進(jìn)行檢驗,用Tamhane,s檢驗進(jìn)行多重比較,P0.05說明具有統(tǒng)計學(xué)意義。結(jié)果:1.正常小腸腸壁平均厚度為(2.00±0.16)mm,十二指腸、空腸及回腸腸壁平均厚度分別為(2.01±0.17)、(2.00±0.15)、(1.99±0.15)mm,各組間差異無統(tǒng)計學(xué)意義;2.正常小腸平均充盈寬度為(23.24±3.23)mm,十二指腸、空腸及回腸平均充盈寬度分別為(25.31±3.03)、(23.53±2.33)、(20.89±2.62)mm,各組間差異有統(tǒng)計學(xué)意義;3.正常小腸腸壁分層較少見,本組數(shù)據(jù)顯示6.5%的十二指腸腸壁分層,余腸段腸壁均以單層為主;4.小腸各組段平掃CT值差異無統(tǒng)計學(xué)意義。同組段小腸增強(qiáng)雙期CT值差異具有統(tǒng)計學(xué)意義,各組段小腸門靜脈期CT值均高于動脈期。而同一期相各組段小腸CT值差異具有統(tǒng)計學(xué)意義,各組段小腸CT值由近及遠(yuǎn)逐漸減低;5.正常小腸腸系膜脂肪密度平均CT值為-96.11HU,標(biāo)準(zhǔn)差為14.35HU,最高值為-67HU,最低值為-131HU。6.平掃小腸各組段在40-160keV單能量的CT值差異均無統(tǒng)計學(xué)意義。動脈期,小腸各組段在40-100keV單能量的CT值差異具有統(tǒng)計學(xué)意義,在110-160keV單能量的CT值差異無統(tǒng)計學(xué)意義。靜脈期,小腸各組段在40-80keV單能量的CT值差異具有統(tǒng)計學(xué)意義,在90-160keV單能量的CT值差異無統(tǒng)計學(xué)意義。結(jié)論:正確認(rèn)識正常小腸CTE表現(xiàn)及能譜曲線特點(diǎn)有助于小腸病變的診斷。目的:探討口服大劑量等滲甘露醇CT小腸造影結(jié)合能譜成像在常見小腸惡性腫瘤診斷中的臨床應(yīng)用價值。方法:收集我院2015年2月-2016年12月期間經(jīng)手術(shù)病理證實的常見小腸惡性腫瘤患者的影像學(xué)資料及臨床資料,共51例,其中間質(zhì)瘤29例,腺癌13例,淋巴瘤9例。所有病例均在口服等滲甘露醇后行CT檢查,其中18例行雙源CT雙能量掃描。觀察并分析三種常見小腸惡性腫瘤的CTE影像學(xué)特征及能譜曲線特點(diǎn),CTE影像特征包括腫瘤(腺癌、間質(zhì)瘤及淋巴瘤)的發(fā)病部位、形態(tài)、大小、生長方式、強(qiáng)化方式、鄰近區(qū)域淋巴結(jié)有無腫大、鄰近臟器受侵及轉(zhuǎn)移等。對腺癌、間質(zhì)瘤及淋巴瘤三組患者的性別及不同危險度間質(zhì)瘤的MSCTE影像學(xué)指標(biāo)(腫瘤形態(tài)、最大徑、生長方式、邊界及強(qiáng)化程度等)采用卡方檢驗,對腺癌、間質(zhì)瘤及淋巴瘤三組腫瘤的發(fā)病年齡、40-160ke V單能量CT值進(jìn)行方差齊性檢驗和單因素方差分析,三組間均數(shù)不同時,兩兩之間比較采用LSD法。P0.05為差異具有統(tǒng)計學(xué)意義。結(jié)果:1.本組13例腺癌,位于回腸6例,十二指腸4例,空腸3例。8例病變腸管呈環(huán)形增厚、管壁僵硬,5例呈腸管內(nèi)軟組織腫塊;9例邊界不清,4例邊界清楚;8例密度均勻,5例密度不均,其中2例病灶內(nèi)可見液化壞死區(qū);增強(qiáng)掃描多呈較明顯不均勻強(qiáng)化;本組4例可見腸系膜根部或腹膜后腫大淋巴結(jié),1例出現(xiàn)肝臟轉(zhuǎn)移。2.本組29例間質(zhì)瘤,位于空腸12例,回腸9例,十二指腸8例,6.90%(2/29)經(jīng)病理證實為極低度危險性間質(zhì)瘤,37.93%(11/29)為低度危險性間質(zhì)瘤,6.90%(2/29)為中度危險性間質(zhì)瘤,48.28%(14/29)為高度危險性間質(zhì)瘤,經(jīng)統(tǒng)計學(xué)分析,不同危險度間質(zhì)瘤的形態(tài)、最大徑、生長方式、密度、邊界、腫瘤血管及轉(zhuǎn)移的差異具有統(tǒng)計學(xué)意義,而強(qiáng)化程度差異無統(tǒng)計學(xué)意義。本研究結(jié)果顯示,腫瘤最大徑5cm、邊界不清、密度不均、增強(qiáng)掃描呈明顯不均勻強(qiáng)化、鄰近組織器官侵犯及遠(yuǎn)處轉(zhuǎn)移等征象高度提示高度危險性間質(zhì)瘤。3.本組9例淋巴瘤,位于回腸7例、十二指腸2例。6例小腸腸壁不均勻增厚,病變累及范圍較廣,其中5例病變腸腔呈動脈瘤樣擴(kuò)張,3例呈腸腔內(nèi)息肉樣軟組織腫塊,其中1例合并腸套疊;平掃7例密度均勻、2例密度不均;增強(qiáng)后病灶呈輕中度延遲強(qiáng)化;5例合并腸系膜或腹膜后淋巴結(jié)腫大,其中3例可見“漢堡包征”。4.常見小腸惡性腫瘤強(qiáng)化特點(diǎn)及能譜曲線特點(diǎn):小腸淋巴瘤多呈輕中度延遲強(qiáng)化;間質(zhì)瘤多呈“快進(jìn)慢出”型強(qiáng)化;腺癌多呈“快進(jìn)快出”型強(qiáng)化。本研究結(jié)果顯示增強(qiáng)雙期,腺癌、淋巴瘤及間質(zhì)瘤三組腫瘤在40-60ke V單能量的CT值差異具有統(tǒng)計學(xué)意義,且腺癌組和間質(zhì)瘤組的單能量CT值均大于淋巴瘤組,而三組腫瘤在70-160ke V單能量的CT值差異無統(tǒng)計學(xué)意義。但兩兩檢驗的結(jié)果顯示靜脈期腺癌組和間質(zhì)瘤組在40-60ke V單能量的CT值差異無統(tǒng)計學(xué)意義。結(jié)論:小腸CT造影能反映常見小腸惡性腫瘤的形態(tài)學(xué)特征;而通過能譜曲線可對其進(jìn)行定量分析。小腸CT造影結(jié)合能譜曲線特點(diǎn)為小腸腫瘤的診斷提供了新的思路和方法,具有較高的臨床應(yīng)用價值。
[Abstract]:Objective: To sum up the characteristics of MSCT and spectral curves of normal small intestine after oral isotonic mannitol, and to provide a comparative basis for the diagnosis of small intestinal diseases. Methods: This study collected 31 patients who had been clinically confirmed without digestive system diseases during the period of December February 2015, 14 of them and 17 in women. All cases were taken orally. CT examination was performed in 6 cases with double source CT scanning. The small intestine was divided into three groups of duodenum, jejunum and ileum, and three groups of intestinal cavity filling width, intestinal wall thickness, intestinal wall stratification, intestinal wall plain scan and enhanced double phase CT value, mesenteric fat density and 40-160keV single energy CT value were observed. The width of the cavity, the thickness of the intestinal wall, the plain scan and the enhancement of the two phase CT value were analyzed with single factor variance. When the variance was consistent, the One-way ANOVA test was used and the LSD was used for 22 comparison. When the variance was not consistent, Brown-Forsythe was used to test, and Tamhane, s test was used for multiple comparison. P0.05 showed statistical significance. Results: 1. normal small. The average thickness of intestinal wall was (2 + 0.16) mm, the average thickness of duodenum, jejunum and ileum was (2.01 + 0.17), (2 + 0.15) and (1.99 + 0.15) mm, and there was no statistical difference between each group. 2. normal small intestine filling width was (23.24 + 3.23) mm, and the average filling width of duodenum, jejunum and ileum was respectively (25.31 + 3.03), and the average filling width of duodenum, jejunum and ileum was respectively (25.31 + 3.03). 33) (20.89 + 2.62) mm, the difference between each group was statistically significant; 3. the intestinal wall stratification of normal small intestine was rare. The data of the duodenum wall in this group showed that 6.5% of the duodenum wall was stratified and the intestinal wall of the remaining intestine was the single layer. The difference of the CT value of the small intestinal segments was not statistically significant. The difference of the CT value of the two stages of the small intestine enhancement in the same group was statistically significant, and the segments were small in each group. The CT value of the enteric portal vein was higher than that of the arterial phase, but the difference in the CT value of small intestine in each stage of the same phase was statistically significant, and the CT value of small intestine in each group decreased gradually, and the average CT value of 5. normal intestinal mesentery was -96.11HU, the standard deviation was 14.35HU, the highest was -67HU, the lowest value was -131HU.6. flat small small intestine segments in 40-160keV. There was no statistically significant difference in the CT value of single energy. In the arterial phase, the difference in the CT value of the single energy of the small intestine in the single energy of the small intestine was statistically significant, and there was no statistical significance in the CT value of the single energy of the 110-160keV. In the venous phase, the difference in the CT value of the single energy of the small intestine at the CT value of the single energy of the small intestine was statistically significant, and the CT difference in the single energy of 90-160keV was different. No statistical significance. Conclusion: a correct understanding of the characteristics of normal small intestinal CTE and spectral curves is helpful for the diagnosis of small intestinal lesions. Objective: To explore the clinical value of oral large dose isosotic mannitol CT small bowel angiography combined with energy spectrum imaging in the diagnosis of common small intestinal malignant tumors. Methods: our hospital was collected during the period of December -2016 February 2015. The imaging data and clinical data of the patients with common intestinal malignant tumor confirmed by pathology were 51 cases, including 29 cases of stromal tumors, 13 cases of adenocarcinoma and 9 cases of lymphoma. All cases were examined by CT after oral administration of mannitol, of which 18 cases were treated with double source CT double energy scan. The CTE imaging features of three common small intestinal malignant tumors were observed and analyzed. Characteristics of the spectrum curve, CTE image features include the site of the tumor (adenocarcinoma, stromal tumor and lymphoma), morphology, size, growth mode, strengthening mode, lymph node enlargement in adjacent area, invasion and metastasis of adjacent viscera, and the MSCTE imaging index of sex and different risk of stromal tumors in three groups of adenocarcinoma, stromal tumor and lymphoma (tumor morphology, maximum diameter, growth mode, boundary and intensification degree, etc.) by chi square test, the onset age of three groups of adenocarcinoma, stromal tumor and lymphoma, 40-160ke V single energy CT value was tested by variance homogeneity test and single factor variance analysis, the number of three groups was different, and 22 compared with LSD.P0.05 as the difference was statistically significant Results: 1. the 13 cases of adenocarcinoma in the group, 6 cases in the ileum, 4 cases in the duodenum, 3 cases of.8 in the jejunum, the thickening of the intestinal tube, the rigid tube wall, the 5 cases of the soft tissue mass in the intestinal canal, 9 cases with unclear boundary and the clear boundary in 4 cases, 8 cases with uniform density and 5 cases of density uneven, among which 2 cases showed liquefied necrotic area in the lesion, and the enhanced scan showed more obvious uneven. There were 4 cases of mesenteric root or retroperitoneal lymphadenoma in 4 cases, 1 cases of liver metastases in 29 cases of interstitial tumor, 12 cases in jejunum, 9 ileum, 8 duodenum, 6.90% (2/29) proved to be extremely low risk stromal tumor, 37.93% (11/29) as low risk stromal tumor, 6.90% (2/29) as moderate risk stromal tumor, 4 8.28% (14/29) was a highly dangerous stromal tumor. Statistical analysis showed that the morphology, maximum diameter, growth mode, density, boundary, tumor blood vessel and metastasis of different risk were statistically significant, but there was no significant difference in the degree of enhancement. The results of this study showed that the maximum diameter of the tumor was 5cm, the boundary was unclear, density was uneven, enhanced scan. There were 9 cases of high risk interstitial tumor.3. in this group, 7 cases in ileum, 2 cases in duodenum and 2 cases of.6 in the duodenum, with a wide range of intestinal lesions, 5 of which were aneurysm like dilation in the intestinal cavity and 3 cases of polyposis in the intestinal cavity. Tissue mass, including 1 cases of intussusception, 7 cases with uniform density, 2 cases of uneven density, enhanced light and moderate delayed enhancement, 5 cases of mesenteric or retroperitoneal lymph node enlargement, and 3 cases of "Hamburg package".4. common small intestinal malignant tumor enhancement characteristics and characteristics: small and moderate delay in small intestinal lymphoma The results showed that the difference of CT value of the single energy of 40-60ke V in the three groups of enhanced double stage, adenocarcinoma, lymphoma and stromal tumor was statistically significant, and the single energy CT value of the adenocarcinoma group and the stromal tumor group was greater than that of the Lymphoma Group, and the three groups were swollen. There was no significant difference in the CT value of the single energy of 70-160ke V, but the results of 22 test showed that there was no statistical difference in the CT value of the single energy of 40-60ke V in the venous phase of the adenocarcinoma group and the stromal tumor group. Conclusion: the small intestinal CT contrast can reflect the morphological characteristics of the common malignant tumor of the small intestine, but the quantitative analysis can be done by the spectrum curve. The characteristics of small bowel CT angiography combined with energy spectrum curve provide new ideas and methods for the diagnosis of small intestinal tumors and have high clinical application value.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R730.44;R735.32

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