MSCT及计算机后处理技术在确定肠梗阻部位中的应用价值  

The Application Value of Multi-Slice Spiral CT Thin-layer and Multiplanar Reformation Technique in the Location of Intestinal Obstruction

作　　者：许传军[1] 李晓东[2] 刘林祥[3] 邵长青[2] 蒋学美[4] 朱西琪[1] 

机构地区：[1]东南大学附属第二医院影像科,南京210003 [2]临沂市人民医院影像科,山东276000 [3]泰山医学院放射学院,泰安271016 [4]东南大学附属第二医院手术室,南京210003

出　　处：《临床放射学杂志》2011年第9期1382-1386,共5页Journal of Clinical Radiology

基　　金：山东省医药卫生科技发展计划项目(2009HZ099)

摘　　要：目的探讨多层螺旋CT(MSCT)薄层扫描及计算机后处理技术在确定肠梗阻部位中的临床应用价值。资料与方法回顾性分析经手术、肠镜和病理证实的肠梗阻患者108例,均采用64层GE Light speed VCT机进行三期动态增强扫描,将薄层容积扫描数据,在工作站进行后重组处理,获得兴趣区的多平面重组(MPR)图像、曲面重组(CPR)图像、滑动薄层块最大密度投影(STS-MIP)图像。对肠梗阻的梗阻部位做出诊断,然后与手术及肠镜结果进行逐一对照。统计比较两名阅片者在常规MSCT与MSCT结合计算机后处理图像诊断肠梗阻之间诊断符合率,双盲法阅片的诊断一致性以及肠梗阻诊断的信心指数评分。结果 MSCT及计算机后处理技术诊断肠梗阻平面的总符合率为82.4%。十二指肠、空肠、回肠、盲、升结肠、横结肠、降结肠、乙状结肠、直肠诊断符合比例分别为:9/9、16/21、24/35、10/11、6/7、9/9、11/12、4/4。如将病例分为十二指肠组、空、回肠组及结、直肠三组,其诊断符合率分别为:9/9、40/56、40/43。三者诊断符合率间有统计学差异(χ2=9.92,P=0.007<0.05)。两名阅片者在常规MSCT与MSCT结合计算机后处理图像诊断肠梗阻之间,诊断符合率分别为78.8%、82.4%,两者间无统计学差异(χ2=2.1429,P>0.05),但不同阅片者双盲法阅片的诊断一致性(k值)提高分别为0.71、0.82,阅片者的诊断信心进一步增加,两者存在明显的统计学差异(P=0.0285<0.05)。结论 MSCT及计算机后处理技术诊断肠梗阻在确定梗阻平面方面具有较高的诊断价值,十二指肠和结、直肠梗阻诊断符合率高于空、回肠梗阻诊断符合率,可以作为肠梗阻患者的首选检查技术。另外运用计算机后处理技术,可以提高不同诊断医师诊断一致性,提高对肠梗阻定位诊断信心指数。Objective To evaluate the clinical value of multi-slice spiral CT（MSCT） thin-layer and image post-processing in the location of intestinal obstruction.Materials and Methods 108 cases with intestinal obstruction confirmed by surgery or colonoscopy received plain and enhanced 64-MSCT scanning of the whole abdomen,followed with image post-processing techniques.Data were transferred to workstation to reconstruct,including multi-planar reconstruction（MPR）,curved planar reformations（CPR）,and volume rending（VR）.The location of intestinal obstruction were evaluated,MSCT findings were compared with pathology of surgery or colonoscopy one by one.Concordance of diagnosis,the score of confidence and accuracy of the two diagnostic methods mentioned above were compared.Results The accurate rate was 82.4%（89/108）in MSCT and image post-processing techniques in location of intestinal obstruction.In detail,the accurate rate of intestinal obstruction of duodenum,jejunum,ileum,cecal-ascending colon,transverse colon,descending colon,sigmoid colon,rectum was 9/9、16/21、24/35、10/11、6/7、9/9、11/12、4/4,respectively.When the cases were divided into three groups：duodenum group,jejunum-ileum group,and colon group,the accurate rate of the three groups was 9/9、40/56、and 40/43,which had a significant difference in three groups（χ2=9.92,P=0.0070.05）.Accurate rate get from routine MSCT and routine MSCT plus image post-processing techniques images were 78.8% and 82.4%,respectively,which had not a significant difference,but diagnosis with image post-processing techniques could improve consistency of two independent readers.（K values is 0.71 and 0.82 respectively）,also could improve the confidence score（P〈0.05）.Conclusion MSCT and image post-processing techniques have high diagnostic value in location of intestinal obstruction.The accurate rate of diagnosis in duodenum obstruction and large bowel obstruction is higher than that in jejunum-ileum obstruction.MSCT and image post-processing techniques

关 键 词：肠梗阻 体层摄影术 X线计算机 多平面重组 诊断价值 

分 类 号：R816.5[医药卫生—放射医学]