小肠活动性出血的MDCT诊断  

The diagnostic performance of MDCT in active small intestinal bleeding

作　　者：林承露 刘术松[1] 涂苍慨 

机构地区：[1]安徽省六安市第二人民医院放射科,安徽六安237008

出　　处：《医学影像学杂志》2012年第4期591-593,597,共4页Journal of Medical Imaging

摘　　要：目的探讨小肠活动性出血的MDCT表现,为寻找小肠出血原因提供依据。方法采用多层螺旋CT(Phil-ips Mx 8000Dual CT和Philips Brilliance 64CT)对15例临床诊断小肠活动性出血患者进行平扫和双期增强扫描(25s和60s)。除急诊患者外,扫描前行清洁肠道准备,并口服20%甘露醇和清水作为阴性对比剂。增强扫描使用300mg/ml碘海醇肘部静脉注射。重建图象层厚2.0mm,结合多平面重组图像对小肠肠腔、肠壁形态及密度进行观察,寻找出血点,并分析其病因,MDCT结果与手术或内镜结果进行对照。结果对照平扫图像,增强后动脉期局部小肠腔内出现高密度对比剂、静脉期其形态及密度有改变为小肠活动性出血的直接征象。15例患者中MDCT发现13例阳性对比剂外溢至肠腔内,15例局部肠壁增厚或肿块,增强后较明显强化。阳性对比剂外溢对活动性小肠出血定位诊断的敏感性、特异性、阳性和阴性预测值分别为97%、100%、100%、88%。阳性对比剂外溢、局部肠壁增厚伴异常强化的位置与手术或内镜所见出血部位高度一致。结论增强后动脉期局部小肠腔内出现高密度对比剂、静脉期其形态及密度有改变为小肠活动性出血的特异性征象;局部肠壁增厚伴异常强化也提示该处为可能的出血点。MDCT可寻找小肠活动性出血部位并为明确病因提供依据,具有较高的临床应用前景。Objective To investigate findings of multidetector CT for patients with active intestinal bleeding, and to search evidence for cause of bleeding. Methods 15 patients with clinical diagnosis of active lower gastrointestinal tract bleeding who had tarry stool several times recently, received multi-detector （16 or 64 row） CT inspection, which included plain scanning and double phase enhancement scanning （25 s and 60 s after contrast material injection by ulnar vein）. In- testinal tract clearing preparation and mannitol solutions drinking （as negative contrast agent） were executed before CT scanning, except for patients presenting to the emergency room. Slice thickness of 2.0 mm reconstruction, and multi-plane reformation were performed to help searching for the abnormal intestinal wall and enteric cavity. Presence and location of bleeding and likely cause of hemorrhage identified at MDCT were compared with the surgical or endoscopic findings. Re- sults Compared with plain scanning, intraluminal hyperattenuating material in small bowel at arterial phase, which the shape and optical density altered at venous phase, was the direct signs of active bleeding. MDCT demonstrated active bleeding in 13 of 15 patients, and local thickening wall of intestine, which was enhanced obviously, occurred after contrast material injection in all patients. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in fixing active bleeding were 97%, 100%, 100%, and 88%, respectively. Findings of MDCT and surgical or en- doscopic results were concordant for fixing the bleeding point. Conclusion The sign of intraluminal hyperattenuating ma- terial in small bowel at arterial phase, which the shape and optical density altered at venous phase, was the characteristic signs of active bleeding. The local thickening wall of intestine which was enhanced obviously occurred after contrast mate- rial injection hinted the location of active hemorrhage. MDCT is very useful to fix the location of active b

关 键 词：小肠 活动性出血 体层摄影术.X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学]