口服等渗甘露醇MR小肠造影  

MR enterography with oral isosmotic mannitol

作　　者：任小军 章士正[2] 张峭巍[2] 

机构地区：[1]西安西电集团医院放射科,西安7100772 [2]浙江大学医学院附属邵逸夫医院放射科,杭州310016

出　　处：《磁共振成像》2013年第6期405-410,共6页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨口服等渗甘露醇MR小肠造影检查方法及其对小肠疾病的诊断价值。材料与方法对临床怀疑小肠疾病的26例患者行MR小肠造影,检查前45 min开始分次口服2.5%等渗甘露醇1500 ml做为肠道对比剂,MR扫描前静脉注射山莨菪碱20 mg抑制肠蠕动。扫描序列包括:平扫:冠状面单次激发快速自旋回波(single-shot FSE,SSFSE)和快速扰相梯度回波(fast spoiled gradient echo,FSPGR);增强:冠状面和横断面FSPGR序列。记录患者不良反应,以差、良好、优等级评估小肠充盈效果和图像质量,将MR小肠造影诊断结果与手术、病理结果或最终临床诊断对照。结果除2例Crohn病患者感轻度恶心外,被检查者无其他不良反应。26例(100%)回肠和空肠远段、22例(85%)空肠近段充盈效果优良,4例空肠近段充盈效果差。呼吸运动伪影、肠蠕动伪影均为0例,少量磁敏感伪影2例,图像质量均为优。最终诊断结果为正常小肠12例,Crohn病7例,小肠梗阻(肠粘连引起)、腺癌、多发间质瘤(GIST)、十二指肠球炎、十二指肠结肠瘘、空肠毛细血管扩张症和小肠旋转不良各1例。1例空肠毛细血管扩张症MR小肠造影未发现异常,其余MR小肠造影诊断与手术、病理或临床诊断结果一致,诊断准确度为96%。结论口服等渗甘露醇MR小肠造影是一种易行、可靠的小肠检查方法,对诊断小肠Crohn病、肿瘤和肠梗阻具有重要价值。Objective： To discuss the method and diagnostic value of MR emero- graphy with oral isosmotic mannitol. Materials and Methods： Twenty-six patients with suspected small bowel disease received MR enterography. All patients ingested 1500 ml of 2.5% isosmotic mannitol solution in succession as intraluminal contrast media and received 20 mg of IV anisodamine to reduce small-bowel peristalsis before MR scan. MRI sequences included： fat-saturated unenhanced coronal T2-weighted single-shot FSE （SSFSE）, TI weighted coronal fast spoiled gradient echo （FSPGR） and enhanced coronal and axial FSPGR. The side effects were recorded and the image quality was graded as bad, good and excellent. Comparison of the results between MR enterography and surgery, pathology or clinic was performed. Results： MR enterography was well tolerated by all patients. No side effect occured except 2 patients had mild nausea during the examination. Good or excellent filling and distension were obtained in ileum and distal jejunum in 26 patients （100%） and in proximal jejunum in 22 patients （85%）, and bad filling and distension in proximal jejunum in the other 4 patients （15%）. All image quality was excellent because of no breathing artifact and bowel peristaltic artifact in all patients and mild sensibility artifact in 2 patients. The final clinical diagnosis was normal small bowel in 12 patients, Crohn disease in 7, bowel obstruction （caused by adhesion）, duodenal carcinoma, multiple gastro intestinal stroma tumor （GIST）, duodenitis, duodenocolic fistula, jejunal capillary telangietasia and small intestinal malrotation in 1 patient, respectively. No abnormality was found in 1 intestinal capillary telangietasia, the other diagnosis of MR enterography was coincident with the final clinical diagnosis, and the diagnostic accuracy was 96%. Conclusion： MR enterography with oral isosmotic mannitol is a feasible anddependable method to diagnose small bowel disease, especially Crohn disease, tumor and obstruction.

关 键 词：磁共振成像 小肠 肠疾病 

分 类 号：R445.2[医药卫生—影像医学与核医学] R574.5[医药卫生—诊断学]