结合CT扫描中肠壁增厚与密度改变征象对小肠梗阻鉴别诊断的作用  

CT differential diagnostic value of small bowel wall thickness and density changes in small bowel obstruction

作　　者：张婷[1] 郭天畅 伍彩云[1] 叶文卫[1] 许达生[2] 郑可国[2] 

机构地区：[1]广东省东莞市石龙人民医院放射科,523326 [2]中山大学附属第一医院影像诊断科

出　　处：《中华放射学杂志》2014年第4期299-302,共4页Chinese Journal of Radiology

摘　　要：目的 探讨CT扫描中肠壁增厚结合密度改变征象对单纯性小肠梗阻（SI）和绞窄性小肠梗阻（ST）的鉴别诊断价值.方法 回顾性分析53例经手术病理或临床证实,且术前CT有小肠壁增厚（厚度＞3mm）的小肠梗阻患者资料,其中SI 27例,ST 26例.所有患者均行CT平扫,35例同时行增强扫描.把增厚肠壁的密度改变分为：内层密度正常、内层密度减低、全层密度减低、内层密度增高和全层密度增高.对SI和ST患者增厚肠壁的密度改变进行分析,并采用x2检验或Fisher精确概率法比较2组患者肠壁密度改变的差异.结果 CT平扫表现为内层密度正常者,SI 21例,ST6例,差异有统计学意义（x2=15.859,P＜0.01）;但增强扫描表现为内层密度正常的SI 13例,ST5例,差异无统计学意义（x2=1.377,P＞0.05）.平扫表现内层密度减低SI 4例,ST 5例;增强扫描内层密度减低SI 4例,ST 4例,差异均无统计学意义（P值均＞0.05）.平扫全层密度减低ST 10例,增强全层密度减低ST 5例,均无SI患者,差异均有统计学意义（P值均＜0.01）.结论 CT影像上肠壁增厚伴肠壁全层密度减低这一征象可以鉴别SI和ST.Objective To investigate the CT diagnostic value of small bowel wall thickness and density in differentiating simple small bowel obstruction （SI） from strangulative small bowel obstruction （ST）.Methods Fifty-three cases with thickened small bowel wall （thickness ＞ 3 mm） confirmed on CT scan were reviewed,including 27 cases of SI and 26 cases of ST,in conjunction with their proven intraoperational,pathological and clinical findings.Of the 53 cases,35 cases also underwent postcontrast CT scan.CT manifestations of relationships between thickened small bowel wall and its density were classified as normal,higher or lower density in tunica mucosa of small bowel wall,higher or lower density in full thickness of small bowel wall for exploring the differential diagnostic features between SI and ST on CT scan.Chi-square or Fisher exact test were used to test the proportion difference of CT scan between SI and ST.Results In cases with normal density in tunica mucosa （NDTM） on precontrast CT,there were 21 cases of SI and 6 cases of ST（x2 =15.859,P ＜0.01）.However,in cases with NDTM on postcontrast CT,there were 13 cases of SI and 5 cases of ST,and there was no significant difference （x2 =1.377,P ＞ 0.05）.Thus,NDTM showed no convincing value in differentiating SI from ST.In cases with lower density in tunica mucosa （LDTM） on precontrast CT,there were 4 cases of SI and 5 cases of ST （P ＞ 0.05）.In cases with LDTM on postcontrast CT,there were 4 cases of SI and 4 cases of ST （P ＞ 0.05）.Thus,LDTM also showed no value in differentiating SI from ST.The lower density in full thickness of small bowel wall （LDFTS） was revealed in 0 of SI and 10 cases of ST on precontrast CT （P ＜ 0.01）,and 0 of SI and 5 cases of ST on postcontrast CT （P ＜ 0.01）,indicating that LDFTS showed significant value in differentiating SI from ST.Conclusion Combining the small bowel wall thickness and density,CT manifestations of early bowel wall pathological changes in small bowel obstruction can be ac

关 键 词：肠梗阻 诊断 鉴别 体层摄影术 X线计算机 

分 类 号：R816.5[医药卫生—放射医学] R574.1[医药卫生—临床医学]