小肠CT造影对肠管出血性疾病的诊断价值  

The Value of Multislice CT Enterography in Diagnosis of Gastrointestinal Bleeding Diseases

作　　者：于洋[1] 蒋涛[1] 王艳[2] 柳建[1] 唐宏斌[1] 杨淑兰[1] 张红培 李敏[1] 梁璐[1] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]首都医科大学附属北京朝阳医院消化内科,北京100020

出　　处：《CT理论与应用研究（中英文）》2014年第4期621-630,共10页Computerized Tomography Theory and Applications

摘　　要：目的:探讨口服等渗甘露醇行小肠CT造影(MSCTE)对肠管出血性疾病的诊断价值。方法:选取16例临床可疑消化道出血的患者。在进行肠道准备之后,分时段口服等渗甘露醇2000mL,采用0.62mm层厚及智能触发技术行动脉期、静脉期及延时期三期全腹扫描,并结合多平面重建(MPR)、最大密度投影(MIP)及容积再现(VR)技术对图像分析诊断。病例经手术、内镜或临床随访证实。结果:在16例中,小肠CT造影存在明确出血且与临床诊断出血部位一致8例,其中包括空肠出血3例,回肠出血2例,回盲部出血1例,升结肠出血1例,内痔出血1例;包括1例活动性出血;另有明确诊断出血原因4例,其中包括憩室出血1例,消化道间质瘤出血1例,小肠淋巴瘤出血1例及内痔1例,憩室出血经结肠镜证实,消化道间质瘤及小肠淋巴瘤经手术病理证实。小肠CT造影诊断存在出血,但出血部位与临床诊断不符1例。小肠CT造影与临床检查均未发现明确出血1例。小肠CT造影未发现明确出血灶,但临床证实出血6例。结论:口服等渗甘露醇行小肠CT造影检查结合图像后处理技术对于诊断消化道出血性疾病有一定价值。Objective： To evaluate the diagnostic value of multislice CT enterography for gastrointestinal bleeding diseases. Methods： 16 patients with clinically suspected gastrointestinal bleeding diseases were all examined using multislice CT enterography after bowel preparation. The patients were initially performed with 0.62 mm slice thickness plain scans and a bolus-tracking software and then three phase enhanced scan using multi-modal reorganization such as multiplanar reconstruction, maximum intensity projection, and volume rendering. Results were compared with those from a reference standard（surgery or endoscopy） and clinical follow-up. Results： In 16 clinically suspected cases of gastrointestinal bleeding disorders, multislice CT enterography and final diagnosis findings were in agreement in 8 cases. Sites of hemorrhage depicted by multislice CT enterography were as follows： 3 cases of jejunal hemorrhage, 2 cases of ileal hemorrhage, 1 case of ileocecal hemorrhage, 1 case of ascending colon hemorrhage, 1 case of internal hemorrhoid. One of 8 patients with positive multislice CT enterography results had an active bleeding. The reason of the hemorrhagic lesions was diverticulitis in 1 cases（confirmed at endoscopy）, gastrointestinal stromal tumor in 1 cases（confirmed at surgery）, lymphoma in 1 cases（confirmed at surgery）, internal hemorrhoid in 1 case. In one case, multislice CT enterography and final diagnosis results were both positive but were not in agreement on the bleeding source. In one case, both mulitislice CT enterography and final diagnosis findings were negative. The results of mulitislice CT enterography were negative in six of 16 patients with positive findings of final diagnosis. Conclusion： Mulitislice CT enterography with relative reconstruction techniques has high value for detecting the site of hemorrhage and detecting the cause of gastrointestinal bleeding.

关 键 词：肠管出血 小肠CT造影 等渗甘露醇 

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