多层螺旋CT对成人腹型过敏性紫癜的诊断及疗效评价  

Multislice Spiral CT in Adult Abdominal Anaphylactoid Purpura: Diagnosis and Treatment Follow-up

作　　者：程小杰[1] 简继华[2] 程若勤[2] 刘群[2] 姚庆东[3] 陆涤宇[1] 

机构地区：[1]武汉市中心医院核医学科,湖北武汉430014 [2]武汉科技大学附属天佑医院,湖北武汉430064 [3]武汉市第一医院放射科,湖北武汉430022

出　　处：《中国医学影像学杂志》2015年第5期369-372,共4页Chinese Journal of Medical Imaging

摘　　要：目的分析腹型过敏性紫癜（AAP）的多层螺旋CT（MSCT）表现,探讨MSCT检查在AAP疗效评价中的作用。资料与方法回顾性分析13例经临床和实验室检查确诊为AAP患者的临床和CT检查资料,治疗前均行腹部CT平扫及薄层重建,8例行胃镜检查;治疗后10例行CT平扫复查,4例行胃镜复查。比较治疗前后临床表现和CT征象的差异。结果治疗前13例CT平扫中,2例一段肠管受累,10例多节段肠管受累,1例无阳性发现;8例累及十二指肠、空回肠,5例累及胃;受累肠管壁环形增厚,密度减低,肠腔均匀性狭窄,轮廓模糊不清,呈＂双环＂征;10例肠管周围见少量渗出,3例腹腔少量积液。CT平扫误诊为急性胰腺炎2例,急性胆囊炎、肠梗阻、腹膜炎各1例。13例患者中,治愈5例,有效8例。患者治疗后四肢皮疹、腹痛、大便潜血、白细胞升高、呕吐、黑便、尿潜血症状较治疗前均得到改善（χ2=5.59~18.33,P〈0.05、P〈0.01）;10例CT复查多节段肠管水肿、肠管周围渗出改变均显著改善（χ2=10.00、9.52,P〈0.01）,腹腔积液差异无统计学意义（χ2=1.14,P〉0.05）。结论 AAP的CT表现无特异性,皮疹出现前MSCT诊断困难,结合多节段肠管水肿、渗出等基本CT征象和临床表现有利于本病的诊断,MSCT检查可以有效评价AAP的治疗效果。Purpose To evaluate multislice spiral CT（MSCT） in diagnosing abdominal anaphylactoid purpura（AAP）, and to explore its role in treatment follow-up. Materials and Methods Clinical and MSCT data of 13 patients with confirmed AAP were retrospectively analyzed. All patients underwent abdominal CT scan and thin layer reconstruction. Upper endoscopy was performed in 8 patients prior to treatment. MSCT was performed in 10 patients and endoscopy in 4 patients posttreatment, then clinical and CT features were compared to pretreatment findings. Results In pretreatment CT scan, single segment bowel involvement was found in 2 cases, multisegmental bowel involvement in 10 cases, and no positive finding in 1 patient. The duodenum and jejunum were involved in 8 patients and stomach in 5 patients. The diseased bowel wall showed swelling and thickening with decreased attenuation and homogeneous luminal narrowing with equivocal lining and ＂double loop＂ sign. Infiltration was found in 10 patients, small ascites in 3 patients. Patients were misdiagnosed as acute pancreatitis in 2 cases, acute cholecystitis, small bowel obstruction and peritonitis in 1 case respectively. Of 13 patients, five patients were cured, and the other 8 patients were improved. The clinical symptoms including rash, abdominal pain, occult blood, leukocytosis, vomiting, melena, urine occult blood were improved（χ2=5.59-18.33, P〈0.05 or P〈0.01）. Post treatment CT showed significant improvement of bowel edema and infiltration（P〈0.01）. There was no statistically significant difference in change of ascites（P〈0.05）. Conclusion MSCT findings of AAP are nonspecific. CT diagnosis is difficult before skin rash. Combining CT characteristics of multisegmental bowel edema and clinical manifestations is helpful. CT examination can effectively follow up treatment response.

关 键 词：紫癜 过敏性 腹痛 体层摄影术 螺旋计算机 治疗结果 误诊 胃镜检查 成年人 

分 类 号：R445.3[医药卫生—影像医学与核医学] R554[医药卫生—诊断学]