CT小肠成像诊断不明原因消化道出血的应用研究  

MSCT Enterography As A Diagnostic Tool in the Evaluation of Obscure Gastrointestinal Bleeding

作　　者：李静[1] 李欣[1] 韩萍[1] 周承凯[1] 吴爱兰[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,430022

出　　处：《临床放射学杂志》2016年第5期750-753,共4页Journal of Clinical Radiology

摘　　要：目的探讨口服法多层螺旋CT小肠成像(MSCTE)检查技术及其优化,评价其诊断不明原因消化道出血(OGIB)的优势及限度,分析OGIB的常见病因及其影像学表现。方法回顾性分析64例OGIB患者的MSCTE资料,评估其中60例无肠梗阻患者肠道扩张情况,将所有MSCTE结果与最终诊断对比。结果患者对检查耐受性较好,近段-远段小肠扩张程度依次提高;本组MSCTE诊断敏感度为84%(42/50),特异度为100%(14/14),准确率为87.5%(56/64),阳性预测值为100%(42/42),阴性预测值为63.6%(14/22)。结论 MSCTE用于OGIB诊断特异度高,阳性的MSCTE结果能可靠地提示出血原因;但对黏膜浅表病变敏感度较低,阴性时可选择胶囊内镜(CE)等进一步检查。Objective To evaluate the MSCT enterography（ MSCTE） examination procedure and investigate the advantages and disadvantages of MSCTE in detecting the bleeding source,and to analysis the common cause of Obscure Gastrointestinal Bleeding OGIB and the imaging findings. Methods 2 radiologists reviewed 64 consecutive inpatients,who underwent 128 slices CTE for detecting the source of OGIB; retrospectively. A four- point scale was used to score the degree of bowel distension qualitatively. Findings depicted at CTE were compared with clinical final diagnosis. Results Most patients can stand the procedure. The score of bowel distension increased from proximal jejunum to distal ileum. The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CTE in identifying sources of bleeding were 84%,100%,87. 5%,100%,63. 6% respectively. Lesions of 8 cases missed by CTE were detected by capsule endoscopy. Conclusion Positive findings in MSCTE can reliably indicate the true source of OGIB but it has low sensitivity in detecting superficial mural lesions.

关 键 词：不明原因消化道出血 多层螺旋CT 小肠 口服法造影 甘露醇 

分 类 号：R57[医药卫生—消化系统] R816.5[医药卫生—内科学]