易漏诊误诊胃肠道异物的MSCT表现特点  

MSCT imaging features of gastrointestinal foreign bodies easily missed and misdiagnosed

作　　者：孙媛媛 陆惠良 张玉峰 吕文娟 黄国 高晓龙 Sun Yuanyuan;Lu Huiliang;Zhang Yufeng;Lv Wenjuan;Huang Guo;Gao Xiaolong(Department of Medical Imaging,Shanghai Boshan Luodian Hospital,Boshan Branch Center of Shanghai Cancer Hospital of Fudan University,Shanghai 201908,China)

机构地区：[1]复旦大学附属肿瘤医院宝山分中心上海市宝山区罗店医院医学影像科,上海201908

出　　处：《中国中西医结合影像学杂志》2020年第2期168-171,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:探究MSCT扫描易误诊漏诊胃肠道异物的影像学特征,旨在提高MSCT对胃肠道异物诊断的正确率。方法:收集116例胃肠道异物患者的临床及影像资料,通过分组阅片(盲法阅片组和对照组)的方式,总结易漏诊误诊胃肠道异物的相关人为影响因素及影像学特点。以手术、内镜及随访为证实异物的金标准。结果:①在未知晓详细病史且仅用常规横断层阅片时漏诊误诊率达12.1%(14/116),使用MSCT后处理技术后,漏诊误诊率降低至7.8%(9/116)。②在了解详细病史后,仅在横断面阅片时漏诊误诊率约2.6%(3/116),使用MSCT后处理技术后,漏诊误诊率约0.9%(1/116)。③未知晓患者详细病史,常规横断面阅片时漏诊误诊14例,其中异物为鱼刺鱼骨6例,枣核4例,胃石、体内藏毒、细针、多枚磁石各1例。结论:胃肠道异物种类复杂,其影像特点与异物形态、密度、大小及位置相关,而垂直或平行于扫描层面的细长异物、等低密度异物及少见异物易漏诊误诊。详细询问病史及使用MSCT后处理技术可显著降低胃肠道异物漏诊误诊率。Objective:To explore the imaging features of gastrointestinal foreign bodies which are easy to be misdiagnosed by multi-detector spiral CT,and to improve the accuracy of MSCT in the diagnosis of gastrointestinal foreign bodies.Methods:A total of 116 cases of foreign bodies were diagnosed and confirmed by abdominal MSCT.The artificial influencing factors and imaging features of missed and misdiagnosed gastrointestinal foreign bodies were summarized by grouping and reading films.Surgery,endoscopy and follow-up were used as the gold standard to confirm foreign bodies.Results:①The missed misdiagnosis rate was 12.1%(14/16)when no detailed medical history was given,and only the conventional transverse section was used.After using MSCT post-processing technology,the missed diagnosis rate was reduced to 7.8%(9/116).②After informing the detailed medical history,the missed misdiagnosis rate was about 2.6%(3/116)only when the cross-section film was read,and about 0.9%(1/116)after using the MSCT post-processing technique.③14 cases without detail medical history were misdiagnosed and missed diagnosis with only cross-section images,6 cases of fishbones,4 cases of date pits,and 1 case each of gastric calculus,narcotic drugs,fine needle and magnets.Conclusions:The types of foreign bodies in gastrointestinal tract are complex,and their imaging characteristics are related to the morphology,density,size and location of foreign bodies,while slender foreign bodies perpendicular to or parallel to the scanning plane are isodensity and low density.It is easy to misdiagnose and misdiagnose bodies and rare foreign bodies.Routine use of MSCT window technique,detailed inquiry of medical history and use of MSCT post-processing technique play an important role in the diagnosis of gastrointestinal foreign bodies,which can significantly reduce the rate of missed diagnosis and misdiagnosis.

关 键 词：体层摄影术 X线计算机 胃肠道异物 漏诊误诊 枣核 鱼刺 毒品 

分 类 号：R816.5[医药卫生—放射医学] R57[医药卫生—临床医学]