肠壁增厚分层并定量分析对小肠坏死的诊断价值  

Diagnostic Value of Quantitative Analysis Based on Each Layer of Thickened Intestinal Wall for Enteric Necrosis

作　　者：葛权昌 冷梅娜 吴华 李慧 朱宝强 林飞飞 GE Quan-chang;LENG Mei-na;WU Hua;LI Hui;ZHU Bao-qiang;LIN Fei-fei(Department of Radiology,Rizhao Central Hospital,Rizhao 276800,Shandong Province,China)

机构地区：[1]日照市中心医院影像科,山东日照276800

出　　处：《罕少疾病杂志》2021年第4期79-81,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨采用增强CT扫描测量肠壁各层结构CT值的方法量化分析小肠梗阻患者是否肠坏死的价值。方法回顾性分析47例小肠梗阻并且出现肠壁增厚分层患者的临床及CT资料,经手术证实肠缺血坏死18例(坏死组)、非坏死29例(缺血组),测量两组患者肠壁内层、中层、外层的平扫CT值、增强CT值及增强幅度,比较两组数值有无统计学差异(P<0.05),对有差异的数值采用ROC曲线分析,计算曲线下面积(AUC),采用“约登指数”确定最佳界值。结果两组患者肠壁内层、中层、外层的平扫CT值均无统计学差异(P>0.05),而增强CT值和增强幅度两组均数有明显差异(P<0.05),其AUC分别为0.890、0.949、0.836、0.813、0.888、0.833,以肠壁内层的增强幅度诊断肠坏死的效能最高,其最佳界值为28HU,敏感性为94.4%、特异性为82.8%。结论测量增强CT扫描中肠壁各层结构CT值能有效量化肠壁缺血程度,并能预测早期肠壁坏死,其中以肠壁粘膜层的增强幅度准确性最高。Objective To explore the value of quantitative analysis of enteric necrosis in patients with intestinal obstruction by using enhanced CT scanning to measure the CT value of each layer of intestinal wall.Methods The clinical and CT data of 47 patients with intestinal obstruction and thickened intestinal wall were analyzed retrospectively.18 patients with enteric necrosis(necrosis group)and 29 patients without enteric necrosis(ischemia group)were confirmed by operation.The plain CT value,enhanced CT value and enhancement extent of the inner,middle and outer layer of intestinal wall of the patients in the two groups were measured.The two groups of values were compared to see whether there is statistical difference(P<0.05).ROC curve was used to analyze the different values,calculate the area under the curve(AUC),and“Youden Index”was used to determine the best cut-off value.Results There was no statistical difference between the plain CT values of the inner,middle and outer layer of intestinal wall of the patients in the two groups(P>0.05).While there was significant difference between the enhanced CT value and enhancement extent of the two groups.The AUC were 0.890,0.949,0.836,0.813,0.888 and 0.833 respectively.The way of diagnosing enteric necrosis by the enhancement extent of the inner layer of intestinal wall was the most effective.The best cut-off value was 28 HU,the sensitivity was 94.4%,and the specificity was 82.8%.Conclusion The measurement of the CT value of each layer of intestinal wall in enhanced CT scanning can effectively quantify the degree of intestinal ischemia,and predict the early changes of enteric necrosis;among which the enhancement extent of the mucosal layer of intestinal wall is the most accurate.

关 键 词：肠梗阻 小肠坏死 定量分析 CT 

分 类 号：R816.5[医药卫生—放射医学] R445.3[医药卫生—临床医学]