摘要
目的探讨肠扭转的多排螺旋CT(multi-detector row spiral CT,MDCT)表现特征。方法纳入经手术证实的31例肠扭转患者,其中CT平扫9例,增强扫描22例,有5例加作了血管成像和特殊图像后处理。2位从事腹部放射诊断的医师回顾性分析患者的影像资料,记录肠扭转的部位、方向、度数、"漩涡征"和"鸟喙征"的出现率、是否有肠壁增厚和腹水以及寻找肠扭转的原因,并与手术结果对照。结果①部位:十二指肠1例,空肠23例,回肠3例,全小肠2例,乙状结肠2例,定位准确27例,准确率87.0%;②方向:顺时针11例,逆时针20例,准确率100%;③度数:180°13例,360°12例,540°、720°和900°各2例,准确23例,准确率74.2%;④"漩涡征"18例和"鸟喙征"20例;9例出现肠壁增厚和腹水;5例图像后处理患者最大密度投影(MIP)和容积再现(VR)图像均显示肠系膜血管异常,有1例多平面重组(MPR)图像显示"漩涡征"和"鸟喙征";有10例患者发现引起肠扭转的原因。结论肠扭转在MDCT上主要表现为肠管和肠系膜血管的"漩涡征"和肠管的"鸟喙征";肠壁增厚和腹水是肠壁血运障碍的重要影像依据。MDCT对肠扭转的诊断和评估扭转肠管的血运情况具有重要价值。
Objective To investigate the imaging features of intestinal volvulus on multi-detector row spiral CT （MDCT）. Methods Thirty-one patients with surgically confirmed intestinal volvulus were included in this study. Nine patients received MDCT plain scan, 22 received contrast enhanced MDCT scan and 5 of them had addi- tional CT angiography. Two abdominal radiologists analyzed the MDCT imaging features of intestinal volvulus observed, such as the location, direction of rotation, degree of volvulus, appearance rate of the ＂whirl sign＂ and the ＂beak sign＂, bowel wall thickening and ascites and the possible causes of volvulus, which were recorded with review of surgical findings. Results The location of volvulus included duodenum （1 case）, jejunum （23 cases）, ileum （3 cases）, entire small intestine （2 cases） and sigmoid colon （2 cases）. The location of volvulus was correctly diagnosed based on MDCT findings in 27 patients （27/31; 87. 0%）. The direction of volvulus was correctly diagnosed for all patients based on MDCT findings （clockwise in 11 cases and counterclockwise in 20 cases）. The degrees of volvulus assessed on MDCT findings were respectively 180° in 13 cases, 360° in 12 cases, 540° in 2 cases, 720° in 2 cases and 900° in 2 cases, as compared with surgical findings of 180° in 17 cases, 360° in 10 cases, 540° in i case, and 720° in 3 cases. The diagnostic accuracy of MDCT for assessing the degree of volvulus was 74.2 %. The ＂whirl sign＂ and ＂beak sign＂ appeared in 18 and 20 patients, respectively. Bowel wall thickening and ascites were showed in 9 patients. In 5 patients with reconstructed images, the images obtained by maximum intensity projection （MIP） and volume rendering （VR） techniques showed the abnormality of mesenteric vessels in all patients, and the multi- planar reconstruction （MPR） image of one patient showed the ＂whirl sign＂ and the ＂beak sign＂. The causes of intestinal volvulus were identified on MDCT in 10 patients. Conclusion The ＂whirl sign＂ and the ＂beak sign＂ are the characteristic images of intestinal volvulus on MDCT. Bowel wall thickening and ascites may indicate the hemody-namic images impairment of volvulus. MDCT plays valuable role in the diagnosis of intestinal volvulus.
出处
《中国普外基础与临床杂志》
CAS
2009年第8期672-676,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肠扭转
肠梗阻
肠壁增厚
断层摄影术/X线计算机
重建
Volvulus
Bowel obstruction
Bowel wall thickening
Tomography/X-ray computed
Reconstruction
