多排螺旋CT在肠梗阻诊断中的价值

目的：探讨多排螺旋CT(MDCT)在肠梗阻诊断中的价值。方法：回顾性总结28例临床怀疑为肠梗阻病例的MDCT检查结果，并将其中MDCT确诊为肠梗阻的病例与临床手术结果对照。扫描采用MDCT平扫或平扫后增强扫描，成像方法为薄层横断面、多方位重建成像。结果：有23例CT诊断为不同程度肠梗阻，其中18例经手术治疗，CT报告梗阻部位正确的为17例，病因诊断正确的为17例，与手术结果对照，符合率均为94％。临床怀疑肠梗阻而。MDCT检查后排除的另5例中有3例发现其他病变，MDCT检查结果与手术完全符合。结论：MDCT对肠梗阻及其病因的诊断、血供情况的了解均有重大意义，可作为肠梗阻的首选检查方法。     

多层螺旋CT对老年人小肠梗阻病因的诊断价值

目的 评价多层螺旋CT对老年人小肠梗阻病因的诊断价值. 方法 119例老年小肠梗阻病例进行了螺旋CT平扫,57例平扫加增强扫描,利用工作站获得重建图像,将CT结果与手术病理对照. 结果 多层螺旋CT正确诊断梗阻病因116例,其中良性病变98例(包括胆石性梗阻、腹斜疝、腹内疝、闭孔疝、黏连性肠梗阻、粪便纤维素性梗阻、肠套叠、小肠克罗恩病和局限性急性肠炎等),恶性病变18例(包括术后吻合口复发、原发性小肠恶性肿瘤和结肠回盲部恶性肿瘤等),误诊3例.74例小肠梗阻患者经手术证实.结论 多层螺旋CT是诊断老年人小肠梗阻病因有效且准确的方法.     

全腹部增强螺旋计算机断层成像及其后处理技术诊断肠梗阻的价值

目的 探讨多层螺旋计算机断层成像(multislice CT,MSCT)对不明原因肠梗阻病因和部位的诊断价值.方法 采用16排多层螺旋CT对68例临床提示肠梗阻患者行全腹部平扫及二期增强扫描,并在GEADW 4.4工作站上进行多平面重建(multi-planar reconstruction,MPR)及最大密度投影(maximum intensity projeotion,MIP).将MSCT表现与手术结果 对比,分析不明原因肠梗阻的CT表现.结果 MSCT能清楚显示肠梗阻部位、原因、梗阻程度,与手术诊断符合率为95.6%(65/68).结论 多层螺旋CT检查为不明原因肠梗阻的梗阻部位、梗阻原因和梗阻程度确定提供快速、简便、有效的诊断手段,是临床医师拟定治疗方案的重要依据.     

CTA诊断小肠梗阻病因的临床价值

目的探讨多层螺旋CT肠系膜血管成像（CTA）诊断小肠梗阻（SBO）病因的临床价值。方法 采用16层螺旋CT,对28例经临床及CT平扫确诊为SBO、但难以明确梗阻病因的患者行肠系膜血管CTA检查。分析不同病因SBO的肠系膜血管CTA表现及其诊断价值。结果28例患者中,最终诊断为粘连性SBO10例,小肠扭转5例,小肠内疝4例,肠系膜血管血栓形成或栓塞9例。肠系膜血管CTA诊断上述疾病病因与最终诊断的符合率分别为70％、100％、50％、100％。结论肠系膜血管CTA对平扫难以明确病因的SBO有很好的诊断价值,对小肠扭转及血运性肠梗阻的确诊率极高,能确诊或提示粘连性SBO及小肠内疝。     

CT诊断急性胰腺炎60例分析

目的探讨CT对急性胰腺炎的诊断价值。方法对60例经手术病理证实和CT复查确诊的急性胰腺炎病例进行回顾性分析,52例平扫 增强扫描,8例患者为急诊病人只做平扫。结果60例急性胰腺炎中:水肿型48例、坏死型12例。其中8例合并感染。结论CT检查对急性胰腺炎有较高的诊断价值,不仅能明确诊断,而且有助于临床定量分析,可发现并发症和判断预后。     

螺旋CT对肠梗阻临床诊断价值分析

目的探讨螺旋CT在肠梗阻临床诊断中的价值。方法选取我院2010年3月至2013年3月收治的62例肠梗阻患者为研究对象,将其行CT检查,并将CT诊断结果与手术结果及临床诊断病因进行比较。结果 CT诊断结肠梗阻22例,小肠低位梗阻33例,腹膜炎半麻痹性肠梗阻1例,高位梗阻6例。CT病因诊断:肿瘤22例,腹部疝3例,肠粘连11例,肠套叠5例,肠系膜血栓1例,炎性病变5例,肠扭转6例,粪便4例,先天性1例,原因不明4例,与临床病因诊断结果相符率为93.55%。结论螺旋CT对肠梗阻具有较高的临床诊断价值,在显示梗阻部位及梗阻原因上有着不可比拟的优势。     

64层螺旋CT冠状动脉血管成像与冠状动脉造影对照研究

目的评价64层螺旋CT诊断冠状动脉粥样硬化性心脏病的临床应用价值。方法40例临床诊断或可疑冠心病患者行64层螺旋CT心电门控平扫及增强扫描,并以冠状动脉造影结果作为对照。得出64层螺旋CT冠状动脉CT血管成像(CTA)诊断冠状动脉狭窄的准确性、敏感性、特异性。结果64层螺旋CT冠状动脉血管成像用于诊断冠心病的敏感性为87.1%,特异性为67.5%,准确性为80.0%。结论①64层螺旋CT检查是一种无创、快捷的冠状动脉血管检查方法,对冠心病的诊断有较高的准确性。②与冠状动脉造影术相比,64层螺旋CT冠状动脉血管成像对冠状动脉血管狭窄程度判断仍有一定差异。     

腰椎间盘突出症的CT及MR诊断价值比较

目的研究CT及MR对于腰椎间盘突出症的临床诊断价值,并且比较两者的优缺点。方法选取本院自2010年8月至2014年8月间曾收治入院的腰椎间盘突出症的患者54例,并对上述患者的临床病例资料进行回顾性分析,上述患者均通过CT及MR检查,并详细记录了诊断结果,后对患者进行手术,将手术的结果与上述两种检查的结果进行对比,从中分析总结两种检查方法对于本病的临床诊断以及诊断的优缺点。结果通过两种方法检查后,CT扫描结果与MR检查结果以及手术确诊的结果进行对比发现,34例椎间盘突出的病例、5例椎间盘真空象病例、10例椎间盘脱出病例、11例椎间盘Schmorl结节病例、14例椎间盘影出病例以及4例椎间盘游离病例,经MR以及CT扫描的正确检出率分别100%vs 94.1%、100%vs 60.0%、90.0%vs 80.0%、90.9%vs 72.7%、92.9%vs 85.7%、100%vs 75.0%。结论由此看来MR检查对于本病的诊断准确性较高,但缺点是花费的时间较长,并且相对于CT扫描价格更高;CT扫描也具有一定的准确性,但对于某些椎间盘的病变不能进行确诊,由此看来,应根据患者的具体情况适当的将两种方法进行结合,对于CT扫描不能确诊的病例进行MR检查。     

腰椎间盘突出症的CT及MR诊断价值比较

目的研究CT及MR对于腰椎间盘突出症的临床诊断价值,并且比较两者的优缺点。方法选取本院自2010年8月至2014年8月间曾收治入院的腰椎间盘突出症的患者54例,并对上述患者的临床病例资料进行回顾性分析,上述患者均通过CT及MR检查,并详细记录了诊断结果,后对患者进行手术,将手术的结果与上述两种检查的结果进行对比,从中分析总结两种检查方法对于本病的临床诊断以及诊断的优缺点。结果通过两种方法检查后,CT扫描结果与MR检查结果以及手术确诊的结果进行对比发现,34例椎间盘突出的病例、5例椎间盘真空象病例、10例椎间盘脱出病例、11例椎间盘Schmorl结节病例、14例椎间盘影出病例以及4例椎间盘游离病例,经MR以及CT扫描的正确检出率分别100%vs 94.1%、100%vs 60.0%、90.0%vs 80.0%、90.9%vs 72.7%、92.9%vs 85.7%、100%vs 75.0%。结论由此看来MR检查对于本病的诊断准确性较高,但缺点是花费的时间较长,并且相对于CT扫描价格更高;CT扫描也具有一定的准确性,但对于某些椎间盘的病变不能进行确诊,由此看来,应根据患者的具体情况适当的将两种方法进行结合,对于CT扫描不能确诊的病例进行MR检查。     

多层螺旋CT与腹部X线在肠梗阻中的诊断价值

目的探讨多层螺旋CT及腹部X线检查在肠梗阻诊断中的价值。方法选取就诊于荆州市第一人民医院普通外科的100例肠梗阻患者,并对所有患者首先行多层螺旋CT检查,然后行腹部X线检查,然后以手术证实为肠梗阻作为金标准,最后比较多层螺旋CT检查与X线在肠梗阻中诊断的符合率及病因分析。结果多层螺旋CT在100例肠梗阻的患者中,诊断符合率为95.0%,X线在100例肠梗阻患者中的诊断符合率为72.0%,差异有统计学意义(P0.05);在病因分析方面,多层螺旋CT较X线在肠梗阻中更能发现肠粘连、肿瘤、炎症感染等病因,差异有统计学意义(P0.05)。结论多层螺旋CT较X线在肠梗阻的诊断中具有更高的诊断准确率及较低的误诊率,因此,对于肠梗阻患者,临床医师可以首选CT检查。     

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.     

系统碘水造影在小肠疾病诊断与治疗中的价值

目的研究系统碘水造影在小肠疾病诊断和治疗中的应用价值。方法回顾性分析2009年1月-2012年3月武汉大学人民医院行系统碘水造影检查的98例疑患小肠疾病患者的临床资料,其中52例为慢性腹痛,21例为反复呕吐,15例为腹痛伴呕吐,5例为慢性腹泻,5例为黑便。患者口服造影剂碘海醇注射液行系统碘水造影,经腹部X线动态观察造影剂在消化道内的充盈和缺损,并与患者DBE检查或手术结果进行对比分析。结果系统碘水造影诊断小肠疾病64例,小肠造影检查未见明显异常34例。其中无内镜检查禁忌证患者34例行DBE检查证实小肠疾病29例,系统碘水造影检查未见小肠疾病而DBE检查发现小肠病变6例;系统碘水造影检出疾病但DBE未发现者7例。无法行DBE检查或DBE检查过程中因肠腔堵塞无法进镜且无手术禁忌证患者行剖腹探查术者17例,系统碘水造影检查与剖腹探查术对小肠疾病检出一致率达100%,多为小肠梗阻及穿孔等急腹症。系统碘水造影检查及DBE检查均未见明显异常者34例。结论系统碘水造影检查对小肠疾病的诊断及治疗方案的选择具有指导意义,对于小肠梗阻患者有较大诊断价值,还能找出内镜遗漏的病变,适用范围更广,可以作为小肠镜检查的有效补充,但其对小肠黏膜较细微的病变显示不足。     

MDCT venography in the evaluation of inferior vena cava in Budd-Chiari syndrome

Objective  To assess the role of multidetector computed tomography (MDCT) venography in the evaluation of the inferior vena cava (IVC) in Budd-Chiari syndrome (BCS), its accuracy as compared to digital subtraction venography (DSV) and the potential of this technique to replace venography for the definitive diagnosis of BCS. Methods  Twenty-five suspected cases of BCS were prospectively enrolled in this study and underwent both MDCT venography and DSV. Two observers independently evaluated and graded both the axial and reformatted MDCT images for the presence, site, degree and length of IVC narrowing. The collateral pathways and the hepatic veins were also assessed in all cases. The degree of correlation between MDCT venography and DSV was expressed using Spearman’s rank correlation coefficient (Rs). Results  There was excellent correlation between MDCT venography and DSV in predicting the presence of stenosis and in grading the degree and length of IVC stenosis (Rs=0.58, p<0.05). Four patients had presence of a web within the IVC and the reconstructed MDCT venography images detected the flap of the membrane in all of them. In three cases of complete obstruction the cranial extent of the obstruction could be determined on the reconstructed MDCT venography images, while double catheter access through the femoral and jugular routes was needed to determine the same on DSV. MDCT venography was significantly more informative in depicting the presence and site of both intrahepatic and extrahepatic collaterals as compared to DSV. Conclusion  MDCT venography, in the present study, accurately provided information of both conventional CT and IVCgraphy, in the evaluation of the IVC in a non-invasive way. It helped overcome the shortcomings of CT in the evaluation of IVC and was better than DSV for the evaluation of collaterals, calcification and complete IVC obstruction. We suggest that CT venography can be used as a frontline investigation for the diagnosis of IVC obstruction and for planning surgery or percutaneous endovascular intervention.     

Multidetector computed tomography cholangiography with multiplanar reformation for the assessment of patients with biliary obstruction

BACKGROUND: We sought to evaluate the diagnostic use of multidetector computed tomography (MDCT) cholangiography with multiplanar reformation (MPR) for the assessment of patients with biliary obstruction. METHODS: MDCT cholangiography with the MPR technique was performed in 58 patients who were thought to have biliary obstruction. No cholangiographic contrast agent was administered. MRCP in 24 patients, Endoscopic retrograde cholangiopancreatography (ERCP) in 46 patients and percutaneous transhepatic cholangiography (PTC) in 24 patients were performed. Eighteen patients underwent biopsy or surgery. The findings on MDCT cholangiography were compared with those of MRCP, ERCP, PTC, biopsy or surgery. RESULTS: The findings of MDCT cholangiography were as follows: choledocholithiasis (n = 34, 56.7%), malignant stricture (n = 14, 23.3%), benign stricture (n = 1, 1.7%), and cholelithiasis (n = 11, 18.3%). A small common bile duct (CBD) stone in one patient could not be detected on MDCT cholangiography. One patient with a small stone in distal CBD detected on MDCT cholangiography had no stone on ERCP. Two patients with initial diagnoses of CBD stones by MDCT cholangiography were disclosed to have malignant bile duct stricture by reference examination. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stones were 96.9% and 96.2%, respectively. The sensitivity and specificity of MDCT cholangiography for the diagnosis of bile duct stricture were 85.7% and 100%, respectively. The overall accuracy of MDCT cholangiography for the diagnoses of the causes of biliary obstruction was 89.8%. CONCLUSION: MDCT cholangiography with the MPR technique is a fast and non-invasive technique with relatively high sensitivity and specificity for the diagnoses of the causes of biliary obstruction.     

Giant Cell Arteritis Presenting as Small Bowel Infarction

Giant cell arteritis predominantly affects cranial arteries and rarely involves other sites. We report a patient who presented with small bowel obstruction because of infarction from mesenteric giant cell arteritis. She had an unusual cause of her obstruction and a rare manifestation of giant cell arteritis. In spite of aggressive therapy with steroids, she died a month later because of multiple complications. We discuss the diagnosis and management of small bowel obstruction and differential diagnosis of vasculitis of the gastrointestinal tract. We were able to find 11 cases of bowel involvement with giant cell arteritis in the English literature. This case report illustrates that giant cell arteritis can be a cause of small bowel obstruction and bowel infarction. In the proper clinical setting, vasculitides need to be considered early in the differential diagnosis when therapy may be most effective.     

Capsule endoscopy retention: is it a complication?

BACKGROUND: Capsule endoscopy has been found superior to barium x-rays and push enteroscopy in the investigation of obscure gastrointestinal bleeding and in the evaluation of suspected Crohn's disease. Currently, small bowel obstruction and strictures are considered by many physicians to be a contraindication to capsule endoscopy for fear of capsule retention or impaction. The goal of this study was to reassess this conventional wisdom that capsule endoscopy is contraindicated in small bowel obstruction and to determine the safety and efficacy of capsule endoscopy in the evaluation of patients with suspected stricture or small bowel obstruction. STUDY: A retrospective chart review was performed using a database of 568 capsule endoscopy cases performed between August 2001 and November 2003. Cases of suspected small bowel obstruction were selected and reviewed. RESULTS: Nineteen cases were identified in which capsule endoscopy was used in the setting of suspected small bowel obstruction. The diagnosis of suspected small bowel obstruction was based on symptoms alone in 8 cases and on symptoms plus abnormal radiographs in the remaining 11 cases. Capsule endoscopy made a definitive diagnosis in 5 of the 19 cases (26%): 2 Crohn's strictures, 1 radiation induced stricture, 1 nonsteroidal anti-inflammatory drug induced stricture, and 1 MALT lymphoma. The capsule was retained proximal to a stricture in 4 cases, in which the obstructing lesions were electively resected without complications. There was no case in which administration of the capsule led to an acute small bowel obstruction. CONCLUSIONS: Capsule endoscopy can be safely used to help identify the etiology and site of a small bowel obstruction. Retention of the capsule may indicate the presence of a lesion requiring surgery, but small bowel obstruction or strictures are not in themselves contraindications to the procedure. It is understood, however, that retention may lead to surgery in a patient who otherwise may have been treated medically without surgery for the same illness (eg, Crohn's disease and nonsteroidal anti-inflammatory drug enteropathy).     

Small bowel volvulus with jejunal diverticulum: Primary or secondary?

Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.     

Value of radiopaque markers in identifying partial small bowel obstruction

Confirming partial small bowel obstruction is often a diagnostic challenge. In this case report, 4-mm solid radiopaque markers were used in 4 patients to show partial small bowel obstruction. Results of enteroclysis were normal in 2 of the 4 patients, and the markers were used to challenge suspected partial obstruction. The markers coalesced in the region of the partial obstruction, which was confirmed at surgery. Enteroclysis is the examination of choice in the diagnosis of partial small bowel obstruction. However, examinations with false- negative results can occur, particularly with adhesive and/or intermittent obstructions. The use of radiopaque markers in these cases proved an effective and useful method of establishing the diagnosis of partial small bowel obstruction, particularly in the 2 cases in which enteroclysis results were normal. Prospective studies are needed to establish the feasibility of this novel technique. (Gastroenterology 1996 Jun;110(6):1958-63)     

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope

AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction.METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann^® Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds.RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudo-obstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction.CONCLUSION: Auscultation of bowel sounds is non-specific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.     

Hepatic veno-occlusive disease after taking Gynura Rhizome: The value of multidetector computed tomography in diagnosing the disease and evaluating the clinical therapeutic effect

Aim: We conducted this study to evaluate the role of multidetector computed tomography (MDCT) in diagnosing and differential diagnosis hepatic veno‐occlusive disease (HVOD), and as well as assessing the clinical therapeutic effects. Methods: From 2007 to 2010, 10 inpatients with weight increasing, liver pains, ascites, jaundice and history of taking gynura rhizome before hospitalization were scanned with a 64‐MDCT. The data were reconstructed every 0.625 mm and reviewed using multiplanar reconstruction (MPR) and liver CT angiography (CTA) on a GE AW4.2 workstation. Patients were re‐scanned with MDCT after medication so that the clinical therapeutic effect could be evaluated before the patients discharging from hospital. Results: In 10 HVOD patients, the diagnoses of MDCT were coincident with clinical results. All patients had ascites and pleural fluid, hepatomegaly except the caudate lobe in MDCT. Failure to view hepatic veins in hepatic 3 phase scans, but portal veins and inferior vena cava were unobstructed. In portal‐phase, hepatic enhancements were non‐uniform. Three patients were incorrectly diagnosed before hospital admission. All patients improved significantly after hepato‐protection and supporting therapy. No ascites, hydrothorax, hepatomegaly and obstruction of hepatic veins were observed by MDCT before patients were discharged from hospital. Conclusion: Multidetector computed tomography combined with MPR and liver CTA images are helpful in the diagnosis and differential diagnosis of HVOD and in the evaluation of clinical therapeutic effects.