双源CT双期增强血管成像对急性肠缺血的诊断

目的:探讨双源CT(DSCT)双期增强扫描血管成像对急性肠缺血(acute mesenteric ischemia,AMI)患者的诊断价值。方法:回顾性分析经手术或介入治疗证实的26例AMI患者的DSCT资料。所有患者均行DSCT双期增强扫描即动脉期和门静脉期血管成像。结果:肠系膜上动脉栓塞8例,肠系膜上动脉血栓形成4例,肠系膜上静脉血栓形成14例。CT直接征象为肠系膜血管内低密度充盈缺损,受累血管腔闭塞(17例)或重度狭窄(9例)。间接征象:肠壁增厚(21例),肠管扩张、肠腔内积液积气(18例),肠壁强化程度降低(7例),肠壁积气(5例),肠系膜脂肪水肿及渗出(19例),"缆绳征"14例,腹腔积液12例。结论:DSCT增强扫描及双期血管成像可清楚显示AMI血管阻塞的部位、范围、程度及继发改变,对明确诊断和指导治疗具有较高的应用价值。

Biphasic contrast enhancement and angiography of dual-source CT in acute mesenteric ischemia

Objective： To investigate the diagnosis value of biphasic contrast enhancement and angiography of dual source CT （DSCT）in acute mesenteric ischemia（AMI）patients. Methods： Twenty-six cases of AMI proven by operation or interventional therapy underwent whole abdomen DSCT pre- and post-contrast scan. Double phase scan and CT angiography were performed at arterial phase and portal venous phase for all patients. Results： It was found that AMI was caused by superior mesenteric ar- tery embolism（n= 8）, superior mesenteric artery thrombosis（n= 4）, mesenteric venous thrombosis（n= 14）. The direct CT signs were found to be filling defect with low density in mesenterie vessels, with embolism（n=17）or severe stenosis（n= 9）. The indi rect CT signs consisted of bowel wall thickening（n= 21 ）, dilatation of bowel loops with air-fluid levels（n= 18）, decrease attenu- ation of enhanced extent in bowel wall（n= 7）, pneumatosis of bowel wall（n= 5）, edema and exudation of mesenteric adipose tis- sue（n = 19）, strand sign（n = 14） and seroperitoneum （n = 12 ）. Conclusions： The biphasic contrast enhancement and angiography of DSCT can clearly demonstrate the definite position,extent and secondary change of mesenteric vessel occlusion and is valua- ble in diagnosis and clinical management.