多层螺旋CT在急性肠缺血诊断中的应用价值精选.doc

多层螺旋CT在急性缺血性肠病诊断中的价值 陈明，李选 （北京大学第三医院放射科，北京100083 ） 摘要：目的 探讨多层螺旋CT（MSCT）诊断急性肠缺血的临床应用价值。方法 回顾性分析24例经临床证实的急性肠缺血患者的CT表现，包括肠系膜上静脉血栓形成13例，肠系膜上动脉栓塞5例、肠系膜上动脉狭窄5例、腹腔干狭窄1例。所有患者均行CT检查，包括平扫、动脉期、门脉期扫描及血管重建，2例行MSCT灌注扫描；21例行DSA检查及介入治疗；5例行手术肠切除。结果 MSCT血管重建均清晰显示病变，不同病因不同程度的肠缺血CT表现有一定差异：肠系膜静脉血栓形成时，肠壁增厚、肠系膜水肿、腹水多见；肠壁积气只见于全层坏死，而其他征象均可见于不同病因、不同程度的肠缺血。结论 MSCT能准确诊断肠缺血并明确病因，有助于判断缺血程度。 关键词：肠缺血；体层摄影术，X线计算机 中图分类号R814.41 Multi-slice CT of Acute Intestinal Ischemia Chen Ming，Li Xuan （Department of Radiology, the Third Hospital , Beijing University, Beijing 100083, China） Abstract：Objective To discuss the clinical value of multi-slice helical CT (MSCT) in diagnosis of acute intestinal ischemia. Methods CT appearances of intestinal ischemia verified by clinic in 24 patients were retrospectively analysed, MSCT was performed in 24 patients including plain scan, the arterial phase scan, and the portal vein phase scan. Intestinal perfusion was performed in 2, DSA and interventional procedures wre performed in 21 and enterotomy was performed in 5 of the 24 patients . The mesenteric arteries and portal veins were reconstructed. Results MSCT can diagnose acute intestinal ischemia and judge the cause of ischemia exactly, bowel wall thickening, mesenteric edema and ascites are most seen in venous thromboses. Except pneumatosis which only seen in transmural infarction, all the abnormal CT findings were seen in different kinds and different degree of ischemia. Conclusion The integrative MSCT examination has great value in diagnosis of acute intestinal ischemia. It can diagnose acute intestinal ischemia exactly, and it is useful in estimate of the ischemic degree. Key words: intestinal ischemia; tomography, X-ray computed, perfusion 急性缺血性肠病临床上并不少见，病程凶险，死亡率高。早期诊断和治疗是降低死亡率的关键[1～4]。近年来，CT技术的发展使急性缺血性肠病的诊断水平明显提高[5～8] 。本文通过回顾24例急性缺血性肠病患者的多层螺旋CT（multi-slice helical CT，MSCT）表现，探讨MSCT在诊断缺血性肠病中的价值。 1 资料和方法 1.1资料 2003年8月～2007年7月经手术或介入治疗证实的24例急性肠缺血患者（肠系膜上静脉血栓形成13例，肠系膜上动脉栓塞5例、肠系膜上动脉狭窄5例、腹腔干狭窄1例）行MSCT检查。其中男11