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急性肠缺血的MSCT诊断价值探讨

时间:2017-09-15 13:00:07 来源: 代写硕士论文

               作者:言伟强 刘晓杰 刘远健 江锦赵 方玲 王成林 刘鹏程

【摘要】  目的 评价MSCT对急性肠缺血(AMI)的诊断价值。方法 回顾性分析5例AMI患者的平扫、动脉期、门静脉期和MSCT肠系膜血管成像(MSCTA)图像,描述AMI的肠系膜血管及其相关病变MSCT的表现特点。结果 5个病例中,1例肠系膜血管显示正常。肠系膜上动脉(SMA)梗塞2例,其中1例断面图像表现为SMA起始端以远血管腔内无对比剂充盈,MSCTA示SMA起始端以远未显影;另1例断面图像SMA未见明显异常,MSCTA显示SMA近端局限性狭窄,血管壁明显增厚。肠系膜上静脉梗塞(SMV)2例,其中1例SMV完全闭塞,管腔内无对比剂充盈,MSCTA示SMV和门静脉均未显影;另1例SMV内见充盈缺损影,MSCTA示SMV内见条状低密度影。。5例均见小肠病变肠管壁明显增厚、肿胀,肠管积液扩张及腹水,2例见肠系膜水肿,2例并肠壁积气。结论 MSCT能准确显示AMI的肠系膜血管及相关病变情况,是AMI的理想检查方法。

【关键词】  肠缺血


     Evaluation of acute mesenteric ischemia with multi-slice CT

      Abstract: Objective To determine the diagnostic value of multi-slice CT (MSCT) in acute mesenteric ischemia (AMI). Methods To analyze of the images of the plain scan、arterial phase、portal venous phase and mesenteric MSCT angiography(MSCTA) in 5 cases of acute mesenteric ischemic, and to describe mesenteric the MSCT features  of AMI. Results: The mesenteric vessels were showed normal in one case. superior mesenteric arterial (SMA) thrombosis were seen in 2 cases, one case showed there had no contrast medium in SMA in arterial phase, and SMA didn,t opacification in MSCTA,in the other case, SMA was confirmed normally in transverse scan, but the stenosis was showed in MSCTA, it accompany with arterial wall thickening.  2 cases of superior mesenteric venous (SMV) thrombosis were found, in one case, the SMV was occlusion completely. MSCTA showed the SMV and portal venous unopacification, in the other case, the filling defect was seen in SMV in portal venous, and the strip low density was seen in MSCTA.. The other signs of AMI included bowel wall edema and thickening、massive fluid in the bowel and ascites in all 5 cases, mesenteric edema and pneumatosis in 2 cases respectively. Conclusions: MSCT   can accurately show the cause of AMI and its corresponding signs, it is very valuable tool in diagnosis of AMI.

    Key words: bowel ischemia;  mesentery; thrombosis; tomography, X-ray computed.                                                                                                                                                                                急性肠缺血(acute mesenteric ischemia, AMI)是一种严重威胁生命的血管急症,其病程凶险,死亡率高达50%?90%[1,2]。该病的临床及病理表现缺乏特征性,早期诊断有一定困难。近年来,随着CT设备不断改进,尤其是多层CT(multi-slice spiral CT, MSCT)的临床应用,腹部CT实现了动脉期、门静脉期薄层快速扫描,并能在工作站上进行腹部血管三维重建,从而为AMI的及时诊断提供了一种有效的检查手段。本文总结我们利用MSCT诊断AMI的初步经验,以便提高对本病变的影像学表现的认识。

      材料与方法

    一、 一般资料

      收集2006年10月至2007年7月期间因剧烈腹痛接受MSCT检查,且证实为急性缺血性肠病的5例患者的资料。其中,男2例,女3例,年龄27?60岁,1例死亡,1例行手术治疗恢复良好,其余3例经保守治疗症状缓解。

    二、 CT检查

       检查采用东芝16层CT机,常规扫描层厚为7mm,扫描范围包括全腹部,分别于25s??30s、55s?65s行动脉期、门静脉期扫描,对比剂为碘海醇,剂量按1.5ml/kg计算,采用CT专用压力注射器(Medrad)以4?5ml/s从前臂静脉注射。常规层厚扫描后,以1mm层厚行薄层重建。常规层厚图像数据传入PACS,并打印胶片供常规影像诊断;薄层图像数据传入后处理工作站(Vitrea 2)进行血管三维重建成像(MSCTA),成像技术采用容积显示(volume rendered, VR)和最大密度投影(maximum intensity projection,MIP),并利用多平面重建技术(multi-planar reconstruction,MPR)观察肠系膜血管及其相关病变情况。

      结 果

      5例患者中保守治疗症状缓解者3例,手术治疗后病变恢复者1例,保守治疗症状无缓解,最后死亡者1例。

      2例SMA梗塞,其中1例常规层厚图像表现为SMA起始端以远血管腔内无对比剂充盈,MSCTA示SMA起始端以远未显影(图1a);另1例常规层厚图像SMA未见明显异常,MSCTA显示SMA近端局限性狭窄,血管壁明显增厚。2例SMV梗塞,其中1例SMV完全闭塞,常规层厚扫描管腔内无对比剂充盈,MSCTA示SMV和门静脉均未显影(图2a);另1例增强扫描SMV内见充盈缺损影,MSCTA示SMV内见条状低密度影。肠系膜血管显示正常者1例。

      5例均见小肠病变肠管壁明显增厚、肿胀,肠管积液扩张(图1a、图2b),2例见肠系膜水肿,2例并肠壁积气,5例均并有腹水形成。

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