多层螺旋CT和CTA在缺血性结肠炎诊断与分期中的价值探讨

发布时间：2018-08-19 18:40

【摘要】：目的探讨CT在缺血性结肠炎(Ischemic Colitis, IC)的诊断及分期中的价值。资料与方法回顾性分析31例经肠镜证实的缺血性结肠炎患者的CT资料,所有病例行全腹CT平扫及增强扫描,并经多平面重建(MPR)及CTA后处理,分析IC急性期、非急性期病变的影像学特征,并与结肠镜检查比较。结果病变较多累及左半结肠,较少累及直肠。主要表现为肠壁均匀对称性增厚、肠壁分层、拇纹征、肠周脂肪间隙模糊或清晰。病变肠段黏膜连续,呈节段性分布,管腔狭窄,腹腔积液。31例结肠镜检查及病理证实的IC患者中,CT检查发现IC的符合率为77.42%(24/31)；其中急性期符合率为90.90%(10/11),非急性期为70.00%(14/20)。急性期与非急性期病变CT在肠壁厚度、拇纹征、肠周脂肪间隙清晰度、肠壁分层、黏膜下强化程度有统计学差异(P0.05)。CTA显示肠系膜上下动脉主干存在异常阳性率为12.90%(4/31),MPR重建显示病变肠段边缘动脉增多改变。结论螺旋CT增强扫描及MPR检查对缺血性结肠炎具有较高的诊断及鉴别诊断价值,对分期有较大的帮助,能指导临床早期治疗从而获取较好疗效。而CTA显示肠系膜上下动脉主干多无栓塞,MPR重建显示边缘动脉增多改变提示IC非血管栓塞所致,可以与急性肠系膜缺血(acute mesenteric ischemia, AMI)相鉴别以避免盲目溶栓治疗。
[Abstract]:objective
Objective to investigate the value of CT in the diagnosis and staging of Ischemic Colitis (IC).
Data and methods
CT data of 31 patients with ischemic colitis confirmed by enteroscopy were analyzed retrospectively. All patients underwent plain and enhanced CT scan of the whole abdomen. The imaging features of acute and non-acute lesions in IC were analyzed and compared with colonoscopy.
Result
The main manifestations were symmetrical thickening of the intestinal wall, stratification of the intestinal wall, thumbprint sign, blurred or clear periintestinal fat space. The lesions were continuous and segmental mucosa with narrow lumen and peritoneal effusion. In 31 patients with IC confirmed by colonoscopy and pathology, CT showed the coincidence rate of IC. The coincidence rate was 90.90% (10/11) in the acute phase and 70.00% (14/20) in the non-acute phase. There were significant differences in the intestinal wall thickness, thumbprint sign, intestinal fat clearance, intestinal wall stratification and submucosal enhancement between the acute phase and the non-acute phase (P 0.05). 0% (4/31), MPR reconstruction showed a change in the marginal artery of the lesion.
conclusion
Enhanced spiral CT scan and MPR examination have higher diagnostic and differential diagnostic value for ischemic colitis, and are helpful for staging and guiding early clinical treatment to obtain better curative effect. It can be differentiated from acute mesenteric ischemia (AMI) to avoid blind thrombolytic therapy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.62

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