MSCT多平面重建对肠梗阻的诊断价值

发布时间：2018-09-12 15:55

【摘要】：目的：通过回顾性分析一组经手术或结肠镜病理证实及经保守治疗追踪观察临床最终诊断的71例肠梗阻病例的CT资料：（1）分析肠梗阻的MSCT影像特征；（2）比较观察单纯横断面图像和结合多平面重建图像对肠梗阻的诊断价值；（3）分析52例增强病例MSCT诊断结果与平扫MSCT诊断结果对比，观察CT平扫和CT增强对肠梗阻的部位诊断和病因诊断符合率比较，评估CT增强对肠梗阻的临床应用价值。方法：使用GE light speed16排螺旋CT，71例肠梗阻病人均接受MSCT全腹部平扫，扫描结束后容积扫描信息送至GE图像工作站进行图像减薄及MPR处理，分析单纯横断面图像和结合MPR图像对肠梗阻的部位和原因的影像表现特征和显示能力，，评估MPR对肠梗阻诊断价值。分析52例CT增强组与71例CT平扫组比较观察，评价增强MSCT对肠梗阻的临床诊断价值。结果：71例肠梗阻包括肠道肿瘤26例，结肠及回盲部炎症9例，粘连性肠梗阻24例，肠外疝5例，胆石性肠梗阻2例，小肠克隆病、乙状结肠扭转、腹茧症、术后腹腔内纱布包块粘连及肠管内粪块各1例。（1）16排螺旋CT对肠梗阻部位诊断符合率单纯横断面组为78.9%（56/71），横断面图像结合MPR组后为92.9％（66/71）（P0.05），但是运用MPR后更加直观显示移行带位置及形态，掌握更多的诊断证据，使不同阅片者双盲法诊断的一致性得到提高，分别为0.556，0.577。提高阅片者的信心（P0.01）。对病因诊断符合率单纯横断面组为73.2%（52/71），横断面结合MPR组后为90.1%（64/71）（P0.05），（2）CT平扫组对梗阻部位诊断准确率为83.1%（59/71），CT增强组为90.4%（47/52）（P0.05）；对病因诊断准确率CT平扫组64.8%（46/71），CT增强组为90.4%（47/52）（P0.05）。结论：1.MSCT单纯横断面图像结合MPR处理后图像观察，可提高肠梗阻的部位诊断及病因诊断符合率。虽然肠梗阻的部位诊断无统计学意义，但是运用MPR后使不同阅片者双盲法诊断的一致性得到提高，并提高阅片者的信心。2.增强CT较平扫CT，对梗阻部位的诊断符合率无统计学意义，但对梗阻病因的诊断符合率有统计学意义。
[Abstract]:Objective: to analyze retrospectively the CT data of 71 cases of intestinal obstruction confirmed by operation or colonoscopy and followed up by conservative treatment: (1) to analyze the characteristics of MSCT images of intestinal obstruction; (2) to compare and observe the diagnostic value of simple cross-sectional images and multiplanar reconstruction images in intestinal obstruction, (3) to analyze the diagnostic results of MSCT and plain scan MSCT in 52 cases. To evaluate the clinical value of CT enhancement in the diagnosis of intestinal obstruction and to evaluate the clinical value of CT enhancement in the diagnosis of intestinal obstruction by observing the coincidence rate of CT plain scan and CT enhancement in the diagnosis of intestinal obstruction. Methods: GE light speed16 spiral CT,71 was used in all patients with intestinal obstruction. The information of volume scan was sent to the GE image workstation for image thinning and MPR processing at the end of the scan. To evaluate the diagnostic value of MPR in the diagnosis of intestinal obstruction, the imaging features and display ability of the location and cause of intestinal obstruction were analyzed by simple cross-sectional images and combined with MPR images. The clinical diagnostic value of enhanced MSCT in intestinal obstruction was evaluated by comparing 52 cases of CT enhancement group with 71 cases of CT plain scan group. Results 71 cases of intestinal obstruction included intestinal tumor in 26 cases, colonic and ileocecal inflammation in 9 cases, adhesive intestinal obstruction in 24 cases, intestinal hernia in 5 cases, cholelithiasis intestinal obstruction in 2 cases, intestinal clonosis, sigmoid volvulus, abdominal cocoon. Postoperative intraperitoneal gauze mass adhesion and intestinal fecal mass in 1 case. (1) 16-row spiral CT for the diagnosis of intestinal obstruction in the simple cross-section group was 78.9% (56 / 71), cross-sectional image combined with MPR group was 92.9% (66 / 71) (P0.05), but the use of MPR is more visual display. The position and shape of the transition zone, With more diagnostic evidence, the consistency of double blind diagnosis of different film readers was improved, which was 0.556n0.577. Improve the confidence of readers (P0.01). The coincidence rate for etiological diagnosis was 73.2% (52 / 71) in the cross-sectional group and 90.1% (64 / 71) in the cross-section combined with MPR group (P0.05), (2). The accuracy of diagnosis of obstructive site in CT plain scan group was 83.1% (59 / 71). The accuracy rate of CT plain scan group was 90.4% (47 / 52) (P0.05), and that of CT plain scan group was 90.4% (47r52) (P0.05). Conclusion 1. The coincidence rate of site diagnosis and etiological diagnosis of intestinal obstruction can be improved by simple cross-sectional images combined with MPR images. Although there was no statistical significance in the diagnosis of intestinal obstruction, the consistency of double blind diagnosis of different film readers was improved after MPR, and the confidence of film readers was improved. 2. The coincidence rate of enhanced CT in diagnosis of obstructive site was not statistically significant compared with that of plain scan CT, but the diagnostic coincidence rate of obstructive etiology was statistically significant.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5;R574.2

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