双源CT低剂量腹部血管双期扫描技术在肠系膜缺血性疾病诊断中的应用价值
|
摘要
肠系膜缺血性疾病(mesenteric ischemia, MI)发病急,起病快,且随着人们生存年龄的增长,随着心血管疾病及自身免疫性疾病发病率的增加,其发病率有明显上升的趋势,但是发病原因至今不明确；由于本病缺乏特异性的临床表现,血生化检查缺乏特异性及敏感性,故病死率较高,有报道称其病死率可达50%以上,是一种严重威胁人类生命健康的血管外科急症。肠系膜缺血性疾病包括肠系膜上、下动脉或肠系膜上静脉缺血所引起的肠道疾病,以动脉性缺血更为常见。其中,肠系膜上动脉栓塞占所有系膜缺血性疾病的50%,继发于动脉粥样硬化的肠系膜动脉狭窄占25%,低血流灌注所致的非闭塞性肠系膜缺血及静脉性肠缺血约占25%。选择性肠系膜血管造影是诊断肠系膜缺血性疾病的金标准,但是仅能观察肠系膜血管的堵塞及狭窄情况,不能观察相应供血区肠管的情况,而且属于有创检查,二维成像、前后组织的重叠导致对部分病变程度的估计可能存在一定的偏差,并且操作复杂、需要麻醉、手术费用昂贵、术后存在穿刺局部血肿、穿刺血管血栓形成及穿刺血管假性动脉瘤形成等并发症,且具有一定的死亡率,故作为一种检查手段,很难被患者及患者家属所接受。
CT尤其是时间空间分辨率高的多层螺旋CT的出现,使得一次屏气完成整个腹部的大范围扫描成为可能；增强扫描后不仅能清晰观察血管情况,还能同时观察相应供血区肠道的情况、能同时观察其他腹腔脏器情况,能够获得与选择性血管造影相似的血管三维图像,同时随着bolus tracking技术的应用,使得在肠系膜上动脉内对比剂高峰期获得清晰的动脉血管图像成为可能；扫描速度快,使得连续获得动、静脉双期扫描图像成为可能；z轴分辨率的提高,能够获得良好的各向同性图像,使得通过一次扫描获得的横断面图像进行无差别的任意角度重建图像成为可能,在诊断肠系膜源性肠缺血中具有独特的优越性；但是制约CT扫描应用的最重要因素是X线辐射剂量。
目前有大量关于CT低剂量扫描的研究及文献,主要集中在成人及小儿冠状动脉血管成像、颅脑CT扫描、眼眶、骨盆及胸部CT扫描,然而目前国内外关于腹部低剂量扫描的研究及文献却很少,而且主要集中在单源CT,且降低辐射剂量的方法主要集中在降低kV,mAs。本课题主要针对双源CT (Dual-source CT,DSCT),研究其在肠系膜缺血性疾病诊断中的应用价值,同时研究双源CT腹部血管的低剂量成像技术,降低辐射剂量的方法,除了降低kV,mAs外,还选择增宽准直、增大螺距等方法。
目的：探讨低剂量双源CT (Dual-source CT, DSCT)腹部动静脉双期血管成像技术在肠系膜缺血性疾病诊治中的应用价值。并与常规扫描组比较图像质量及辐射剂量。
方法：80例临床疑诊为肠系膜缺血性疾病的患者,同期行双源CT低剂量腹部动静脉血管双期成像扫描及传统数字血管造影(DSA)检查；利用后处理工作站对CTA获得的腹部血管尤其是肠系膜上动脉、肠系膜下动脉及肠系膜上静脉进行靶重组(包括MIP, MPR, CPR, VRT),结合横断面图像对疾病进行诊断,评价相应肠管有无异常征象,并将其与传统的数字血管造影(DSA)及外科手术结果进行对照比较,评价DSCT低剂量腹部血管成像技术对栓子的诊断准确性；同时,与外科手术所见比较,评价DSCT低剂量腹部扫描对肠管病变情况的诊断准确性。所有阳性患者均经导管行血管内溶栓术治疗(n=23)或行外科手术血管切开取栓术治疗(n=22)证实。选择同期经双源CT常规扫描条件行腹部强化CT检查的患者80例作为对照组,由2名具有多年腹部CT诊断资格的放射科医师采用双盲法对VR图像按照差(0分)、中(1分)、良(2分)、优(3分)等级进行质量评估,用t检验比较2组患者的图像质量评分。同时,记录机器自动生成的2组患者的辐射剂量参数(CTDIvol, DLP),换算成有效剂量(effective dose) mSv后,经t检验,比较2组患者的有效辐射剂量。
结果：80例患者均成功完成DSCT低剂量腹部动静脉血管成像扫描。其中,45例阳性患者中,动脉性病变35例,其中,动脉粥样硬化性斑块所致管腔偏心性狭窄19例；非动脉粥样硬化性栓塞16例；前者表现为病变血管及腹主动脉管壁弥漫多发的斑块状钙化斑块,管腔偏心性软斑块及狭窄；后者重组图像表现为局限性管腔内充盈缺损,典型者横断面表现为“靶征”,腹主动脉等周围血管显示良好,无粥样硬化表现；肠系膜上静脉血栓形成10例,表现为肠系膜上静脉内不规则的充盈缺损,其中伴有门静脉血栓3例。DSCT可清晰显示肠管情况,显示不同程度肠梗阻21例,表现为肠腔内的液气平,其中15例增强扫描肠壁呈层状增厚,腹腔内不同程度积液等,6例肠壁无明显强化；除此,DSCT还显示肠道肿瘤2例。与DSA结果及外科手术结果比较,DSCT诊断肠系膜血管性病变的诊断准确率为100%；与外科手术结果比较,DSCT对肠管病变的显示诊断准确率为100%。低剂量组患者的平均图像质量评分为(2.1±0.9)分,普通扫描对照组患者的平均图像质量评分为(2.3±1.1)分,二者差异无明显统计学意义(p>0.05)。低剂量组患者的平均有效剂量为(2.4±0.8)mSv,普通扫描对照组患者的平均有效辐射剂量为(4.2±1.3)mSv,二者差异有明显统计学意义(p<0.05)。
结论：双源CT低剂量腹部血管双期扫描成像技术具有辐射剂量低,诊断准确率高等优点,是诊断肠系膜缺血性疾病的理想检查手段之一。
Purpose:To evaluate the accuracy of low-dose biphasic dual-source computed tomography (DSCT) angiography in the diagnosis of acute mesenteric ischemia (AMI). Compared with the group of regular scan, evaluate the imaging quality and the effective dose.
Materials and Methods:Eighty patients suspected with AMI underwent low-dose biphasic DSCT angiography and conventional digital subtraction angiography (DSA). The images of SMA, IMA and SMV were reconstructed with multi-planar reformation (MPR), curved planar reformation (CPR), maximum intensity projection (MIP) and volume-rendered techniques (VRT). Combined with axial image, evaluate the abnormal signs of intestinal canal. Compared with percutaneous intra-arterial thrombolysis and embolectomy by arteriotomy, evaluate the accuracy of low-dose biphasic DSCT angiography in the diagnosis of AMI. All scans were evaluated by two independent radiologists for CT evidence of ischemia. Patients with AMI was confirmed by embolectomy by arteriotomy (n=22) or percutaneous intra-arterial thrombolysis (n=23).80 randomly selected objects with abdominal angiography were chosen to undertake clinical analysis. The imaging quality was classified into four grades:bad (0 score), moderate (1 scores), good (2 score), excellent (3scores) with the blind evaluation of 2 experienced radiologists. And the effective dose between the 2 groups was evaluated by t test.
Results:A total of 80 patients underwent low-dose DSCT angiography successfully. AMI was diagnosed in 45 patients. The CT angiography images depicted arterial disease in 30 patients,19 patients are induced on the basis of a pre-existent atherosclerosis, and 16 patients are induced on the basis of non-atherosclerotic disease. The symptom of the former is eccentric stenosis of target vascular accompanied with calcification in vessel wall, the sign of the latter is local change of target vascular and the vessel wall of abdominal aorta is normal, "target sign" is the typical symptom. The CT angiography images depicted venous disease in 10 patients, the symptom is irregular filling defects in SMV,3 patients concomitant with thrombosis in portal vein. The situation of intestinal canal can be displayed clearly, intestinal obstruction was observed in 21 patients at different degree, the gas-liquid interface is the main finding. Among them, the intestinal wall was layered enhancement in 15 patients, and non-enhanced in 6 patients.2 patients with tumor in ascending colon were also displayed clearly. Compared with Compared with percutaneous intra-arterial thrombolysis and embolectomy by arteriotomy, the diagnosed accuracy of DSCTA for vascular disease was 100%. Compared with the embolectomy by arteriotomy, the diagnosed accuracy of DSCT for intestinal canal was 100%. The image quality score of low-dose group was (2.1±0.9) vs (2.3±1.1) in regular scan group. The effective dose of low-dose group was (2.4±0.8) mSv vs (4.2±1.3) mSv in regular scan group.
Conclusion:Low-dose biphasic DSCT angiography is a non-invasive examination for mesenteric arteries and veins thrombus, the advantages of this examination were low effective dose, high accuracy rate, and DSCT abdominal angiography is one of the valuable examinations for acute mesenteric ischemia.
CT尤其是时间空间分辨率高的多层螺旋CT的出现,使得一次屏气完成整个腹部的大范围扫描成为可能；增强扫描后不仅能清晰观察血管情况,还能同时观察相应供血区肠道的情况、能同时观察其他腹腔脏器情况,能够获得与选择性血管造影相似的血管三维图像,同时随着bolus tracking技术的应用,使得在肠系膜上动脉内对比剂高峰期获得清晰的动脉血管图像成为可能；扫描速度快,使得连续获得动、静脉双期扫描图像成为可能；z轴分辨率的提高,能够获得良好的各向同性图像,使得通过一次扫描获得的横断面图像进行无差别的任意角度重建图像成为可能,在诊断肠系膜源性肠缺血中具有独特的优越性；但是制约CT扫描应用的最重要因素是X线辐射剂量。
目前有大量关于CT低剂量扫描的研究及文献,主要集中在成人及小儿冠状动脉血管成像、颅脑CT扫描、眼眶、骨盆及胸部CT扫描,然而目前国内外关于腹部低剂量扫描的研究及文献却很少,而且主要集中在单源CT,且降低辐射剂量的方法主要集中在降低kV,mAs。本课题主要针对双源CT (Dual-source CT,DSCT),研究其在肠系膜缺血性疾病诊断中的应用价值,同时研究双源CT腹部血管的低剂量成像技术,降低辐射剂量的方法,除了降低kV,mAs外,还选择增宽准直、增大螺距等方法。
目的：探讨低剂量双源CT (Dual-source CT, DSCT)腹部动静脉双期血管成像技术在肠系膜缺血性疾病诊治中的应用价值。并与常规扫描组比较图像质量及辐射剂量。
方法：80例临床疑诊为肠系膜缺血性疾病的患者,同期行双源CT低剂量腹部动静脉血管双期成像扫描及传统数字血管造影(DSA)检查；利用后处理工作站对CTA获得的腹部血管尤其是肠系膜上动脉、肠系膜下动脉及肠系膜上静脉进行靶重组(包括MIP, MPR, CPR, VRT),结合横断面图像对疾病进行诊断,评价相应肠管有无异常征象,并将其与传统的数字血管造影(DSA)及外科手术结果进行对照比较,评价DSCT低剂量腹部血管成像技术对栓子的诊断准确性；同时,与外科手术所见比较,评价DSCT低剂量腹部扫描对肠管病变情况的诊断准确性。所有阳性患者均经导管行血管内溶栓术治疗(n=23)或行外科手术血管切开取栓术治疗(n=22)证实。选择同期经双源CT常规扫描条件行腹部强化CT检查的患者80例作为对照组,由2名具有多年腹部CT诊断资格的放射科医师采用双盲法对VR图像按照差(0分)、中(1分)、良(2分)、优(3分)等级进行质量评估,用t检验比较2组患者的图像质量评分。同时,记录机器自动生成的2组患者的辐射剂量参数(CTDIvol, DLP),换算成有效剂量(effective dose) mSv后,经t检验,比较2组患者的有效辐射剂量。
结果：80例患者均成功完成DSCT低剂量腹部动静脉血管成像扫描。其中,45例阳性患者中,动脉性病变35例,其中,动脉粥样硬化性斑块所致管腔偏心性狭窄19例；非动脉粥样硬化性栓塞16例；前者表现为病变血管及腹主动脉管壁弥漫多发的斑块状钙化斑块,管腔偏心性软斑块及狭窄；后者重组图像表现为局限性管腔内充盈缺损,典型者横断面表现为“靶征”,腹主动脉等周围血管显示良好,无粥样硬化表现；肠系膜上静脉血栓形成10例,表现为肠系膜上静脉内不规则的充盈缺损,其中伴有门静脉血栓3例。DSCT可清晰显示肠管情况,显示不同程度肠梗阻21例,表现为肠腔内的液气平,其中15例增强扫描肠壁呈层状增厚,腹腔内不同程度积液等,6例肠壁无明显强化；除此,DSCT还显示肠道肿瘤2例。与DSA结果及外科手术结果比较,DSCT诊断肠系膜血管性病变的诊断准确率为100%；与外科手术结果比较,DSCT对肠管病变的显示诊断准确率为100%。低剂量组患者的平均图像质量评分为(2.1±0.9)分,普通扫描对照组患者的平均图像质量评分为(2.3±1.1)分,二者差异无明显统计学意义(p>0.05)。低剂量组患者的平均有效剂量为(2.4±0.8)mSv,普通扫描对照组患者的平均有效辐射剂量为(4.2±1.3)mSv,二者差异有明显统计学意义(p<0.05)。
结论：双源CT低剂量腹部血管双期扫描成像技术具有辐射剂量低,诊断准确率高等优点,是诊断肠系膜缺血性疾病的理想检查手段之一。
Purpose:To evaluate the accuracy of low-dose biphasic dual-source computed tomography (DSCT) angiography in the diagnosis of acute mesenteric ischemia (AMI). Compared with the group of regular scan, evaluate the imaging quality and the effective dose.
Materials and Methods:Eighty patients suspected with AMI underwent low-dose biphasic DSCT angiography and conventional digital subtraction angiography (DSA). The images of SMA, IMA and SMV were reconstructed with multi-planar reformation (MPR), curved planar reformation (CPR), maximum intensity projection (MIP) and volume-rendered techniques (VRT). Combined with axial image, evaluate the abnormal signs of intestinal canal. Compared with percutaneous intra-arterial thrombolysis and embolectomy by arteriotomy, evaluate the accuracy of low-dose biphasic DSCT angiography in the diagnosis of AMI. All scans were evaluated by two independent radiologists for CT evidence of ischemia. Patients with AMI was confirmed by embolectomy by arteriotomy (n=22) or percutaneous intra-arterial thrombolysis (n=23).80 randomly selected objects with abdominal angiography were chosen to undertake clinical analysis. The imaging quality was classified into four grades:bad (0 score), moderate (1 scores), good (2 score), excellent (3scores) with the blind evaluation of 2 experienced radiologists. And the effective dose between the 2 groups was evaluated by t test.
Results:A total of 80 patients underwent low-dose DSCT angiography successfully. AMI was diagnosed in 45 patients. The CT angiography images depicted arterial disease in 30 patients,19 patients are induced on the basis of a pre-existent atherosclerosis, and 16 patients are induced on the basis of non-atherosclerotic disease. The symptom of the former is eccentric stenosis of target vascular accompanied with calcification in vessel wall, the sign of the latter is local change of target vascular and the vessel wall of abdominal aorta is normal, "target sign" is the typical symptom. The CT angiography images depicted venous disease in 10 patients, the symptom is irregular filling defects in SMV,3 patients concomitant with thrombosis in portal vein. The situation of intestinal canal can be displayed clearly, intestinal obstruction was observed in 21 patients at different degree, the gas-liquid interface is the main finding. Among them, the intestinal wall was layered enhancement in 15 patients, and non-enhanced in 6 patients.2 patients with tumor in ascending colon were also displayed clearly. Compared with Compared with percutaneous intra-arterial thrombolysis and embolectomy by arteriotomy, the diagnosed accuracy of DSCTA for vascular disease was 100%. Compared with the embolectomy by arteriotomy, the diagnosed accuracy of DSCT for intestinal canal was 100%. The image quality score of low-dose group was (2.1±0.9) vs (2.3±1.1) in regular scan group. The effective dose of low-dose group was (2.4±0.8) mSv vs (4.2±1.3) mSv in regular scan group.
Conclusion:Low-dose biphasic DSCT angiography is a non-invasive examination for mesenteric arteries and veins thrombus, the advantages of this examination were low effective dose, high accuracy rate, and DSCT abdominal angiography is one of the valuable examinations for acute mesenteric ischemia.
引文
[1]强金伟,李若坤,冯琴,等.多排螺旋CT肠系膜血管造影诊断急性肠缺血[J].中华普外科杂志,2010,25(1)：24-27.
[2]杨婷,吴子刚.缺血性肠病诊断方法的研究进展[J].国际消化病杂志,2010,30(2)：101-102,123.
[3]Park WM, Gloviczki P, Cherry JR, et al. Contemporary management of acute mesenteric ischemia:Factor associated with survival [J]. J Vasc Surg,2002,35(3): 445-452.
[4]Kim AY, Ha HK. Evaluation of suspected mesenteric ischemia efficacy of radiologic studies [J]. Radiol Clin North Am.2003,41(2):327-342.
[5]Ofer A, Abadi S, Nitecki S, et al. Multidetector CT angiography in the evaluation of acute mesenteric ischemia [J]. Eur Radiol.2009,19(1):24-30.
[6]Zandrino F, Musante F, Gallesio I, et al. Assessment of patients with acute mesenteric ischemia:multislice computed tomography signs and clinical performance in a group of patients with surgical correlation [J]. Minerva Gastroenterol Dietol.2006,52(3):317-325.
[7]黄泽和.急性肠系膜上动脉梗塞的CT诊断[J].临床放射学杂志,2010,29(2)：261-263.
[8]陈明,李选,谢敬霞.急性肠缺血的多层螺旋CT评价[J].中国医学科学院学报,2006,28(1)：80-83.
[9]胡鹏志,王维,聂唯,等.急性肠系膜血管梗塞中多排CT征象与肠梗塞病变分期及预后的相关性研究[J].南方医科大学学报,2010,30(6)：1392-1394.
[10]魏晓洁,王锡明,孙丛,等.急性肠缺血的双源CT诊断价值探讨[J].医学影像学杂志.2011,2(21)：218-220.
[11]Wiesner W, Khurana B, Ji H, et al. CT of acute bowl ischemia[J]. Radiology, 2003,226(3):635-650.
[12]王锡明,段艳华,李乐平.多层螺旋CT检查在结直肠肿瘤诊断中的应用[J].中华消化外科杂志,2010：9(6)：465-467.
[13]Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia:initial experience [J]. Radiology.2003,229(1):91-8.
[14]秦维昌,刘传亚,亓恒涛.重视医用X线检查低剂量成像方法学的研究[J].中华放射学杂志,2008,42(10)：1013-1014.
[15]袁旭春,王贤主,廖文凌等,前瞻性心电门控在64层CT冠状动脉成像的初步应用[J].中华放射学杂志,2008,42(10)：1053-1055.
[16]Wang M, Qi HT, Wang XM, et al, Dose performance and image quality:Dual source CT versus single source CT in cardiac CT angiography [J]. EJR.2009, 72(3):396-400.
[17]张森,杜湘珂,李剑颖,等.心电图调制电流对于容积CT心脏扫描图像质量及曝光剂量影响的评估[J].中华放射学杂志,2006,40(9)：974-976.
[18]徐磊,晏子旭,张兆琪,等.双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用[J].中华放射学杂志.2009,43(7)：700-703.
[19]付传明,王开华,陈义加,等.低剂量CT在颅脑-颌面部外伤联合扫描中的应用[J].临床放射学杂志.2010,29(4)：535-538.
[20]吴爱琴,郑文龙,许崇永,等.早产儿颅脑CT低剂量扫描意义[J].医学影像学杂志.2006,16(12)：1332-1334.
[21]杨瑞,代立梅,李剑颖,等.多层螺旋CT低剂量扫描在眼眶部外伤检查中的应用[J].中华放射学杂志,2010,44(7)：731-734.
[22]相爱花,囤荣耀,杨蕾,等.螺旋CT低剂量扫描在育龄男女骨盆病变中的应用研究[J].医学影像学杂志.2009,19(10)：1315-1318.
[23]王国平.多层螺旋CT低剂量扫描技术在胸部的应用价值[J].生物医学工程学进展.2010,31(2)：81-82.
[24]张树桐,陈燕浩,金朝林,等.64层螺旋CT低剂量扫描在胸部疾病诊断中的应用价值[J].实用放射学杂志.2009,(7)：1064-1066.
[25]肖圣祥,毛定立,柴春华,等.64排螺旋CT腹部血管成像低剂量扫描的可行性研究[J].中华放射医学与防护杂志.2010,30(4)：480-482.
[26]杨谦,李伟,赵煜.急性肠系膜缺血性疾病早期CT血管成像影像特征分析[J].实用医院临床杂志.2010,7(5)：90-92.
[27]Horton KM, Fishman EK.Multi-detector row CT of mesenteric ischemia: can it be done? [J]. Radiographics.2001,21(6):1463-73.
[28]Angelelli G, Scardapane A, Memeo M, et al. Acute bowel ischemia:CT findings [J]. Eur J Radiol.2004,50(1):37-47.
[29]Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia:systematic review and meta-analysis [J]. Radiology.2010,256(1): 93-101.
[30]郑毅.急性肠系膜血管缺血性疾病35例报告[J].临床外科杂志.2007,15(7)：463.
[31]钟武,何延政,石赞,等.肠系膜上动脉栓塞的诊断与治疗[J].中华普通外科杂志,2010,25(04).
[32]郭荣利,王涛,黄岜,等.CDFI在诊断急性肠系膜上动脉狭窄或闭塞性肠缺血中的临床应用[J].山东医药,2010,50(15)：87-88.
[33]Horton KM, Fishman EK. Multidetector CT angiography in the diagnosis of mesenteric ischemia [J]. Radiol Clin North Am.2007,45(2):275-88.
[34]吴孟超,吴在德,黄家驷.外科学[M].第7版.北京：人民卫生出版社,2008.
[35]Xu L, Yang L, Zhang Z, et al. Low-dose adaptive sequential scan for dual-source CT coronary angiography in patients with high heart rate:Comparison with retrospective ECG gating [J]. Eur J Radiol 2010; 76:183-187.
[36]Bongartz G, Golding SJ, Jurik AG, et al. European guidelines on quality criteria for computed tomography:EUR 16262.2000. Luxembourg: European Commission.
[37]朱德祥,秦震声,周宝祥,等.急性肠系膜缺血性疾病的临床诊治分析[J].医学理论与实践.2010,23(7)：819-820.
[38]Ottinger D, Swanson JR. Diagnosing intestinal perforation:a new approach [J]. Am J Perinatol.2008,25(5):291-293.
[39]王跃龙.彩色多普勒超声检查在正常成人肠系膜上动脉血流参数测定中的应用[J].临床和实验医学杂志.2008,7(12)：19-20.
[40]陈广才.急性肠系膜血管缺血性疾病的早期诊断和治疗[J].医药论坛杂 志.2010,31(8)：94-95.
[41]Li KC. MR angiography of abdominal ischemia? [J]. Semin Ultrasound CT MRI,1996,17 (4):352-359.
[42]Lefkovitz Z, Cappell MS, Lookstein R, et al. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia [J]. Med Clin North Am, 2002,86(6):1357-1399.
[43]Lee R, Tung HK, Tung PH, et al. CT in acute mesenteric ischaemia [J]. Clin Radiol.2003,58(4):279-87.
[44]Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT [J]. Radiology,1996,199(7):632-636.
[1]Wiesner W,Khurana B,JiH,etal.CT of acute bowl ischemia.Radiology,2003, 226(3):635-650
[2]尚克中,程英升.肠缺血的临床与影像学进展.世界华人消化杂志.2004
[3]范岳峰,金龙.刘慧君.杜湘珂,洪楠.急性肠缺血的多层螺旋CT分析.使用放射学杂志.2009,7(25)：986-989
[4]汪波,曾广源.增强CT对肠梗阻及肠缺血的诊断家孩子.当代医学.2010,16(9)：144-145
[5]皮执民.消化外科学[M].北京：人民卫生出版社,2002.464.
[6]Ming-Chen PS,Hagspiel KD.CTA and MRA in mesenteric ischemia.part l,role in diagnosis and differential diagnosis[J].AJR,2007,188(2):452-461.
[7]Okino Y,Kiyosue H,Mori H,et al.Root of the small-bowel mesentery:correlative anstomy and CT features of pathologic conditions[J]. Radiographics,2001,21:1475-1490.
[8]Ha HK,Rha SE,Kim AY,et al.CT and MR diagnosis of intestinal ischemia.Semin Ultrasound CTMR,2000,21:40-55.
[9]Chaudhuri TK,Davis H.Acute mesenteric ischemia and malpractice claims. South Med J,2000,93(2):210-214.
[10]Lefkovitz Z, Cappell MS, Lookstein R, et al. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia[J]. Med Clin North Am,2002,86 (6):1357-1399.
[11]Reinus JF,Brandt LJ,Boley SJ.Ischemic disease of the bowel[J]. Gastroenterol Clin North Am,1990,19(2):319-343.
[12]Cademartiri F,Raaijmakers RHJM,Kuiper JW,et al.Multi-detector row CT angiography in patients with abdominal angina[J]. RadioGraphics,2004,24(4):969-984.
[13]Acosta S,Ogren M,Stemby NH,et al.Mesenteric venous thrombosis with transmural intestinal infarction:a population based study[J].J Vasc Surg,2005,41(1):59-63.
[14]Yamada Y,Nishimura S,Inoue T,et al.Anorexia nervosa with ischemic necrosis of the segmental ileum and cecum[J].Intern Med,2000,40(4):304-307.
[15]Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT[J]. Radiology,1996,199:632-636.
[16]Wiesnen W,Khwrana B,Jiol,et al,CT of acute bowel ischemia,Radiology, 2003,226:635-650.
[17]陈广才.急性肠系膜血管缺血性疾病的早期诊断和治疗[J].医药论坛杂志.2010,31(8)：94-95.
[18]Bakal C, Sprayregen S, Wolf E. Radiology in intestinal ischemia:angeographic diagnosis and management[J]. Surg Clin North Am,1992,72 (1):125-141.
[19]Stamatakos M,Stefanaki C,Mastrokalos D,et al.Mesenteric ischemia:still adeadly puzzle for the medical community.Tohoko J Exp Med,2008,216:197-204.
[2]杨婷,吴子刚.缺血性肠病诊断方法的研究进展[J].国际消化病杂志,2010,30(2)：101-102,123.
[3]Park WM, Gloviczki P, Cherry JR, et al. Contemporary management of acute mesenteric ischemia:Factor associated with survival [J]. J Vasc Surg,2002,35(3): 445-452.
[4]Kim AY, Ha HK. Evaluation of suspected mesenteric ischemia efficacy of radiologic studies [J]. Radiol Clin North Am.2003,41(2):327-342.
[5]Ofer A, Abadi S, Nitecki S, et al. Multidetector CT angiography in the evaluation of acute mesenteric ischemia [J]. Eur Radiol.2009,19(1):24-30.
[6]Zandrino F, Musante F, Gallesio I, et al. Assessment of patients with acute mesenteric ischemia:multislice computed tomography signs and clinical performance in a group of patients with surgical correlation [J]. Minerva Gastroenterol Dietol.2006,52(3):317-325.
[7]黄泽和.急性肠系膜上动脉梗塞的CT诊断[J].临床放射学杂志,2010,29(2)：261-263.
[8]陈明,李选,谢敬霞.急性肠缺血的多层螺旋CT评价[J].中国医学科学院学报,2006,28(1)：80-83.
[9]胡鹏志,王维,聂唯,等.急性肠系膜血管梗塞中多排CT征象与肠梗塞病变分期及预后的相关性研究[J].南方医科大学学报,2010,30(6)：1392-1394.
[10]魏晓洁,王锡明,孙丛,等.急性肠缺血的双源CT诊断价值探讨[J].医学影像学杂志.2011,2(21)：218-220.
[11]Wiesner W, Khurana B, Ji H, et al. CT of acute bowl ischemia[J]. Radiology, 2003,226(3):635-650.
[12]王锡明,段艳华,李乐平.多层螺旋CT检查在结直肠肿瘤诊断中的应用[J].中华消化外科杂志,2010：9(6)：465-467.
[13]Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia:initial experience [J]. Radiology.2003,229(1):91-8.
[14]秦维昌,刘传亚,亓恒涛.重视医用X线检查低剂量成像方法学的研究[J].中华放射学杂志,2008,42(10)：1013-1014.
[15]袁旭春,王贤主,廖文凌等,前瞻性心电门控在64层CT冠状动脉成像的初步应用[J].中华放射学杂志,2008,42(10)：1053-1055.
[16]Wang M, Qi HT, Wang XM, et al, Dose performance and image quality:Dual source CT versus single source CT in cardiac CT angiography [J]. EJR.2009, 72(3):396-400.
[17]张森,杜湘珂,李剑颖,等.心电图调制电流对于容积CT心脏扫描图像质量及曝光剂量影响的评估[J].中华放射学杂志,2006,40(9)：974-976.
[18]徐磊,晏子旭,张兆琪,等.双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用[J].中华放射学杂志.2009,43(7)：700-703.
[19]付传明,王开华,陈义加,等.低剂量CT在颅脑-颌面部外伤联合扫描中的应用[J].临床放射学杂志.2010,29(4)：535-538.
[20]吴爱琴,郑文龙,许崇永,等.早产儿颅脑CT低剂量扫描意义[J].医学影像学杂志.2006,16(12)：1332-1334.
[21]杨瑞,代立梅,李剑颖,等.多层螺旋CT低剂量扫描在眼眶部外伤检查中的应用[J].中华放射学杂志,2010,44(7)：731-734.
[22]相爱花,囤荣耀,杨蕾,等.螺旋CT低剂量扫描在育龄男女骨盆病变中的应用研究[J].医学影像学杂志.2009,19(10)：1315-1318.
[23]王国平.多层螺旋CT低剂量扫描技术在胸部的应用价值[J].生物医学工程学进展.2010,31(2)：81-82.
[24]张树桐,陈燕浩,金朝林,等.64层螺旋CT低剂量扫描在胸部疾病诊断中的应用价值[J].实用放射学杂志.2009,(7)：1064-1066.
[25]肖圣祥,毛定立,柴春华,等.64排螺旋CT腹部血管成像低剂量扫描的可行性研究[J].中华放射医学与防护杂志.2010,30(4)：480-482.
[26]杨谦,李伟,赵煜.急性肠系膜缺血性疾病早期CT血管成像影像特征分析[J].实用医院临床杂志.2010,7(5)：90-92.
[27]Horton KM, Fishman EK.Multi-detector row CT of mesenteric ischemia: can it be done? [J]. Radiographics.2001,21(6):1463-73.
[28]Angelelli G, Scardapane A, Memeo M, et al. Acute bowel ischemia:CT findings [J]. Eur J Radiol.2004,50(1):37-47.
[29]Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia:systematic review and meta-analysis [J]. Radiology.2010,256(1): 93-101.
[30]郑毅.急性肠系膜血管缺血性疾病35例报告[J].临床外科杂志.2007,15(7)：463.
[31]钟武,何延政,石赞,等.肠系膜上动脉栓塞的诊断与治疗[J].中华普通外科杂志,2010,25(04).
[32]郭荣利,王涛,黄岜,等.CDFI在诊断急性肠系膜上动脉狭窄或闭塞性肠缺血中的临床应用[J].山东医药,2010,50(15)：87-88.
[33]Horton KM, Fishman EK. Multidetector CT angiography in the diagnosis of mesenteric ischemia [J]. Radiol Clin North Am.2007,45(2):275-88.
[34]吴孟超,吴在德,黄家驷.外科学[M].第7版.北京：人民卫生出版社,2008.
[35]Xu L, Yang L, Zhang Z, et al. Low-dose adaptive sequential scan for dual-source CT coronary angiography in patients with high heart rate:Comparison with retrospective ECG gating [J]. Eur J Radiol 2010; 76:183-187.
[36]Bongartz G, Golding SJ, Jurik AG, et al. European guidelines on quality criteria for computed tomography:EUR 16262.2000. Luxembourg: European Commission.
[37]朱德祥,秦震声,周宝祥,等.急性肠系膜缺血性疾病的临床诊治分析[J].医学理论与实践.2010,23(7)：819-820.
[38]Ottinger D, Swanson JR. Diagnosing intestinal perforation:a new approach [J]. Am J Perinatol.2008,25(5):291-293.
[39]王跃龙.彩色多普勒超声检查在正常成人肠系膜上动脉血流参数测定中的应用[J].临床和实验医学杂志.2008,7(12)：19-20.
[40]陈广才.急性肠系膜血管缺血性疾病的早期诊断和治疗[J].医药论坛杂 志.2010,31(8)：94-95.
[41]Li KC. MR angiography of abdominal ischemia? [J]. Semin Ultrasound CT MRI,1996,17 (4):352-359.
[42]Lefkovitz Z, Cappell MS, Lookstein R, et al. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia [J]. Med Clin North Am, 2002,86(6):1357-1399.
[43]Lee R, Tung HK, Tung PH, et al. CT in acute mesenteric ischaemia [J]. Clin Radiol.2003,58(4):279-87.
[44]Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT [J]. Radiology,1996,199(7):632-636.
[1]Wiesner W,Khurana B,JiH,etal.CT of acute bowl ischemia.Radiology,2003, 226(3):635-650
[2]尚克中,程英升.肠缺血的临床与影像学进展.世界华人消化杂志.2004
[3]范岳峰,金龙.刘慧君.杜湘珂,洪楠.急性肠缺血的多层螺旋CT分析.使用放射学杂志.2009,7(25)：986-989
[4]汪波,曾广源.增强CT对肠梗阻及肠缺血的诊断家孩子.当代医学.2010,16(9)：144-145
[5]皮执民.消化外科学[M].北京：人民卫生出版社,2002.464.
[6]Ming-Chen PS,Hagspiel KD.CTA and MRA in mesenteric ischemia.part l,role in diagnosis and differential diagnosis[J].AJR,2007,188(2):452-461.
[7]Okino Y,Kiyosue H,Mori H,et al.Root of the small-bowel mesentery:correlative anstomy and CT features of pathologic conditions[J]. Radiographics,2001,21:1475-1490.
[8]Ha HK,Rha SE,Kim AY,et al.CT and MR diagnosis of intestinal ischemia.Semin Ultrasound CTMR,2000,21:40-55.
[9]Chaudhuri TK,Davis H.Acute mesenteric ischemia and malpractice claims. South Med J,2000,93(2):210-214.
[10]Lefkovitz Z, Cappell MS, Lookstein R, et al. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia[J]. Med Clin North Am,2002,86 (6):1357-1399.
[11]Reinus JF,Brandt LJ,Boley SJ.Ischemic disease of the bowel[J]. Gastroenterol Clin North Am,1990,19(2):319-343.
[12]Cademartiri F,Raaijmakers RHJM,Kuiper JW,et al.Multi-detector row CT angiography in patients with abdominal angina[J]. RadioGraphics,2004,24(4):969-984.
[13]Acosta S,Ogren M,Stemby NH,et al.Mesenteric venous thrombosis with transmural intestinal infarction:a population based study[J].J Vasc Surg,2005,41(1):59-63.
[14]Yamada Y,Nishimura S,Inoue T,et al.Anorexia nervosa with ischemic necrosis of the segmental ileum and cecum[J].Intern Med,2000,40(4):304-307.
[15]Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT[J]. Radiology,1996,199:632-636.
[16]Wiesnen W,Khwrana B,Jiol,et al,CT of acute bowel ischemia,Radiology, 2003,226:635-650.
[17]陈广才.急性肠系膜血管缺血性疾病的早期诊断和治疗[J].医药论坛杂志.2010,31(8)：94-95.
[18]Bakal C, Sprayregen S, Wolf E. Radiology in intestinal ischemia:angeographic diagnosis and management[J]. Surg Clin North Am,1992,72 (1):125-141.
[19]Stamatakos M,Stefanaki C,Mastrokalos D,et al.Mesenteric ischemia:still adeadly puzzle for the medical community.Tohoko J Exp Med,2008,216:197-204.