急性肠缺血早期影像学研究进展
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摘要
急性肠缺血(AMI)是肠道血液供应不足导致肠道组织缺血坏死的疾病。其起病隐匿,症状及体征不成比例,早期诊断困难是导致AMI死亡率高的重要原因,因此及时诊断和快速治疗是改善患者预后的关键。目前,在临床上肠缺血疾病的早期诊断仍是多学科的挑战。随着影像学技术的不断进步,超声检查、CT、磁共振成像及数字减影血管造影等影像学检查在诊断AMI中起至关重要的作用,在评估肠系膜血管血供情况和肠段缺血情况等方面相辅相成,这不仅使AMI的早期诊断率得到提高,还改善了疾病的预后。未来,磁共振成像技术将成为肠壁各层结构缺血变化的研究方向。
Acute intestinal ischemia( AMI) is a disease of intestinal ischemia and necrosis caused by insufficient intestinal blood supply. The onset of disease is hidden,symptoms and signs are disproportionate,and early diagnosis difficulty is an important cause of the high mortality rate of AMI,so timely diagnosis and rapid treatment are the keys to improve the prognosis of the patients. At present,the early diagnosis of intestinal ischemic disease is still a multidisciplinary challenge in clinical. With the continuous progress of imaging technology,imaging tests such as ultrasonography,CT,magnetic resonance imaging and digital subtraction angiography are playing important roles in the diagnosis of AMI,and complement each other in the assessment of mesenteric vascular blood supply and intestinal ischemia,which not only improves the early diagnosis rate of AMI,but also improves the prognosis of the disease. In the future,magnetic resonance imaging technology will become the research direction of ischemic changes of intestinal wall structures.
Acute intestinal ischemia( AMI) is a disease of intestinal ischemia and necrosis caused by insufficient intestinal blood supply. The onset of disease is hidden,symptoms and signs are disproportionate,and early diagnosis difficulty is an important cause of the high mortality rate of AMI,so timely diagnosis and rapid treatment are the keys to improve the prognosis of the patients. At present,the early diagnosis of intestinal ischemic disease is still a multidisciplinary challenge in clinical. With the continuous progress of imaging technology,imaging tests such as ultrasonography,CT,magnetic resonance imaging and digital subtraction angiography are playing important roles in the diagnosis of AMI,and complement each other in the assessment of mesenteric vascular blood supply and intestinal ischemia,which not only improves the early diagnosis rate of AMI,but also improves the prognosis of the disease. In the future,magnetic resonance imaging technology will become the research direction of ischemic changes of intestinal wall structures.
引文
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[29]Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR Am J Roentgenol,2009,192(2):408-416.
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[2]Luther B,Mamopoulos A,Lehmann C,et al.The Ongoing Challenge of Acute Mesenteric Ischemia[J].Visc Med,2018,34(3):217-223.
[3]van Dijk LJ,van Petersen AS,Moelker A.Vascular imaging of the mesenteric vasculature[J].Best Pract Res Clin Gastroenterol,2017,31(1):3-14.
[4]Copin P,Zins M,Nuzzo A,et al.Acute mesenteric ischemia:Acritical role for the radiologist[J].Diagn Interv Imaging,2018,99(3):123-134.
[5]Schoots IG,Koffeman GI,Legemate DA,et al.Systematic review of survival after acute mesenteric ischaemia according to disease aetiology[J].Br J Surg,2004,91(1):17-27.
[6]Haglund U,Bergqvist D.Intestinal ischemia--the basics[J].Langenbecks Arch Surg,1999,384(3):233-238.
[7]Jia Z,Jiang G,Tian F,et al.Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli[J].Eur J Vasc Endovasc Surg,2014,47(2):196-203.
[8]Gans SL,Stoker J,Boermeester MA.Plain abdominal radiography in acute abdominal pain;past,present,and future[J].Int J Gen Med,2012,5:525-533.
[9]Oldenburg WA,Lau LL,Rodenberg TJ,et al.Acute mesenteric ischemia:A clinical review[J].Arch Intern Med,2004,164(10):1054-1062.
[10]Wale A,Pilcher J.Current role of ultrasound in small bowel imaging[J].Semin Ultrasound CT MR,2016,37(4):301-312.
[11]Pastor-Juan MDR,Ripollés T,Martí-BonmatíL,et al.Predictors of severity in ischemic colitis:Usefulness of early ultrasonography[J].Eur J Radiol,2017,96:21-26.
[12]Expert Panels on Vascular Imaging and Gastrointestinal Imaging,Ginsburg M,Obara P,et al.ACR appropriateness criteriaimaging of mesenteric ischemia[J].J Am Coll Radiol,2018,15(11S):S332-340.
[13]Strobel D,Goertz RS,Bernatik T.Diagnostics in inflammatory bowel disease:Ultrasound[J].World J Gastroenterol,2011,17(27):3192-3197.
[14]Reginelli A,Genovese E,Cappabianca S,et al.Intestinal Ischemia:US-CT findings correlations[J].Crit Ultrasound J,2013,5 Suppl1:S7.
[15]Mc Carthy E,Little M,Briggs J,et al.Radiology and mesenteric ischaemia[J].Clin Radiol,2015,70(7):698-705.
[16]Aburahma AF,Stone PA,Srivastava M,et al.Mesenteric/celiac duplex ultrasound interpretation criteria revisited[J].J Vasc Surg,2012,55(2):428-436.e6;discussion:435-436.
[17]Chen S,Hu Y,Liu Q,et al.Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis[J].Pediatr Surg Int,2018,34(5):535-541.
[18]Elliott CL,Maclachlan J,Beal I.Paediatric bowel ultrasound in inflammatory bowel disease[J].Eur J Radiol,2018,108:21-27.
[19]Kanasaki S,Furukawa A,Fumoto K,et al.Acute mesenteric ischemia:Multidetector CT findings and endovascular management[J].Radiographics,2018,38(3):945-961.
[20]Menke J.Diagnostic accuracy of multidetector CT in acute mesenteric ischemia:Systematic review and meta-analysis[J].Radiology,2010,256(1):93-101.
[21]Bala M,Kashuk J,Moore EE,et al.Acute mesenteric ischemia:Guidelines of the World Society of Emergency Surgery[J].World J Emerg Surg,2017,12:38.
[22]Krkkinen JM,Acosta S.Acute mesenteric ischemia(partⅠ)-Incidence,etiologies,and how to improve early diagnosis[J].Best Pract Res Clin Gastroenterol,2017,31(1):15-25.
[23]Salim S,Ekberg O,Elf J,et al.Clinical implications of CT findings in mesenteric venous thrombosis at admission[J].Emerg Radiol,2018,25(4):407-413.
[24]Kammerer S,Schuelke C,Berkemeyer S,et al.The role of multislice computed tomography(MSCT)angiography in the diagnosis and therapy of non-occlusive mesenteric ischemia(NOMI):Could MSCT replace DSA in diagnosis?[J].PLo S One,2018,13(3):e0193698.
[25]Wittenberg J,Harisinghani MG,Jhaveri K,et al.Algorithmic approach to CT diagnosis of the abnormal bowel wall[J].Radiographics,2002,22(5):1093-1107.
[26]Horton KM,Fishman EK.Multidetector CT angiography in the diagnosis of mesenteric ischemia[J].Radiol Clin North Am,2007,45(2):275-288.
[27]Schieda N,Fasih N,Shabana W.Triphasic CT in the diagnosis of acute mesenteric ischaemia[J].Eur Radiol,2013,23(7):1891-1900.
[28]Yikilmaz A,Karahan OI,Senol S,et al.Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia[J].Eur J Radiol,2011,80(2):297-302.
[29]Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR Am J Roentgenol,2009,192(2):408-416.
[30]Macari M,Megibow AJ,Balthazar EJ.A pattern approach to the abnormal small bowel:Observations at MDCT and CT enterography[J].AJR Am J Roentgenol,2007,188(5):1344-1355.
[31]Macari M,Balthazar EJ.CT of bowel wall thickening:significance and pitfalls of interpretation[J].AJR Am J Roentgenol,2001,176(5):1105-1116.
[32]Barrett T,Upponi S,Benaglia T,et al.Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery[J].Br J Radiol,2013,86(1030):20130277.
[33]Barmase M,Kang M,Wig J,et al.Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia[J].Eur J Radiol,2011,80(3):e582-587.
[34]Wiesner W,Khurana B,Ji H,et al.CT of acute bowel ischemia[J].Radiology,2003,226(3):635-650.
[35]Meaney JF,Prince MR,Nostrant TT,et al.Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia[J].J Magn Reson Imaging,1997,7(1):171-176.
[36]Siedek F,Giese D,Weiss K,et al.4D flow MRI for the analysis of celiac trunk and mesenteric artery stenoses[J].Magn Reson Imaging,2018,53:52-62.
[37]Zhao DW,Cheng C,Kuang LQ,et al.A new approach using manganese-enhanced MRI to diagnose acute mesenteric ischemia in a rabbit model:Initial experience[J].Biomed Res Int,2015,2015:579639.
[38]Bruhn RS,Distelmaier MS,Hellmann-sokolis M,et al.Early detection of acute mesenteric ischemia using diffusion-weighted3.0-T magnetic resonance imaging in a porcine model[J].Invest Radiol,2013,48(4):231-237.
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