多层螺旋CT口服小肠造影（MSCTE）的临床应用
摘要
目的:通过口服等渗甘露醇溶液进行多层螺旋CT扫描来评估小肠的扩张度,探讨口服小肠造影在肠道疾病中应用的优越性及临床应用价值。
方法:对50例怀疑小肠疾病患者使用多层螺旋常规扫描后,口服2.5%的甘露醇等渗溶液,于再次扫描前75钟内共饮1800ml(未成年半量),分四次饮服,以达到小肠各段充分扩张,每次450ml,在25、50分钟依次服用第2、3次,最后一次在65分钟时静脉内注入低张药物后喝下(肠梗阻患者除外),约75分钟时行全腹部CT扫描及增强扫描。50例患者按年龄及病因分为儿童组、成人组(不包括有梗阻患者);无肠梗阻组与肠梗阻组(所有肠梗阻患者均为成人),将小肠扩张的程度数据分别统计。
结果:
1.口服法多层螺旋CT小肠造影在47例患者中取得较好耐受性,3例患者不能耐受只服用500ml,48例病人扫描时对比剂均达回盲部。
2.口服法多层螺旋CT小肠造影能适度地扩张肠腔,37成人无肠梗阻患者中空肠扩张度平均为19.3±3.9mm ,回肠扩张度为平均16.1±5.3mm,4例未成年患者空肠扩张平均为17.2±3.6mm,回肠扩张度为13.5±2.2mm,41例无肠梗阻患者(包括未成年)空肠扩张度大于回肠。
3.口服法多层螺旋CT小肠造影诊断小肠肿瘤15例,活动性Corhn's 3例,肠结核3例,小肠淋巴瘤5例,结肠癌8例,其它疾病11例,5例无异常发现。
4.口服法多层螺旋CT小肠造影诊断肠道疾病的敏感性、特异性、准确性、阳性预测值及阴性预测值各自为97.8% ,100%, 98%,100% and 80%,而MSCT常规扫描则分别为90.9%, 66.7%, 88%,95.2%, 50%;MSCTE检查在肠道病变的检出率要高于常规MSCT扫描。
结论:
1.口服法多层螺旋CT小肠造影方法简便,易于发现和显示肠道病变,在肠道疾病的诊断上优越于常规MSCT,尤其在小肠疾病的诊断上。
2.口服法多层螺旋CT小肠造影在腹腔疾病的鉴别诊断上有重要的临床价值。
Objective: 50 patients who were suspected of having small-bowel dieases underment a noninvasive peroral MSCT enterography with isosmotic mannitol to estimate small-bowel distention and to investigate the superiority in clinical application to diseases of intestinal tract.
Methods : After all patients were underment routined CT scanning, they were assigned to drink a total of 1,800ml(impuberism just taken 900ml) isosmotic mannitol in 75 minutes by four times prior to CT enterography in order to increase gastric and small bowel engorge. Each time was given 450ml. At the beginning the first aliquots was given to the patients and subsequent aliquots were given at 25, 50, and 65 minutes ;then inject the peristaltic agent(excluding who have bowel obstruction ). CT scanning was performed at 75 minutes after the first taken.50 patients were divided into impuberism groups, alduts groups,bowel obstruction groups(All patients with bowel obstruction were aldut.) and without bowel obstruction groups.
Results
1.Peroral MSCT enterography was well tolerated in 47 patients ;3 patients in adults who complained just taken 500ml.At MSCTE scanning the material contrast in 48 patients were reached the ileocecal junction.
2.MSCTE with isosmotic mannitol can make the bowel luminal adequate distention. The 37 adult patients,who haven’t bowel obstruction ,of luminal distention of jejunum was 19.3±3.9mm ,ileum was 16.1±5.3mm. 4 impuberism patients of luminal distention of jejunum was 17.2±3.6mm, ileum was 13.5±2.2mm. Distensibility of jejunum of patients who haven’t bowel obstruction including the impuberism was better than ileum.
3.MSCTE allowed the diagnosis of small-bowel masses (n = 15), active Crohn disease (n =3), bowel tuberculosis (n = 3), small-bowel lymphoma disease (n =5), colon carcinoma(n=8) ,normal findings (n=5 ) and other findings (n=11) (all including confirmed bowel obstruction n=9).
4. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MSCTE were 97.8 % ,100%, 98 % ,100% and 80%, respectively; But the regular MSCT scanning was 90.9%, 66.7%, 88%,95.2%,50%. The detection rate of the diseases of intestinal tract by MSCTE is higher than by regular MSCT .
Conclusion :
1. The method of Peroral MSCT enterography with isosmotic mannitol is simple which can adequately dialate the small bowel and easily find and display the pathological changes of digestive tract. It was better than the regular CT at diagnosising the diease in intestinal tract; it has great superiority especially in small-bowel diease.
2. Peroral MSCT enterography also have important vaule in differential diagnosis of abdominal cavity diease.
方法:对50例怀疑小肠疾病患者使用多层螺旋常规扫描后,口服2.5%的甘露醇等渗溶液,于再次扫描前75钟内共饮1800ml(未成年半量),分四次饮服,以达到小肠各段充分扩张,每次450ml,在25、50分钟依次服用第2、3次,最后一次在65分钟时静脉内注入低张药物后喝下(肠梗阻患者除外),约75分钟时行全腹部CT扫描及增强扫描。50例患者按年龄及病因分为儿童组、成人组(不包括有梗阻患者);无肠梗阻组与肠梗阻组(所有肠梗阻患者均为成人),将小肠扩张的程度数据分别统计。
结果:
1.口服法多层螺旋CT小肠造影在47例患者中取得较好耐受性,3例患者不能耐受只服用500ml,48例病人扫描时对比剂均达回盲部。
2.口服法多层螺旋CT小肠造影能适度地扩张肠腔,37成人无肠梗阻患者中空肠扩张度平均为19.3±3.9mm ,回肠扩张度为平均16.1±5.3mm,4例未成年患者空肠扩张平均为17.2±3.6mm,回肠扩张度为13.5±2.2mm,41例无肠梗阻患者(包括未成年)空肠扩张度大于回肠。
3.口服法多层螺旋CT小肠造影诊断小肠肿瘤15例,活动性Corhn's 3例,肠结核3例,小肠淋巴瘤5例,结肠癌8例,其它疾病11例,5例无异常发现。
4.口服法多层螺旋CT小肠造影诊断肠道疾病的敏感性、特异性、准确性、阳性预测值及阴性预测值各自为97.8% ,100%, 98%,100% and 80%,而MSCT常规扫描则分别为90.9%, 66.7%, 88%,95.2%, 50%;MSCTE检查在肠道病变的检出率要高于常规MSCT扫描。
结论:
1.口服法多层螺旋CT小肠造影方法简便,易于发现和显示肠道病变,在肠道疾病的诊断上优越于常规MSCT,尤其在小肠疾病的诊断上。
2.口服法多层螺旋CT小肠造影在腹腔疾病的鉴别诊断上有重要的临床价值。
Objective: 50 patients who were suspected of having small-bowel dieases underment a noninvasive peroral MSCT enterography with isosmotic mannitol to estimate small-bowel distention and to investigate the superiority in clinical application to diseases of intestinal tract.
Methods : After all patients were underment routined CT scanning, they were assigned to drink a total of 1,800ml(impuberism just taken 900ml) isosmotic mannitol in 75 minutes by four times prior to CT enterography in order to increase gastric and small bowel engorge. Each time was given 450ml. At the beginning the first aliquots was given to the patients and subsequent aliquots were given at 25, 50, and 65 minutes ;then inject the peristaltic agent(excluding who have bowel obstruction ). CT scanning was performed at 75 minutes after the first taken.50 patients were divided into impuberism groups, alduts groups,bowel obstruction groups(All patients with bowel obstruction were aldut.) and without bowel obstruction groups.
Results
1.Peroral MSCT enterography was well tolerated in 47 patients ;3 patients in adults who complained just taken 500ml.At MSCTE scanning the material contrast in 48 patients were reached the ileocecal junction.
2.MSCTE with isosmotic mannitol can make the bowel luminal adequate distention. The 37 adult patients,who haven’t bowel obstruction ,of luminal distention of jejunum was 19.3±3.9mm ,ileum was 16.1±5.3mm. 4 impuberism patients of luminal distention of jejunum was 17.2±3.6mm, ileum was 13.5±2.2mm. Distensibility of jejunum of patients who haven’t bowel obstruction including the impuberism was better than ileum.
3.MSCTE allowed the diagnosis of small-bowel masses (n = 15), active Crohn disease (n =3), bowel tuberculosis (n = 3), small-bowel lymphoma disease (n =5), colon carcinoma(n=8) ,normal findings (n=5 ) and other findings (n=11) (all including confirmed bowel obstruction n=9).
4. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MSCTE were 97.8 % ,100%, 98 % ,100% and 80%, respectively; But the regular MSCT scanning was 90.9%, 66.7%, 88%,95.2%,50%. The detection rate of the diseases of intestinal tract by MSCTE is higher than by regular MSCT .
Conclusion :
1. The method of Peroral MSCT enterography with isosmotic mannitol is simple which can adequately dialate the small bowel and easily find and display the pathological changes of digestive tract. It was better than the regular CT at diagnosising the diease in intestinal tract; it has great superiority especially in small-bowel diease.
2. Peroral MSCT enterography also have important vaule in differential diagnosis of abdominal cavity diease.
引文
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[1] Furukawa A, Saotome T, Yamasaki M,et al. Cross-sectional imaging in Crohn disease[J]. Radiographics, 2004, 24: 689～702.
[2]Peter B. Wold, MD, Joel G. Fletcher, MD, C. Daniel Johnson,MD et al.Assessment of Small Bowel Crohn Disease: Noninvasive Peroral CT Enterography Compared with Other Imaging Methods and Endoscopy—Feasibility Study [J] .Radiology 2003;229:275-281.
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[8]Albert JG, Martiny F, Krummenerl A,et al.Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis[J]. Gut, 2005, 54:1721～1727.
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[13]Maglinte D D,Kelvin F M,Rowe M G,el al.Smal1.bowel obstruction:optimizing radiologic investigation and nonsurgica Imanagement [J].Radiology,2001,218(1):39—46.
[14]Small-Bowel Obstruction: Coronal Reformations from Isotropic Voxels at 16-Section Multi–Detector Row CT Tracy A. Jaffe, Lucie C. Martin, John Thomas,et al [J]Radiology 2006 238 (1) :138-142.
[15] 贺锋,杨帆,屠惠敏 等.MSCT小肠造影在小肠梗阻病变诊断中的应用[J].放射学实践,2007,22,946-949.
[16] Walter Wiesner, MD, Bharti Khurana, MD, Hoon Ji, MD, PhD, et al.CT of Acute Bowel Ischemia[J]. Radiology 2003;226:635-650.
[17] Artnicke BJ,Balfe DM.CT appearance of intestinal ischemia and intramural hemorrhage.Radiol Clin North Am 1994;32:845-860.
[18] Furukawa A, Saotome T, Yamasaki M,et al. Cross-sectional imaging in Crohn disease[J]. Radiographics, 2004, 24: 689～702.
[19] Gourtsoyiannis NC, Papanikolaou N, Karantanas A. Magnetic resonance imaging evaluation of small intestinal Crohn’s disease[J]. Best Pract Res Clin Gastroenterol,2006, 20: 137～156.
[20]Francesca Maccioni, MD, Antonio Bruni, MD, Angelo Viscido, MD et al . MR Imaging in Patients with Crohn Disease: Value of T2- versus T1-weighted Gadolinium-enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent [J].Radiology 2005; 238: 517-530.
[2] Rollandi G A,Curone P F,Biscaldi E.Spiral CT of the abdomen after distention of small bowel loops with transparent enema in patients with Clohn’s disease[J].Abdom Imaging. 1999;24(6):544—549.
[3] Peter B. Wold, MD, Joel G. Fletcher, MD, C. Daniel Johnson,MD et al.Assessment of Small Bowel Crohn Disease: Noninvasive Peroral CT Enterography Compared with Other Imaging Methods and Endoscopy—Feasibility Study [J] .Radiology 2003;229:275-281.
[4] Amy K. Hara,MD Jonathan A. Leighton,MD,Russell I. Heigh,MD et al . Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-Bowel follow-through,and ileoscopy [J]. Radiology, 2006; 238(1): 128-134.
[5] Furukawa A, Saotome T, Yamasaki M,et al. Cross-sectional imaging in Crohn disease[J]. Radiographics, 2004; 24(3): 689～702.
[6] Pilleul F, Penigaud M, Milot L et al. Possible Small-Bowel Neoplasms: Contrast-enhanced and Water-enhanced Multidetector CT Enteroclysis [J].Radiology 2006,241(3):796-801.
[7] Maccioni F, Bruni A, Viscido A, et al . MR Imaging in Patients with Crohn Disease: Value of T2- versus T1-weighted Gadolinium-enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent [J].Radiology 2005;238(2):517-530.
[8] Sailer J, Peloschek P, Schober E,et al.Diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn’s disease[J].AJR Am Roentqenol, 2005; 185(6): 1575～1581.
[9] Albert JG, Martiny F, Krummenerl A,et al.Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis[J]. Gut, 2005; 54(12):1721～1727.
[10]章士正 任小军.应用现代医学影像技术提高小肠疾病诊断水平 [J]. 中华医学杂志,2005,85,301.
[11]刘炜,秦明伟,潘卫东等.CT 小肠造影对小肠Crohn 病的诊断价值[J]. 中国消化内镜,2007;5:42-44.
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