磁共振注气小肠灌肠及水成像对小肠疾病诊断价值的研究
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摘要
1．研究目的
探讨磁共振注气小肠灌肠及小肠磁共振水成像检查技术及其对小肠疾病的诊断价值。
2．材料与方法
(1)检查分组：对临床怀疑小肠疾病的38例患者行小肠磁共振成像(MRI)检查。其中前15例行磁共振注气小肠灌肠(MR enteroclysis，称注气灌肠组)，后23例行小肠磁共振水成像(称水成像组)。为了扩张小肠，注气灌肠组行小肠插管至十二指肠空肠曲后向小肠注入空气约1000ml，水成像组中22例口服2.5％的等渗甘露醇1500ml，1例严重肠梗阻直接利用肠腔内潴留的液体行小肠MRI。
(2)检查方法与序列：除1例肠梗阻外，其余病例扫描前均静脉注射山莨菪碱(654—2)20mg以抑制肠蠕动。各序列扫描均带脂肪抑制。扫描序列包括：a．注气灌肠组，静脉注射钆喷替酸葡甲胺(Gd—DTPA)12ml后冠状面和横断面T1WI的自旋回波(SE)序列和快速干扰梯度回波(fast spoiled gradient echo,FSPGR)序列；b．水成像组，
冠状面TZWI的单次激发舰自旋回波（劝担忙－sho fs SE，SSFSE）
序歹，TIWI的FSPGR序列禾增强后冠状丽o横断面FSPGR禾 SE
序歹。
D）对照：将小肠MRI的诊断结果与手术、病理或临床诊硼
照，同时评价两种小肠MRI的图像特点。
3．结果
O厂两组小肠MRI检查中，注气灌肠组小肠正常5例，克罗恩
（Cohn’s）病5例，回肠间质瘤（GIST）2例，淋巴瘤、肠结核和易
激眺搬1例；水成幽正常刁肠9例，Cri’s病7例，f碰刁
肠梗阻2例＊瘤和慢陷恃夺异性炎症各1例），十二f涮＋瘤、十
二眠球炎、十二腼结肠瘦、空肠毛细血管扩张症和小肠旋转不良
各1例。1例克罗恩（Cri’幻病被MRI误诊为淋巴瘤，l例小肠毛
细血管扩张断pl 例易激综合症MM未发现异常，其余邯U的MM
诊断均与手术、病理或临床诊断一致。
（2）．水一气扫描FSP皿踌禾 SSFSE序列的图像无呼
吸运动伪影和磁敏感伪影，质量优于SE序列和注气灌肠组的图像，
水成像组的图像增强后带脂肪抑制的FSPGR序列屏气扫描对肠壁的
显示最清楚。
4．结论
门厂磁共振注气小肠灌肠及水成像对诊断小肠器质性病变，尤
其是Cohn’S病、肿瘤和绷IJ小肠梗阻原因具有重要价值；
Q厂两种检查方法中，日服等渗甘露醇的小肠磁共振水成像较
磁共振注气小肠灌肠更优越。
1. PURPOSE:
To investigate the technique of air-infused MR enteroclysis and hydro-MRI and their value in diagnosis of small bowel disease.
2. MATERIAL AND METHODS:
(1). Group division: 38 patients with suspected small bowel disease received small-bowel magnetic resonance imaging(MRI).15 patients underwent air-infused MR enteroclysis (group of air-infused enteroclysis), and the other 23 patients underwent small bowel hydro-MRI(group of hydro-MRI). To distend the small bowel, about 1000ml of air was infused into the small bowel of the patients of air-infused enteroclysis through a nasoenteric tube, and 1500ml of 2.5% osmotic mannitol was ingested in the 22 patients of hydro-MRI and 1 patient with severe small bowel
obstruction used directly the intraluminal solution.
(2) . Methods and sequences of examination: Before MRI, all patients received 20 mg of IV anisodamine to reduce small-bowel peristalsis except the patient with severe small bowel obstruction. Fat-saturation was used in all sequences. The MRI sequences included: a. Group of air-infused enteroclysis, Gd-DTPA enhanced coronal and axial T1-weighted spin-echo(SE) sequence and fast spoiled gradient echo(FSPGR) sequence, b. Group of hydro-MRI, coronal T2-weighted singl e-shot fast SE (SSFSE), Tl weighted coronal FSPGR and enhanced coronal and axial FSPGR and SE sequences.
(3). Comparison: Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed, and the image characteristic of the two kinds of small bowel MRI was assessed.
3.RESULTS:
(1): In group of air-infused MR enteroclysis, there were 5 case of normal small bowel, 5 Crohn' s disease, 2 gastric intestinal stromal tumor(GIST), lymphoma, tuberculosis and irritable bowel syndrome 1 case, respectively. In group of hydro-MRI, there were 9 cases of small bowel were normal, 7 Crohn' s disease, 2 small bowel obstruction(caused by tumor and inflammatory bowel disease, respectively), duodenal tumor, duodenitis, duodenocolic fistula ,small intestinal capillary telangietasia and small intestinal malrotation 1 case,espectively. Except 1 Crohn' s disease was diagnosed as lymphoma and no abnormality was found in 1 intestinal
capillary telangietasia and 1 irritable bowel syndrome, the other diagnosis of MRI was correct.
(2). Because of no breath and sensibility artifact, the quality of breath-hold scanning images of hydro-MRI is superior to that of SE sequence and air-infused MR enteroclysis, and the small bowel wall in the breath-hold scanning image of enhanced fat-saturated FSPGR sequence is the clearest.
4.CONCLUSION:
(1). Small bowel MRI is of important value to diagnose Crohn' s disease, small bowel tumor and to differentiate the reason of small bowel obstruction;
(2). hydro-MRI with oral osmotic mannitol is superior to air-infused MR enteroclysis.
探讨磁共振注气小肠灌肠及小肠磁共振水成像检查技术及其对小肠疾病的诊断价值。
2．材料与方法
(1)检查分组：对临床怀疑小肠疾病的38例患者行小肠磁共振成像(MRI)检查。其中前15例行磁共振注气小肠灌肠(MR enteroclysis，称注气灌肠组)，后23例行小肠磁共振水成像(称水成像组)。为了扩张小肠，注气灌肠组行小肠插管至十二指肠空肠曲后向小肠注入空气约1000ml，水成像组中22例口服2.5％的等渗甘露醇1500ml，1例严重肠梗阻直接利用肠腔内潴留的液体行小肠MRI。
(2)检查方法与序列：除1例肠梗阻外，其余病例扫描前均静脉注射山莨菪碱(654—2)20mg以抑制肠蠕动。各序列扫描均带脂肪抑制。扫描序列包括：a．注气灌肠组，静脉注射钆喷替酸葡甲胺(Gd—DTPA)12ml后冠状面和横断面T1WI的自旋回波(SE)序列和快速干扰梯度回波(fast spoiled gradient echo,FSPGR)序列；b．水成像组，
冠状面TZWI的单次激发舰自旋回波（劝担忙－sho fs SE，SSFSE）
序歹，TIWI的FSPGR序列禾增强后冠状丽o横断面FSPGR禾 SE
序歹。
D）对照：将小肠MRI的诊断结果与手术、病理或临床诊硼
照，同时评价两种小肠MRI的图像特点。
3．结果
O厂两组小肠MRI检查中，注气灌肠组小肠正常5例，克罗恩
（Cohn’s）病5例，回肠间质瘤（GIST）2例，淋巴瘤、肠结核和易
激眺搬1例；水成幽正常刁肠9例，Cri’s病7例，f碰刁
肠梗阻2例＊瘤和慢陷恃夺异性炎症各1例），十二f涮＋瘤、十
二眠球炎、十二腼结肠瘦、空肠毛细血管扩张症和小肠旋转不良
各1例。1例克罗恩（Cri’幻病被MRI误诊为淋巴瘤，l例小肠毛
细血管扩张断pl 例易激综合症MM未发现异常，其余邯U的MM
诊断均与手术、病理或临床诊断一致。
（2）．水一气扫描FSP皿踌禾 SSFSE序列的图像无呼
吸运动伪影和磁敏感伪影，质量优于SE序列和注气灌肠组的图像，
水成像组的图像增强后带脂肪抑制的FSPGR序列屏气扫描对肠壁的
显示最清楚。
4．结论
门厂磁共振注气小肠灌肠及水成像对诊断小肠器质性病变，尤
其是Cohn’S病、肿瘤和绷IJ小肠梗阻原因具有重要价值；
Q厂两种检查方法中，日服等渗甘露醇的小肠磁共振水成像较
磁共振注气小肠灌肠更优越。
1. PURPOSE:
To investigate the technique of air-infused MR enteroclysis and hydro-MRI and their value in diagnosis of small bowel disease.
2. MATERIAL AND METHODS:
(1). Group division: 38 patients with suspected small bowel disease received small-bowel magnetic resonance imaging(MRI).15 patients underwent air-infused MR enteroclysis (group of air-infused enteroclysis), and the other 23 patients underwent small bowel hydro-MRI(group of hydro-MRI). To distend the small bowel, about 1000ml of air was infused into the small bowel of the patients of air-infused enteroclysis through a nasoenteric tube, and 1500ml of 2.5% osmotic mannitol was ingested in the 22 patients of hydro-MRI and 1 patient with severe small bowel
obstruction used directly the intraluminal solution.
(2) . Methods and sequences of examination: Before MRI, all patients received 20 mg of IV anisodamine to reduce small-bowel peristalsis except the patient with severe small bowel obstruction. Fat-saturation was used in all sequences. The MRI sequences included: a. Group of air-infused enteroclysis, Gd-DTPA enhanced coronal and axial T1-weighted spin-echo(SE) sequence and fast spoiled gradient echo(FSPGR) sequence, b. Group of hydro-MRI, coronal T2-weighted singl e-shot fast SE (SSFSE), Tl weighted coronal FSPGR and enhanced coronal and axial FSPGR and SE sequences.
(3). Comparison: Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed, and the image characteristic of the two kinds of small bowel MRI was assessed.
3.RESULTS:
(1): In group of air-infused MR enteroclysis, there were 5 case of normal small bowel, 5 Crohn' s disease, 2 gastric intestinal stromal tumor(GIST), lymphoma, tuberculosis and irritable bowel syndrome 1 case, respectively. In group of hydro-MRI, there were 9 cases of small bowel were normal, 7 Crohn' s disease, 2 small bowel obstruction(caused by tumor and inflammatory bowel disease, respectively), duodenal tumor, duodenitis, duodenocolic fistula ,small intestinal capillary telangietasia and small intestinal malrotation 1 case,espectively. Except 1 Crohn' s disease was diagnosed as lymphoma and no abnormality was found in 1 intestinal
capillary telangietasia and 1 irritable bowel syndrome, the other diagnosis of MRI was correct.
(2). Because of no breath and sensibility artifact, the quality of breath-hold scanning images of hydro-MRI is superior to that of SE sequence and air-infused MR enteroclysis, and the small bowel wall in the breath-hold scanning image of enhanced fat-saturated FSPGR sequence is the clearest.
4.CONCLUSION:
(1). Small bowel MRI is of important value to diagnose Crohn' s disease, small bowel tumor and to differentiate the reason of small bowel obstruction;
(2). hydro-MRI with oral osmotic mannitol is superior to air-infused MR enteroclysis.
引文
1. Koh DM, Miao Y, Chinn RJS, et al. MR imaging evaluation of the activity of Crohns disease. AJR, 2001, 177: 1325-1332.
2. Low RN, Francis IR. MR imaging of the gastrointestinal tract with Ⅳ gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. AJR, 1997, 169(4): 1051-1059.
3. Madsen SM, Thomsen HS, Munkholm P, et al. Magnetic resonance imaging of Crohn's disease:early recognition of treatment response. Abdom Imagong 1997;22:164-166.
4. Kettritz U, Isaacs K, Warshauer DM, et al. Crohn's disease. Pilot study comparing MRI of the abdomen with clinical evaluation. J Clin Gastroenterol, 1995,21: 249-253.
5. Rieber A, Wruk D, Potthast S, et al. Diagnostic imaging in Crohn's disease: comparison of magnetic resonance imaging and conventional imaging methods. Int J Colorectal Dis, 2000, 15:176-181.
6. Low RN, Francis IR, Politoske D, et al. Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J-Magn-Reson-Imaging, 2000,11: 127-135.
7. Maccioni F, Viscido A, Broglia L, et al. Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom-Imaging. 2000, 25:219-222.
8. Maccioni F, Kharrub Z, Buzzi G, et al. MRI in Crohns disease: assessment of treatment response or relapse. In: Scientific Program, The RSNA 87th scientific
assembly and annual meeting, Chicago, 2001.254.
9. Semelka RC, John G, Kelekis NL, et al. Small bowel neoplastic disease: demonstration by MRI. J Magn Reson Imaging, 1996, 6: 855-860.
10. Low RN, Chen SC. Unenhancement and gadolinium-enhanced SGE MR Imaging of bowel obstruction in patients with malignancy: distinguish benign from malignant etiologies. In: Scientific Program, The RSNA 87th scientific assembly and annual meeting, Chicago, 2001. 254.
2. Low RN, Francis IR. MR imaging of the gastrointestinal tract with Ⅳ gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. AJR, 1997, 169(4): 1051-1059.
3. Madsen SM, Thomsen HS, Munkholm P, et al. Magnetic resonance imaging of Crohn's disease:early recognition of treatment response. Abdom Imagong 1997;22:164-166.
4. Kettritz U, Isaacs K, Warshauer DM, et al. Crohn's disease. Pilot study comparing MRI of the abdomen with clinical evaluation. J Clin Gastroenterol, 1995,21: 249-253.
5. Rieber A, Wruk D, Potthast S, et al. Diagnostic imaging in Crohn's disease: comparison of magnetic resonance imaging and conventional imaging methods. Int J Colorectal Dis, 2000, 15:176-181.
6. Low RN, Francis IR, Politoske D, et al. Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J-Magn-Reson-Imaging, 2000,11: 127-135.
7. Maccioni F, Viscido A, Broglia L, et al. Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom-Imaging. 2000, 25:219-222.
8. Maccioni F, Kharrub Z, Buzzi G, et al. MRI in Crohns disease: assessment of treatment response or relapse. In: Scientific Program, The RSNA 87th scientific
assembly and annual meeting, Chicago, 2001.254.
9. Semelka RC, John G, Kelekis NL, et al. Small bowel neoplastic disease: demonstration by MRI. J Magn Reson Imaging, 1996, 6: 855-860.
10. Low RN, Chen SC. Unenhancement and gadolinium-enhanced SGE MR Imaging of bowel obstruction in patients with malignancy: distinguish benign from malignant etiologies. In: Scientific Program, The RSNA 87th scientific assembly and annual meeting, Chicago, 2001. 254.