肠系膜放射解剖学研究
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摘要
第一部分 正常小肠系膜、横结肠系膜和乙状结肠系膜多排螺旋CT表现
目的
肠系膜主要包括小肠系膜、横结肠系膜和乙状结肠系膜,均为双层腹膜结构,系膜两层腹膜间潜在间隙为SpS的一部分。肠系膜自身可发生病变,也可来自邻近脏器、远距离脏器及某些全身性疾病。近十几年来,肠系膜病变逐渐引起人们的重视。对肠系膜病变认识的提高,有助于对它作出全面准确的影像诊断,并利于确定治疗方案及预后评估。多排探测器螺旋CT(Multi-detector spiral CT,简称MDCT)的临床应用,提供了较传统CT更优越的检查手段,具有一次曝光获取多幅图像的特点。它的扫描速度更快,从而减少了运动和呼吸伪影;层面更薄,减少了容积效应;可快速进行大容积扫描,同时保证了Z轴分辨率,上述特点使冠状位和矢状位重建图像失真小,可良好显示腹腔内解剖结构。文献中采用多排螺旋CT研究肠系膜病变的报道甚少,未见采用多排螺旋CT研究正常系膜的报道。本研究的目的在于采用多排螺旋CT探讨正常小肠系膜、横结肠系膜和乙状结肠系膜在轴位、冠状位和矢状位的表现。
PurposeTo investigate the CT manifestations of the normal small bowel mesentery (SBM), the transverse mesocolon(TM) and the sigmoid mesocolon(SM) in multi-detector spiral CT(MDCT) scanning.Materials and methods1. Research subjects: Plain scan and enhanced contrast study with 16 detector spiral CT scanner were performed in 50 consecutive patients from Nov. 2003 to Mar. 2004 in West China Hospital. Those patients which had no disease revealed on CT images were considered as the normal individuals group, some patients with small liver cyst、 renal cyst and liver hemangioma were included. Those patients whose CT images were not fit for the analysis were excluded. 50 cases were 27 males, 23 females, and their ages ranged from 22-64 year.2. CT scanner and scanning parameters: In our study, Siemens sensation 16 CT scanner and Medrad-100 power injector were used. Contrast materials
were Ultravist(Schering, Germany )(300mgI/ml) and Omnipaque (Nycomed, Norway) (300mgI/ml). All of those patients in this study underwent MDCT scan with a scanning coverage from the dome of the diaphragm to the pelvic floor with one-breath-hold. Parameters of CT scans were: 120KV, 165eff mAs, 0.5s/360°; 16X0.75mm, 1 mm MPR reconstruction slice width.3. Image interpretation: Three experienced radiologists reviewed the images, and emphasis was placed on the followning findings: manifestation of major mesenteric vessels such as the vessels located in the SBM, TM and SM; location of the SBM, TM and SM; the correlation of the SBM, TM and SM with their responding bowels; lymph nodes of the SBM, TM and SM; the fat within the SBM, TM and SM.Results1. The revealing rates of the superior mesenteric artery(SMA) and the superior mesenteric vein(SMV) were 100%(50/50) on axial, coronal and sagittal scans of MDCT images; the middle colic artery(MCA) was 86.0%(43/50) on axial and coronal scans of MDCT images; the gastrocolic trunk was 68.0%(34/50) on axial and coronal scans of MDCT images; the inferior mesenteric artery(IMA) and the inferior mesenteric vein(IMV) were 100%(50/50) on axial, coronal and sagittal scans of MDCT images.2. In the left upper quadrant abdomen, the jejunal mesentery was revealed in 98.0% (49/50); in the left lower quadrant abdomen, the ileal mesentery and the jejunal mesentery were revealed in 1OO%(5O/5O); in the right upper quadrant abdomen, the ileal mesentery and the jejunal mesentery were revealed in 92%(46/50); and no SBM was revealed in 8.0%(4/50);13
in the right lower quadrant abdomen, the ileal mesentery was revealed in 100% (50/50); the SBM presentated in the pelvis mostly was ileal mesentery.3. The jejunal mesetery and ileal mesentery had different appearance.4. In 29(58.0%)cases, the small bowel was revealed above the middle segment of transverse colon.5. The SM, 36 cases were covered within the study extent, were analysed. In 26(72.2%, 26/36) cases, the SM did not cross the middle line of body. In 13 (36.1%, 13/36)cases, the second segment of sigmoid colon attached to the level above the crista iliac.6. In 6(12.0%) cases, the normal lymph nodes were revealed in the SBM> TM, and were not revealed in the SM.7. The attenuation of the fat located within the SBM, TM and SM was ranged from -82Hu to -120Hu.Conclusion1. The SMA, SMV, MCA, IMA and IMV can be revealed readily on the MDCT images of normal individuals.2. The demonstration of the SBM is best on coronal MDCT images; integrating the axial, coronal and sagittal MDCT images can illustrate the TM completely; combining the axial and sagittal MDCT images can easily demonstrate the SM.3. The MDCT offers important advantages over conventional CT. The axial, coronal and sagittal MDCT images can demonstrate the normal manifestations of the SBM, TM and SM in a certain extent.
目的
肠系膜主要包括小肠系膜、横结肠系膜和乙状结肠系膜,均为双层腹膜结构,系膜两层腹膜间潜在间隙为SpS的一部分。肠系膜自身可发生病变,也可来自邻近脏器、远距离脏器及某些全身性疾病。近十几年来,肠系膜病变逐渐引起人们的重视。对肠系膜病变认识的提高,有助于对它作出全面准确的影像诊断,并利于确定治疗方案及预后评估。多排探测器螺旋CT(Multi-detector spiral CT,简称MDCT)的临床应用,提供了较传统CT更优越的检查手段,具有一次曝光获取多幅图像的特点。它的扫描速度更快,从而减少了运动和呼吸伪影;层面更薄,减少了容积效应;可快速进行大容积扫描,同时保证了Z轴分辨率,上述特点使冠状位和矢状位重建图像失真小,可良好显示腹腔内解剖结构。文献中采用多排螺旋CT研究肠系膜病变的报道甚少,未见采用多排螺旋CT研究正常系膜的报道。本研究的目的在于采用多排螺旋CT探讨正常小肠系膜、横结肠系膜和乙状结肠系膜在轴位、冠状位和矢状位的表现。
PurposeTo investigate the CT manifestations of the normal small bowel mesentery (SBM), the transverse mesocolon(TM) and the sigmoid mesocolon(SM) in multi-detector spiral CT(MDCT) scanning.Materials and methods1. Research subjects: Plain scan and enhanced contrast study with 16 detector spiral CT scanner were performed in 50 consecutive patients from Nov. 2003 to Mar. 2004 in West China Hospital. Those patients which had no disease revealed on CT images were considered as the normal individuals group, some patients with small liver cyst、 renal cyst and liver hemangioma were included. Those patients whose CT images were not fit for the analysis were excluded. 50 cases were 27 males, 23 females, and their ages ranged from 22-64 year.2. CT scanner and scanning parameters: In our study, Siemens sensation 16 CT scanner and Medrad-100 power injector were used. Contrast materials
were Ultravist(Schering, Germany )(300mgI/ml) and Omnipaque (Nycomed, Norway) (300mgI/ml). All of those patients in this study underwent MDCT scan with a scanning coverage from the dome of the diaphragm to the pelvic floor with one-breath-hold. Parameters of CT scans were: 120KV, 165eff mAs, 0.5s/360°; 16X0.75mm, 1 mm MPR reconstruction slice width.3. Image interpretation: Three experienced radiologists reviewed the images, and emphasis was placed on the followning findings: manifestation of major mesenteric vessels such as the vessels located in the SBM, TM and SM; location of the SBM, TM and SM; the correlation of the SBM, TM and SM with their responding bowels; lymph nodes of the SBM, TM and SM; the fat within the SBM, TM and SM.Results1. The revealing rates of the superior mesenteric artery(SMA) and the superior mesenteric vein(SMV) were 100%(50/50) on axial, coronal and sagittal scans of MDCT images; the middle colic artery(MCA) was 86.0%(43/50) on axial and coronal scans of MDCT images; the gastrocolic trunk was 68.0%(34/50) on axial and coronal scans of MDCT images; the inferior mesenteric artery(IMA) and the inferior mesenteric vein(IMV) were 100%(50/50) on axial, coronal and sagittal scans of MDCT images.2. In the left upper quadrant abdomen, the jejunal mesentery was revealed in 98.0% (49/50); in the left lower quadrant abdomen, the ileal mesentery and the jejunal mesentery were revealed in 1OO%(5O/5O); in the right upper quadrant abdomen, the ileal mesentery and the jejunal mesentery were revealed in 92%(46/50); and no SBM was revealed in 8.0%(4/50);13
in the right lower quadrant abdomen, the ileal mesentery was revealed in 100% (50/50); the SBM presentated in the pelvis mostly was ileal mesentery.3. The jejunal mesetery and ileal mesentery had different appearance.4. In 29(58.0%)cases, the small bowel was revealed above the middle segment of transverse colon.5. The SM, 36 cases were covered within the study extent, were analysed. In 26(72.2%, 26/36) cases, the SM did not cross the middle line of body. In 13 (36.1%, 13/36)cases, the second segment of sigmoid colon attached to the level above the crista iliac.6. In 6(12.0%) cases, the normal lymph nodes were revealed in the SBM> TM, and were not revealed in the SM.7. The attenuation of the fat located within the SBM, TM and SM was ranged from -82Hu to -120Hu.Conclusion1. The SMA, SMV, MCA, IMA and IMV can be revealed readily on the MDCT images of normal individuals.2. The demonstration of the SBM is best on coronal MDCT images; integrating the axial, coronal and sagittal MDCT images can illustrate the TM completely; combining the axial and sagittal MDCT images can easily demonstrate the SM.3. The MDCT offers important advantages over conventional CT. The axial, coronal and sagittal MDCT images can demonstrate the normal manifestations of the SBM, TM and SM in a certain extent.
引文
1. Oliphant M, Berne AS. Computed tomography of the subperitoneal space: demonstration of direct spread of intraabdominal disease. Journal of Computer Assisted Tomography 1982; 6:1127-1137
2. Horton KM, Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions. RadioGraphics 2002; 22:161-172
3. DeMeo JH, Fulcber AS, Austin RF Jr. Anatomic CT demonstration of the peritoneal spaces, ligaments, and mesenteries: normal and pathologic processes. RadioGraphics 1995; 15:755-770
4. Silverman PM, Kelvin FM, Korobkin M, et al. Computed tomography of the normal mesentery. AJR 1984; 143:953-957
5. Oliphant M, Berne AS, Meyers MA. Spread of disease via the subperitoneal space: the small bowel mesentery. Abdominal Imaging 1993;18:109-116
6. Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. RadioGraphics 2001; 21:1475-1490
7. Dynamic Radioloy of the Abdomen-normal and pathologic anatomy. Meyers MA. 3rd ed. New york NY: Springer-verlag, 1988
8.临床解剖学丛书(腹、盆部分册).韩永坚 刘牧之 主编 北京:人民卫生出版社 第一版 1992,5
9. Gray's Anatomy. Williams PL. 38rd New york NY: Churchill livingstone Inc, 1995
10. Blachar A, Federle MP, Dodson, SF. Inernal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 2001; 218:68-74
11. Macari M, Hines J, Balthazar E, et al. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR 2002; 178:853-858
12. Gore RM. CT of inflammatory bowel disease. Radiologic Clinics of North America 1989; 27:717-729
13. Mindelzun RE, Jeffrey RB Jr, Lane MJ, et al. The misty mesentery on CT: differential diagnosis. AJR 1996; 167:61-65
14. Cbarnsangavej C, DuBrow RA, Varma DG, et al. CT of the mesocolon—part 1. Anatomic considerations. RadioGraphics 1993; 13: 1035-1045
15. Blachar A, Federle MP, Brancatelli G, et al. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 2001; 221:422-428
16. Padidar AM, Jeffrey RB Jr, Mindelzun RE, et al. Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis. AJR 1994; 163:81-83
2. Horton KM, Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions. RadioGraphics 2002; 22:161-172
3. DeMeo JH, Fulcber AS, Austin RF Jr. Anatomic CT demonstration of the peritoneal spaces, ligaments, and mesenteries: normal and pathologic processes. RadioGraphics 1995; 15:755-770
4. Silverman PM, Kelvin FM, Korobkin M, et al. Computed tomography of the normal mesentery. AJR 1984; 143:953-957
5. Oliphant M, Berne AS, Meyers MA. Spread of disease via the subperitoneal space: the small bowel mesentery. Abdominal Imaging 1993;18:109-116
6. Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. RadioGraphics 2001; 21:1475-1490
7. Dynamic Radioloy of the Abdomen-normal and pathologic anatomy. Meyers MA. 3rd ed. New york NY: Springer-verlag, 1988
8.临床解剖学丛书(腹、盆部分册).韩永坚 刘牧之 主编 北京:人民卫生出版社 第一版 1992,5
9. Gray's Anatomy. Williams PL. 38rd New york NY: Churchill livingstone Inc, 1995
10. Blachar A, Federle MP, Dodson, SF. Inernal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 2001; 218:68-74
11. Macari M, Hines J, Balthazar E, et al. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR 2002; 178:853-858
12. Gore RM. CT of inflammatory bowel disease. Radiologic Clinics of North America 1989; 27:717-729
13. Mindelzun RE, Jeffrey RB Jr, Lane MJ, et al. The misty mesentery on CT: differential diagnosis. AJR 1996; 167:61-65
14. Cbarnsangavej C, DuBrow RA, Varma DG, et al. CT of the mesocolon—part 1. Anatomic considerations. RadioGraphics 1993; 13: 1035-1045
15. Blachar A, Federle MP, Brancatelli G, et al. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 2001; 221:422-428
16. Padidar AM, Jeffrey RB Jr, Mindelzun RE, et al. Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis. AJR 1994; 163:81-83