摘要：
目的 评价口服高渗甘露醇盐水对比剂行多层螺旋CT小肠造影(MSCTE)的可行性和临床价值.方法 81例消化道病变和有小肠疾患症状的病例纳入研究(男47例,女34例,年龄26～81岁),在90 min内口服约1500～3000 ml 高渗甘露醇盐水(2.5%甘露醇,1.5% NaCl)后,肌注20 mg山莨菪碱20 min后行CT三期扫描,并在工作站行冠状面、矢状面及任意斜面重组、多平面重组(MPR)、最大密度投影(MIP)和容积重建(VR).将胃、小肠和结肠充盈程度分为满意、较好、不满意;按小肠长短和重叠分布程度分为密集型、均匀型和离散型.测量十二指肠、空肠和回肠各段小肠的最大管外径和肠壁强化程度,在动、静脉期将肠壁强化分为明显强化(＞90 HU)、中度强化(60～89 HU)和轻度强化(＜60 HU).分析不同小肠病变的MSCTE表现.结果 除5例检查完成后出现腹泻外,其余患者均能顺利完成检查,未发现相关并发症.胃、小肠和结肠充盈满意46例,较好23例,不满意12例,十二指肠、空肠及回肠的充盈度经统计分析分别为(24±4.5)mm、(24±3.9)mm、(23±3.3)mm;小肠分布:小肠分布密集型7例,均匀型58例,离散型16例.小肠壁明显强化9例(动脉期明显强化有3例),中度强化60例(动脉期明显强化17例),轻度强化11例(动脉期明显强化3例).MSCTE清楚地显示了肿瘤、Crohn病、粘连性肠梗阻等多种消化道疾患的肠内、肠壁、肠外血管、系膜及腹内脏器情况.结论 高渗甘露醇盐水MSCTE是一种简便、全方位显示小肠疾病的方法.%Objective To assess the feasibility and value of multislice CT enterography (MSCTE) with large dose economy and convenience orally administered hypertonic mannitol salt water (2.5% mannitol and 1.5% NaCl salt water) as negative contrast in demonstrating normal and abnormal small bowel. Methods 81 patients suffered from digestive disease and suspected of various kinds of small intestinal diseases were examined (male/female =47/34,26 - 81years old,average 57.8years).About 1500 ml ~3000 ml hypertonic mannitol saline was oral administered within 90 minutes and 20 mg of raceanisodamine hydrochloride injection was injected intramuscularly. CT scanning was performed 20 minutes later. Imaging data were post processed with coronal, sagittal and oblique reconstruction, multiplanar reformation (MPR), maximum intensity projection (MIP), and volumer rendering technique (VRT). The filling degree of stomach, intestine and colon was classified as satisfactory, better and unsatisfactory. The length and superposition of small intestine was classified as dense-type, uniformity-type and straggling-type. The maximum outer diameters of duodenum,jejunum, and ileum were measured respectively in different segments. The degree of bowel wall enhancement in arterial phase and venous phase was classified as obvious enhancement (>90 HU), medium enhancement (60-90 HU) and mild enhancement (<60 HU). CT features of various kinds of small bowel diseases were analyzed. Results The hypertonic mannitol saline was acceptable by patients, except 5 patients with diarrhea. The filling degree of stomach, intestine and and colon was classified as satisfactory in 46 cases, better in 23 cases and unsatisfactory in 12 cases. The maximum outer diameters of small bowel in different segments were 24 mm±4.5 mm at duodenum,24 mm±3.9 mm at jejunum and 23 mm±3.3 mm at ileum respectively .The length and superposition of small intestine were classified as dense-type in 7 cases, uniformity-type in 58 cases and straggling-type in 16 cases. The enhancement of bowel wall in arterial phase and venous phase were classified obvious enhancement in 9 cases (arterial phase obvious enhancement in 3 cases), medium enhancement in 60 cases (arterial phase obvious enhancement in 17 cases) and mile enhancement in 11 cases (arterialphase obvious enhancement in 3 cases).MSCT features of many kinds of small bowel diseases such as tumors,Crohn's disease, and post operative adhesion, etc were clearly displayed, including mass, luminal stenosis or dilatation, wall thickening, mural enhancement, mesenteric fibro fatty change, mesenteric vasculature change, enlarged lymphnodes by MSCTE. Conclusion MSCTE with negative contrast hypertonic mannitol saline to distend the small bowel is a simple and reliable method for evaluating small bowel diseases.
