CAJ | 학술논문

　　目的总结胃肠道管壁弥漫血管瘤的CT表现，增强对本病影像表现的认识。方法回顾性分析2012年4-11月于我院就诊的4例胃肠道管壁弥漫血管瘤患者的临床资料及影像表现。3例行常规腹部平扫+增强CT扫描，1例因下消化道出血行盆腔平扫+增强CT扫描。结果4例患者，男性3例，年龄分别为16、30、42岁；女性1例，年龄33岁。3例自出生后反复无痛性血便，1例血便1月余。CT显示病变累及胃壁和多节段肠壁，表现为较长节段管壁环形不规则增厚，局部合并管腔狭窄；病变内均可见多个点状或结节状钙化影。增强扫描常规动脉期、门静脉期病变无明显强化，延迟90~120 s，病变渐进性强化，CT值升高20~30 HU。1例在延迟50 min后扫描，病变呈中度均匀强化，CT值约60 HU。病变邻近动脉血管均未见异常。3例引流至门静脉，1例经腹部皮下迂曲静脉引流，其中2例引流静脉粗大。2例门脉正常结构消失，显示门静脉海绵样变。结论对自幼血便或长期反复血便者，应注意胃肠道管壁弥漫血管瘤的可能，CT表现具有特征性，结合临床病史可做出正确诊断。
　　목적총결위장도관벽미만혈관류적CT표현，증강대본병영상표현적인식。방법회고성분석2012년4-11월우아원취진적4례위장도관벽미만혈관류환자적림상자료급영상표현。3례행상규복부평소+증강CT소묘，1례인하소화도출혈행분강평소+증강CT소묘。결과4례환자，남성3례，년령분별위16、30、42세；녀성1례，년령33세。3례자출생후반복무통성혈편，1례혈편1월여。CT현시병변루급위벽화다절단장벽，표현위교장절단관벽배형불규칙증후，국부합병관강협착；병변내균가견다개점상혹결절상개화영。증강소묘상규동맥기、문정맥기병변무명현강화，연지90~120 s，병변점진성강화，CT치승고20~30 HU。1례재연지50 min후소묘，병변정중도균균강화，CT치약60 HU。병변린근동맥혈관균미견이상。3례인류지문정맥，1례경복부피하우곡정맥인류，기중2례인류정맥조대。2례문맥정상결구소실，현시문정맥해면양변。결론대자유혈편혹장기반복혈편자，응주의위장도관벽미만혈관류적가능，CT표현구유특정성，결합림상병사가주출정학진단。
Objective To improve the understanding of gastrointestinal wall diffuse hemangioma (GWDH)by summarizing its CT features. Methods Clinical data and imaging features of 4 GWDH patients admitted to our hospital from April to November 2012 were retrospectively analyzed. Of the 4 patients, 3 underwent routine abdominal plain and enhanced CT scanning, 1 underwent pelvis plain and enhanced CT scanning due to bleeding in the lower digestive tract. Results The average age of the 4 patient was 16,30,42 and 33 years old, respectively. The 3 male patients had presented with repeated painless bloody stools since their childhood and the female patient had bloody stools for more than 1 month. CT showed that the lesions involving gastric wall and several segments of intestinal wall were manifested as circularly and irregularly thickened long segment wall with local lumen stricture and multiple punctuate and nodular calcification shadows. Enhanced CT showed no significant change in the lesions at conventional arterial and venous phases but at the delayed 90-120 s phase. The lesions showed progressive enhancement with their CT value increased to 20-30 HU. Moderate homogenous enhancement of the lesions was observed in 1 patient 50 min after delayed scanning with the CT value of about 60 HU. A portal venin drainage tube was placed in 3 patients and a tortuous subcutaneous vein drainage tube was placed in 1 patient. No normal structure of the portal vein was observed in 2 patients, indicating that sponge-like degeneration occurs in the portal vein. Conclusion Attention should be paid to GWGH in those who have presented with bloody stools or repeated bloody stools since their childhood. Specific CT features in combination with clinical history contribute to the correct diagnosis of bloody stools.