CAJ | 학술논문

目的：比较CT造影在不同扫描时相下对小肠肠壁及血管的显示效果，确定最佳扫描时相，评价该时相的临床诊断效能。方法将286例行小肠CT造影的住院患者分别进行动脉期、肠道期及门脉期扫描，测量十二指肠、空肠及回肠肠壁CT值、血管显示数量及血管CT值，比较分析后选择最佳扫描时相，评价该时相CT图像小肠及血管病变的诊断效能。结果（1）十二指肠、空肠及回肠肠壁CT值均为肠道期高于动脉期和门脉期（P＜0.05），而动脉期和门脉期差异无统计学意义。（2）回肠动脉在各时相CT值比较：动脉期＞门脉期，肠道期与动脉期、门脉期差异无统计学意义。回肠静脉在各时相CT值比较：肠道期＞门脉期＞动脉期（P＜0.05）。（3）小肠CT造影诊断小肠疾病的灵敏度为95.8%，特异度为94.9%，正确率为95.1%，阳性预测值为79.3%，阴性预测值为99.1%。（4）小肠CT造影证实小肠淋巴瘤22例、间质瘤10例、腺瘤1例、血管瘤3例、克罗恩病8例、小肠结核1例、缺血性肠病3例，对于血管瘤的诊断需结合动脉期。结论小肠CT造影肠道期对小肠肠壁及血管有较好的显示效能，利用动脉期及肠道期双期扫描方式进行小肠CT造影检查，可对大多数小肠疾病做出准确诊断。
목적：비교CT조영재불동소묘시상하대소장장벽급혈관적현시효과，학정최가소묘시상，평개해시상적림상진단효능。방법장286례행소장CT조영적주원환자분별진행동맥기、장도기급문맥기소묘，측량십이지장、공장급회장장벽CT치、혈관현시수량급혈관CT치，비교분석후선택최가소묘시상，평개해시상CT도상소장급혈관병변적진단효능。결과（1）십이지장、공장급회장장벽CT치균위장도기고우동맥기화문맥기（P＜0.05），이동맥기화문맥기차이무통계학의의。（2）회장동맥재각시상CT치비교：동맥기＞문맥기，장도기여동맥기、문맥기차이무통계학의의。회장정맥재각시상CT치비교：장도기＞문맥기＞동맥기（P＜0.05）。（3）소장CT조영진단소장질병적령민도위95.8%，특이도위94.9%，정학솔위95.1%，양성예측치위79.3%，음성예측치위99.1%。（4）소장CT조영증실소장림파류22례、간질류10례、선류1례、혈관류3례、극라은병8례、소장결핵1례、결혈성장병3례，대우혈관류적진단수결합동맥기。결론소장CT조영장도기대소장장벽급혈관유교호적현시효능，이용동맥기급장도기쌍기소묘방식진행소장CT조영검사，가대대다수소장질병주출준학진단。
Objective To evaluate the influence of the CT enterography (CTE) in different scan phases of small intesti?nal wall and arteriovenous vessels, and to confirm the diagnostic efficiency thereof. Methods A total of 286 patients under?went CTE were collected, and their CT image of three scan phases, including 20 s, 40 s and 60 s after injection, were record?ed. Values of reinforcement of the intestinal wall and arteriovenous enhancing degree in all phases were collected. A statisti?cal analysis was used to confirm the best phase for showing the structure. The diagnostic efficiency of the best phase of CT image was evaluated for the clinical diagnosis of small intestine and vascular lesions. Results (1) The CT value of the small intestinal wall in the intestinal phase was significantly higher than other two phases (P<0.05). There was no significant dif?ference in CT value between arterial phase and portal phase. (2) Comparison between three phases of CT values of ileum showed that artery:arterial phase>intestinal phase, and there is no statistical difference between the intestinal phase and oth?er two phases. The result of CT value of ileum vein showed that intestinal phase>portal phase>arterial phase (P<0.05). (3) The sensitivity was 95.8%, the specificity was 94.9%, the accuracy was 95.1%, the positive predictive value was 79.3%and the negative predictive value was 99.1%using CT image of intestinal period for diagnosing small intestinal diseases. (4) The intestinal period showed small intestinal lesions and confirmed by pathology including 22 cases of small intestinal lympho?ma, 10 cases of stromal tumor, 1 case adenoma, cavernous 3 cases hemangioma and 8 cases of Crohn's disease. The diagno?sis of hemangioma should be combined with arterial phase. Conclusion Small intestinal wall and blood vessels have better display performance in the intestinal phase of multiphase CT enterography, using the arterial phase and intestinal phase scan?ning, we can make an accurate diagnosis for the majority of small intestinal diseases.