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MRI在肠道急腹症诊断的临床应用价值*

作者:沈海平 郑晓林 邹玉坚 王 刚 杨沛钦 范宪淼

所属单位:广东省东莞市人民医院放射科(广东 东莞 523000)

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摘要

目的探讨MRI在诊断肠道急腹症 中的应用价值。方法 回顾性分析40例肠 道急腹症患者的MRI表现,所有病例均经 手术、病理或临床证实。结果 恶性病变 19例,17例伴肠梗阻:原发肠癌伴梗阻9 例,腹膜转移粘连伴梗阻5例,肠淋巴瘤 伴梗阻2例,肠间质瘤伴梗阻1例;另直肠 癌伴穿孔、感染和乙状结肠癌伴周围感染 各1例。良性病变21例,12例伴肠梗阻: 单纯粘连性肠梗阻7例,其他原因所致梗 阻5例;另肠穿孔伴周围感染3例,肠系 膜血管病变2例,回盲部结核、回盲部感 染伴脓肿、腹壁疝、肠系膜粘连扭转各1 例。本组病例MRI对肠道急腹症的定位诊 断准确率达92.5%(37/40),定性诊断敏 感性90.91%、特异性94.44%,病因诊断符 合率82.5%(33/40)。结论 MRI对病变的发 现与显示,及定位、定性、病因学诊断具 有较高的准确性,能为临床治疗方案的选 择提供重要信息,在诊断肠道急腹症方面 有重要的价值。

Objective To explore the value of MRI in the diagnosis of acute abdominal disease. Methods The MRI findings of 40 patients with intestinal acute abdomen were analyzed retrospectively and all cases were confirmed by surgery, pathology or clinical diagnosis. Results There were 19 cases of malignant lesions in total, and 17 cases with intestinal obstruction, including primary colorectal cancer with obstruction in 9 cases, peritoneal metastases with obstruction in 5 cases, intestinal lymphoma with obstruction in 2 cases, intestinal stromal tumor with obstruction in 1 case; besides, rectal cancer with perforation, infection and sigmoid colon cancer with peripheral infection in 1 case. There were 21 cases of benign lesion in total, 12 cases with intestinal obstruction: 7 cases of simple adhesive intestinal obstruction, 5 cases of obstruction caused by other causes; the other 3 cases of intestinal perforation with peripheral infection, 2 cases of mesenteric angiopathy ; besides, ileocecal tuberculosis, ileoceae infection with abscess, abdominal hernia and mesenteric adhesion torsion in 1 case. This group of patients with MRI on the diagnosis of intestinal acute abdomen. The localization accuracy rate was 92.5%(37/40), the qualitative diagnostic sensitivity was 90.91% and specificity was 94.44%, and the diagnostic accuracy rate was 82.5% in this group of patients. Conclusion MRI has high accuracy for the discovery and display of the lesions, as well as the diagnosis of localization, qualitative and etiological diagnosis. It can provide important information for the selection of clinical treatment programs. It is of great value in the diagnosis of acute abdomen.

【关键词】急腹症;肠道;磁共振成像

【中图分类号】R445;R574.2

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.07.042

前言

肠道急腹症是以急性腹痛为主要表现的肠道或与肠道紧密相关的 疾病。其特点是起病急、进展快、病情重,需早期诊断和及时处理, 若延误诊断或治疗不及时,将会给患者带来严重的后果、甚至危及生 命。肠道急腹症是临床工作中的常见病,病因多种多样,影像学检查 是诊断肠道急腹症的重要手段,以往主要依靠B超、X线摄片及CT检 查,但都有各自的优缺点和局限性。笔者回顾性分析本院近年来肠 道急腹症运用MRI检查的情况,探讨MRI在肠道急腹症诊断中的应用价 值,旨在提高MRI诊断肠道急腹症的特异性、敏感性和准确性、符合 率,为临床治疗提供更精准、更丰富的信息。