| Part I The comparison of three different neutral contrast media for MSCT enterographyObjective:To analyse and compare the small bowel distention degree differences among the patients suspected small intestinal diseases with oral three different neutral contrast,and to choose the best contrast for the clinicians.Methods:60 patients suspected small intestinal diseases with no clear bowel obstruction were collected in our hospital clinical and randomly divided into three groups,of which 2.5%isotonic mannitol group 20 cases,pure milk group 20 cases,20 cases of pure water group.CT dual phase enhanced scan were done in 60 patients and all data were leaded into the independent workstation to built the thin background images after the reorganization,and then to analyse the reconstructed images by two experienced radiologists with blinded principle,judging the distention degree of the whole group of small intestine and every intestines.In the end,all the datas were analyzed statistically by SPSS 17.0.Results:The degree of the whole small bowel distention:There was statistically significant difference between the the 2.5%isotonic mannitol group and the other two groups,the 2.5%isotonic mannitol group is the better respectively(P<0.05),but there was no significant difference between the pure milk group and pure water group(P>0.05).The degree of small bowel distention in each group:the ileum distention is the best,the jejunum distention was superior than the duodenum.Conclusion:The group of 2.5%isotonic mannitol is the best contrast to expand intestinals,to discover the small intestinal lesions effectively,it should be recommended to the clinicians widely.PartⅡThe diagnostic value research of multislice CT hypotonic oral enterography(MSCTE)on the small intestinal diseasesObjective:To discuss the clinical application value of multislice CT hypotonic oral enterography on the diagnosis of small intestinal diseases.Methods:98 cases were collected in our hospital department of gastroenterology suspected small intestinal diseases and in accordance with the research conditions underwent MSCTE in all.Before the CT scan,all cases take orally 2.5%isotonic mannitol solution 1000～1500ml.The CT manifestations characteristic of the lesion site,size,morphology,enhanced features,relationship with surrounding tissue and distant metastasis and so on were observed in detail.Meanwhile,all patients had both CT imagings and pathological results.At last,MSCTE diagnosis and the final clinical diagnosis were analyzed.Results:In this study of 98 patients,53 patients with MSCTE diagnosed with intestinal diseases,no evidence of small bowel lesions were 45 cases,but the final clinical diagnosis were 58 cases of small intestinal lesions,40 patients were negative.5 cases were missed diagnosis,and occurred 2 misdiagnosis cases in MSCTE.The sensitivity of MSCTE diagnosis of small intestinal disease in this study was 91.38%(53/58),the specificity was 100%(40/40),the positive predictive value was 100%(53/53),the negative predictive value was 88.89%(40/45),the rate of correct diagnosis was 92.86%((51+40)/98).In all small intestinal lesions,tumors were 26 cases,including 13 cases of adenocarcinoma,which 3 cases occurred in the duodenum,5 cases occurred in the jejunum,and another 5 cases were adenocarcinoma of the ileum,1 caes was misdiagnosed as intestinal lymphoma,1 cases misdiagnosed in the MSCTE.The cases of small intestinal lymphoma,stromal tumor and lipoma each were 4 cases,6 cases and 3 cases.The small intestinal inflammatory disease were 24 cases in total.Among them,4 cases were Crohn’s disease,3 cases were ulcerative colitis,7 cases were intestinal tuberculosis,and 5 cases of abdominal type allergic purpura,5 cases of general inflammatory disease.1 cases of intestinal calculus was missed in MSCTE.7 cases of mesenteric vascular lesion in all were discovered,including 2 cases mesenteric volvulus,2 cases superior mesenteric vein and portal vein thrombosis and 1 case embolism of superior mesenteric artery,another 2 case were intestinal vascular malformations,but MSCTE un-discovered them.Conclusion:The small intestine tumor lesions,inflammatory diseases and vascular lesions have characteristic CT performance respectively.MSCTE plays an important role in the diagnosis of small intestinal diseases by displaying the bowel,mesentery,mesenteric blood vessel and intestinal lesions all-roundly. |
