| Objective To compare the diagnostic value of CT and ultrasonography in the diagnosis of intussusception in adults,to conduct the etiological analysis of CT in adult intussusception and to explore the significance of CT in the evaluation of adult intussusception treatment.Materials and Methods A total of 141 cases of intussusception were collected from June 2015 to December 2017 of the Tianjin Hospital of ITCWM Nankai Hospital.According to the test inclusion and exclusion criteria,the patients aged 18 years and above,who had preoperative imaging examination,complete treatment,pathological diagnosis after surgery and clinically diagnosed,were selected for 94 cases,and the CT and ultrasonography data were analyzed and studied respectively.Results 94 cases of adult intussusception were selected for clinical diagnosis,and 94 patients underwent CT scan before operation.Among them,70 patients underwent preoperative intestinal ultrasound examination.The preoperative ultrasound and CT examination in 70 cases were grouped and compared with postoperative diagnosis,CT and ultrasonography in adult intussusception diagnosis is as follows: CT diagnosis accuracy Rate 91.4 %(64/70),of which 3 cases(4.3%)were missed and misdiagnosed in 3 cases(4.3%).In 3 missed cases,2 cases were diagnosed as internal hernia,1 cases were adhesive intestinal obstruction,and 3 cases of misdiagnosis were small intestine hernia.The correct rate of ultrasound diagnosis was 75.7%(53/70)and missed diagnosis in 10 cases(14.3%),misdiagnosis of 7 cases(10.0%),ultrasound missed diagnosis in 10 cases: 5 cases of colon cancer,5 cases of appendicitis and stimulation of the back of the blind caused intussusception;7 cases of misdiagnosis of ultrasonography: 3 cases misdiagnosed as internal hernia 2 cases were the small intestine adhesion of pelvic cavity and 2 cases were peritonitis.The results showed that both groups had diagnostic value in adult intussusception and the diagnostic accuracy of CT was higher than that of ultrasonography.In the clinical group,94 cases of intussusception were diagnosed,all of them were scanned by CT,and 33 cases were plain CT,plain scan and enhancement in 36 cases,and simple CT enhancement in 25 cases.Compared with postoperative diagnosis,the results of CT diagnosis of intussusception in adults are as follows: the accuracy rate of CT diagnosis is 90.4%(85/94),of which 6 cases(6.4%)were misdiagnosed,and 3 cases(3.2%)were missed.The diagnostic accuracy of Plain CT was 87.8%(29/33),missed diagnosis in 2 cases(6.1%),misdiagnosis in 2 cases(6.0%),CT plain scan + enhanced diagnosis correct rate is 91.7%(33/36),missed diagnosis 1 cases(2.8%),misdiagnosis 2 cases(5.6%);Simple CT enhanced diagnostic accuracy 92%(23/25)Misdiagnosis of 2 cases(8.0%).All three groups of examinations were valuable for the diagnosis of intussusception in adults,but there was no difference in the diagnostic accuracy between three groups.For 94 cases of adult intussusception,72 cases was diagnosed as adult intussusception.The primary etiology was found in 72 adults with intussusception,small intestine intussusception in 25 cases(34.7%),the back-blind overlap in 27 cases(37.5%),and colon intussusception in 20 cases(27.8%).In the primary etiology,benign lesions in 34 cases(47.2%),malignant lesions in 38 cases(52.7%).The benign lesions in the primary lesions of the small intestine were more than 19 cases(76.0%),6 cases of polyps were found(24.0%)and metastatic tumors in 4 cases.17 cases of malignant lesions in the primary colonic lesions(85.0%)were more common,and 14 cases of colon cancer were found.There were 12 cases(44.4%)of benign lesions in the primary lesion of adult intussusception,15 cases(55.6%)with malignant lesions,and the incidence of malignant lesions were higher;malignant primary etiology with colon cancer in 6 cases,the benign primary cause of inflammatory stimulation in 8 cases common.In this group,72 cases of adult intussusception were reported.Benign primary lesions include polyps,inflammation and lipoma,and malignant primary lesions include colon cancer,metastatic tumor and lymphoma.For the 72 cases of adult intussusception,the primary etiological diagnosis was analyzed by CT imaging data: The diagnostic accuracy of CT scan for adult intussusception was 77.8%(56/72)and 16 cases(22.2%)failed to detect primary etiology,of which 4 cases(5.5%)were colon cancer,6 cases(8.3%)of small intestinal polyps,2 cases(2.8%)of small bowel adenoma,adhesion in 2 cases(2.8%),inflammatory stimulation in 1 cases(1.4%),and small intestinal Crohn's disease in 1 cases(1.4%).In 25 cases of plain CT scanning,the detection rate of primary etiology of CT plain scan was 60%(15/25).CT plain Scan + enhancement in 28 cases,CT Plain scan + enhanced primary etiology detection rate is 89.3%(25/28),simple ct enhancement in 19 cases,CT enhanced primary etiology detection rate is 84.2%(16/19).The primary lesions of adult intussusception were more easily detected by CT Plain and enhanced CT scan.In this group,12 cases of intussusception were treated without operation and the intussusception was confirmed recover after colonoscopy.Among them,4 cases were patients after intestinal catheter implantation,4 cases were the back blind intussusception caused by inflammatory stimulation,and 4 cases of polyp loosened recovered after colonoscopy treatment.Of the remaining 58 patients who underwent surgical treatment,24 were diagnosed with intussusception before operation,and during the operation,the intestinal tract of the intussusception was loose recovered automatically and the release rate of intussusception in adults was 40%(24/60).In this cases,5 cases of benign lesions,19 cases of malignant lesions,the rate of free release of benign lesions was 22.7%(5/22),and the rate of free release of malignant lesions was 50%(19/38),which proved that the preoperative release of intussusception was more likely to occur in malignant tumors.Conclusion MSCT and ultrasonography have diagnostic value and accuracy in adult intussusception,and MSCT is superior to ultrasonography.Adult intussusception is secondary,there are primary disease,MSCT for adult intussusception of the primary cause of detection and evaluation of diagnostic value,simple CT contrast enhanced and CT scan + enhanced diagnosis more accurate.The treatment of adult intussusception is related to the primary etiology and intussusception of intussusception,and the benign lesion can be removed by colonoscopy before treatment.In adult intussusception caused by different benign and malignant primary causes,intussusception of malignant etiology is more prone to release of intussusception.However,due to the primary etiology of adult intussusception is more tumor-prone,malignant tumors are more common,so even if intestinal intussusception is loose,still need clinical staging and surgical treatment of tumors. |
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