Clinical and Multilayer Spiral CT Diagnosis of Colon Innervation Defect
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摘要: 目的:分析结肠神经节缺乏症的多层螺旋CT(MSCT)的影像和临床表现,提高对结肠神经节缺乏症认识。方法:回顾性分析经手术病理证实的结肠神经节缺乏症患者临床以及MSCT影像资料。检查设备采用GE Discovery 750 HD宝石能谱CT和Philips Brilliance Ingenuity 128层多层螺旋,层厚1 mm,层间距1 mm,管电压120 kV,自动管电流,扫描范围自膈顶扫描至双侧耻骨联合下缘。在肠道自然状态下CT扫描(不做肠道准备,即不清洁灌肠和洗肠),扫描后在CT工作站进行MPR三维重建,在PACS系统存档分析。观察MSCT病变段肠管位置,分别测量扩张段和狭窄段肠壁厚度;对病理标本测量狭窄段(病变段)肠管长度;通过多期MSCT观察肠道蠕动情况;通过增强观察肠道血运情况;总结结肠神经节缺乏症患者的临床特征性表现。结果:结肠神经节缺乏症的临床特点表现为成年人长期的便秘和不完全性肠梗阻。本组5例成人结肠神经节缺乏症患者,病变部位分别位于结肠脾曲和降结肠,其中病变段为狭窄段肠管,扩张段结肠为次生继发性改变,病变段肠管位于降结肠3例,位于结肠脾曲2例;MSCT表现为病变段结肠相对狭窄和病变近端结肠扩张,影像特征表现为结肠扩张后狭窄;测量扩张段和狭窄段肠壁厚度:狭窄段病变区肠壁厚度正常,扩张段肠壁厚度正常或有所增厚,本组增厚的肠壁厚度小于0.9 cm;测量病变段肠管长度:本组病变段肠管长度介于4.3~8.6 cm之间;观察结肠血供和肠道功能情况:MSCT增强扫描肠系膜血管以及系膜密度均未见异常改变、病变段结肠肠壁无异常强化,提示扩张与狭窄段结肠血供正常;MSCT三期增强扫描显示病变段肠管僵直、无蠕动,提示病变段肠管蠕动功能丧失。结论:结肠神经节缺乏症具有结肠扩张后狭窄特征性的影像学表现和临床特点,MSCT结合临床资料能够在术前提示结肠神经节缺乏症的诊断。Abstract: Objective: To analyze the image performance of colon innervation defect with multilayer spiral CT (MSCT) and clinical manifestations, summarize its image characteristics and make correct diagnosis. Methods: The clinical features of colonic innervations deficiency present with prolonged constipation and incomplete ileus. MSCT imaging data using GE gem energy spectrum, CT 750 HD, and Philips MSCT. 1 mm layer thickness, 1 mm layer spacing, tube voltage, 120 kV, automatic tube current from the diaphragm to the bilateral pubic joint. Scan in the natural state of the intestine (No bowel preparation, no cleansing enema and bowel cleansing), after scanning, conduct MPR 3D reconstruction at the CT workstation, and the reconstructed data were archived and analyzed in the PACS system. Clarify the intestinal location of the diseased segment, measure intestinal wall thickness of dilated segment and narrow segment respectively; measure intestinal tube length of diseased segment (narrow segment); observe intestinal peristalsis with multiple-stage MSCT; and observe intestinal blood transport through enhancement. Results: The clinical features of colon innervations defect was constipation and incomplete ileus. In this study group, there were 5 adult patients with colon innervations defect, and the lesion site was located in the spleen and descending colon respectively, among which the diseased segment was located in 3 cases and the spleen was located in 2 cases of colon; MSCT shows relative narrowing of the colon and expansion of the proximal colon; The intestinal wall thickness was normal in the diseased area, and the intestinal wall thickness of the dilated colon section was normal or somewhat thickened, and the thickened intestinal wall in this group is less than 0.9 cm; The intestinal length of the diseased segment in this group was somewhere between 4.3~8.6 cm. The MSCT enhancement scan of mesangic vessels and mesangial density showed no abnormal changes, and no abnormal enhancement of the colon wall in the diseased section, suggesting normal blood supply; MSCT enhanced scan showed rigidity and no peristalsis in the diseased segment, suggesting loss of peristaltic function in the diseased segment. Conclusion: Colonic innervations defect has imaging findings of characteristic post dilating stenosis and clinical features of prolonged constipation and incomplete obstruction in adults, The MSCT combined with clinical data was able to indicate the diagnosis of colonic innervations defect before surgery.
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Key words:
- X-ray computer tomography /
- imaging diagnosis /
- colon innervations defect
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图 1 上腹CT平扫,横结肠脾曲肠腔扩张内径7 cm,肠壁均一弥漫性增厚,厚约0.5 cm,扩张肠腔内大量粪便集聚;结肠脾曲肠腔相对狭窄(空白箭),肠壁厚0.4~0.6 cm
Figure 1. CT image of the abdomen,The splenic flexure of colon intestinal lumen was dilated, with an internal diameter of 6 cm, and the intestinal wall was diffuse and thickened, about 0.5 cm thick, and a large number of feces were concentrated in the dilated intestinal lumen. Colonic spleen curved intestinal lumen is relatively narrow (blank arrow), and the intestinal wall is 0.4~0.6 cm thick
图 2 上腹CT平扫,横结肠肠腔扩张,大部分肠壁厚度正常、局部肠壁轻微增厚,最厚约0.4 cm,扩张的肠腔内大量粪便;降结肠病变段肠管相对狭窄(空白箭),肠壁厚约0.8 cm
Figure 2. CT image of the abdomen,The transverse colon lumen is dilated, with uneven thickening, the thickest intestinal wall diameter is about 0.4 cm, a large number of fees were concentrated in the dilated intestinallumen. The diseased segment of the descending colon is relatively narrow (blank arrow), the local thickness is about 0.8 cm
图 4 图1患者术后大体标本,肉眼所见:全结肠切除标本:结肠长68 cm,周径5~12 cm,回肠长7 cm,周径3 cm。扩张段肠管长15 cm,周径12 cm,壁厚0.5 cm,粘膜灰红色,质软,皱襞较清晰;狭窄段肠管,长5 cm,周径5 cm,壁厚0.5 cm
Figure 4. The Patient of fig.1, postoperative gross specimen, as seen by the naked eye. Total colon resection specimen: The colon is 68 cm long, the peripheral diameter is 5~12 cm, The ileum was 7 cm long with a circumference diameter of 3 cm. The intestine of the dilated segment was 15 cm long, Peridiameter 12 cm, wall thickness 0.5 cm, Mucosal membrane is grey-red, soft, The wrinkles are clear; The arrow segment intestine, 5 cm long, The circumference diameter is 5 cm and the wall thickness is 0.5 cm
图 5 与图1同一患者,HE染色10×10结合免疫组化S-100,显示狭窄段肠黏膜下层及肌间神经节细胞数量显著减少。病理诊断:结肠神经节缺乏症(结肠假性)
Figure 5. The same patient of fig.1, HE pathological staining, 10×10 combined with immunohistochemistry S-100, a narrow segment of the intestinal mucosa is shown the number of lower and myomuscular ganglion cells was significantly reduced. Pathological diagnosis: Colonic innervation defect (Hirschsprung' Disease)
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