Applications of Industrial Computed Tomography Technology in the Geosciences
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摘要:
工业CT作为计算机断层成像（CT）发展至今的一个重要分支，得益于其分辨率高、可重复、探测范围广等优势，在航空航天、军事工业、地质分析等多个领域得到了广泛应用。本文在深入调研国内外工业CT技术研究现状的基础上，综述了在地球科学领域中的3种典型工业CT技术（地震波CT、电阻率CT、电磁波CT）以及多种物探方法组合而成的综合物探方法，重点介绍工业CT在孔隙研究、天然气水合物研究、构建数字岩心和二氧化碳地质利用与封存方面的最新应用。同时，总结工业CT在地球科学领域中的发展趋势。
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关键词:
- 工业CT /
- 地球科学 /
- 孔隙 /
- 天然气水合物 /
- CO2地质利用与封存
Abstract:As an important branch of computed tomography (CT), industrial CT is used widely in many fields, such as aerospace, military industry, and geological analysis fields, because of its advantages of high resolution, repeatability, and wide detection range. On the basis of thorough investigation and study, this paper summarizes three typical industrial CT technologies (i.e., seismic wave CT, resistivity CT, and electromagnetic wave CT) as well as the comprehensive geophysical exploration methods used in the geosciences. The current applications of industrial CT in pore structure studies, gas hydrate studies, digital core construction, and geological utilization and storage of carbon dioxide are introduced. The development trend of industrial CT in the geosciences is also discussed.
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1. 病历资料
1.1 临床资料与实验室检查
患者，女性，38岁，13 h前无明显诱因突发上腹部疼痛，为间断绞痛，无放射痛，改变体位及进食后疼痛加重，来我院急诊就诊。
查体：心率80次/min，血压140/90 mmHg；血常规：白细胞11.94×109/L（升高）、嗜中性粒细胞10.06×109/L（升高）、嗜中性粒细胞百分比84.2％（升高）、血红蛋白77 g/L（下降）、平均红细胞体积73.5 fL（下降），淀粉酶167 U/L（升高）、脂肪酶665 U/L（升高），C-反应蛋白0.6 mg/L。以“急性胰腺炎”收入我院消化科治疗，常规治疗后患者病情未见明显改善。
1.2 影像学检查
X线立位腹平片图像显示：脾脏轮廓显示不清，脾区仅见充气扩张的胃肠道影（图1）。
腹部CT平扫图像显示：脾脏增大并向前移位，超过中线（图2）。脾门区结构不清；脾脏内侧与膈肌间可见“漩涡征”（图2（d）～图2（f））。
腹部CT增强动脉期图像显示：脾脏增大并未见明显强化（图3），脾门区结构不清，脾静脉显示不清，脾动脉及胰尾部呈“漩涡状”改变（横轴位图像图3（a）～图3（f）、曲面重建图像图3（g））；白色箭头指向胰尾，黑色箭头指向脾动脉（图3（e））。
腹部CT增强门脉期及延迟期图像显示：脾脏增大并延迟强化，局部脾脏无明显强化，脾动脉及胰尾部呈“漩涡状”改变（门静脉期图像图4（a）～图4（c）、延迟期图4（d）～图4（f））；腹部CT平扫及增强检查诊断脾扭转伴胰尾扭转。
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图 4 腹部CT增强门脉期和延迟期图像Figure 4. Abdominal CT enhanced portal vein phase and delayed phase images1.3 诊疗过程
全腹CT平扫及三期增强扫描诊断脾扭转并胰尾扭转，剖腹探查结果与CT相同，行脾脏切除手术（图5（a）），术中见脾脏大小约35×15×10 cm，脾门血管扭转1周，胰尾牵拉反翘，脾肾韧带、脾结肠韧带均有撕脱，脾活动度大，在脾下极处可见大小约8×5×4 cm黑色缺血区域，将脾脏搬出体外，顺时针旋转1周解除脾门血管扭转及胰尾扭转，观察胰尾无异常，还纳胰腺后，行脾脏全切除术，术后病理脾脏出血、坏死（图5（b））。术后患者顺利复苏，安返病房。
术后第1天化验提示：淀粉酶77 U/L、脂肪酶59 U/L均较术前下降，症状明显减轻，仅有伤口不适，给予抗感染、抗凝血、补液、止痛等对症治疗，1周后患者恢复良好。化验提示：血小板820×109/L，彩超检查门静脉及肠系膜上静脉，未见血栓形成，予以出院。
1.4 随访
出院后口服阿司匹林，术后5周血小板降至正常水平，并停止服用阿司匹林，术后8周及12周复查未见异常。
2. 讨论
2.1 病因及发病机制
游走脾（wandering spleen，WS）是一种因固定脾脏的悬韧带（包括脾胃、脾肾、脾结肠及膈脾4条韧带）发育不良或松弛、过长的脾门血管蒂，导致脾脏的活动度增加，不在正常解剖位置（即左季肋区脾窝内），所引起的急或慢性疾病[1]。
脾扭转是在游走脾的基础上出现了脾蒂扭转，该病发病率不到0.2％[2]。好发人群呈双峰状分布，以30岁左右的育龄妇女（占70％）及10岁以下儿童（占30％）好发[3]，女性在成年人中的发病率比男性高7～10倍[4-5]。
脾扭转伴发胰尾扭转极为罕见，正常胰腺是腹膜后器官，不会因脾蒂扭转而伴发扭转，只有当胚胎发育期壁层腹膜未与背侧胃系膜正常融合而使胰尾部位于腹腔内时，才会和脾蒂血管一起扭转[6-7]。
2.2 临床特征
游走脾的临床症状多变，从无症状到出现急腹症症状[1]。患者一般以急或慢性腹痛、恶心、呕吐及腹部包块就诊。剧烈运动、外伤或消化道功能紊乱等原因，均可导致脾扭转的发生。脾蒂的扭转有急性扭转和慢性扭转之分，随之产生的病症，也不尽相同。
急性扭转或重度扭转（扭转至2～3圈）时脾蒂血管完全梗阻，导致脾脏坏死、胃底食管静脉曲张出血，患者出现突发剧烈腹痛甚至休克。慢性扭转或轻度扭转（扭转小于半圈或180°）时，静脉回流受到阻碍，多表现为脾脏的淤血肿大，临床可出现轻度或间断的腹痛及因脾脏增大邻近脏器受压所致的相应症状。实验室检查对该病缺乏特异性，少数患者可出现白细胞增多、C反应蛋白增高[8]。
当脾扭转合并胰尾扭转时还需要注意观察有无闭合性胰腺损伤：外伤或重度脾蒂扭转挤压胰尾时，胰腺可出现不同程度损伤（从无症状或轻度损伤到胰腺导管损伤），虽然临床表现各有不同，但部分症状与脾扭转相似，不易鉴别。由于临床诊断的困难性及该病的罕见性，极易导致误诊，因此影像学检查为该病的确诊手段。
2.3 影像学表现
X线腹部平片可观察左上腹脾脏轮廓是否正常，游走脾的患者常看不清脾脏轮廓，脾区仅可看见充气的胃肠道影，并见左肾影轮廓升高。彩超可以显示脾脏位置、体积及脾脏血供情况[9]，但检查结果受操作者水平、手法及腹部肠气的影响极大，容易误诊、漏诊。所以主要的检查方式为CT平扫及增强检查，脾游走的CT检查可观察脾脏形态、位置、大小、密度的改变。
①CT平扫典型表现是脾脏游离出正常脾区，而在腹盆腔其他位置以软组织肿块方式显影。②当出现脾蒂血管扭转时可观察到特异性征象“漩涡征”（扭转的脾蒂血管呈“麻花样”），CT增强检查此征象更加明显。③当出现脾脏血管栓塞、脾脏坏死时平扫可看到脾门血管高密度充盈缺损、脾脏增大及“假包膜征”（当脾脏缺血坏死后，出现侧枝循环，导致脾实质的密度低于脾包膜），增强后脾门血管和脾脏不强化或延迟强化。④CT检查还可观察游走脾与邻近脏器的解剖关系及腹腔内其他情况，如伴发胰尾扭转、胃扭转，腹水、周围系膜水肿等[10-13]。
核磁共振与CT的检查结果基本相同，其优点是无需造影剂，脾脏的缺血或出血情况即可在T1加权序列上清晰显示，脾动脉的解剖形态及血流情况在磁共振血管成像序列上亦可做出诊断，胰尾扭转后有无闭合性胰管损伤也可在磁共振水成像序列上（MRCP）明确显示，其缺点是检查时间较长、禁忌症较多、基层医疗机构普及率低，故不作为首选检查。
2.4 治疗及转归
WS治疗上以外科手术为主，部分无症状患者可以采取保守治疗[14]，但考虑到易合并脾扭转导致脾梗死的情况，所以即使无症状患者，大多数也建议手术治疗。手术方式为脾固定术或脾切除术，原则上要尽量采用脾固定术，防止脾扭转，保脾治疗可避免脾脏切除后患败血症的风险。但脾蒂血管栓塞、脾梗死、巨脾及脾功能亢进等仍是脾切除术的手术指征，临床上使用哪种术式还需结合患者的年龄、临床症状和影像表现等因素综合考虑[13]。
近年来，随着医学的发展，腹腔镜手术已经可以替代传统外科手术，完成脾脏复位、固定和切除等手术，效果堪比开腹手术，并且其具有手术时间短、创伤小、术后恢复快等优点，因此在游走脾和脾扭转的治疗上，腹腔镜手术已经逐步取代了传统外科手术。
值得注意的是，脾脏切除后常会引进继发性血小板增多症，此时需要观察血小板情况及行门静脉、肠系膜上静脉彩超检查观察有无血栓形成，术后抗凝治疗[15-18]。
本病例中，患者脾蒂扭转伴发胰尾扭转，手术时需观察胰腺情况，明确胰腺有无肿胀、出血坏死及胰液渗漏等情况，并给与相应处理。术后因胰腺具有内、外分泌腺功能，还需观察相关实验室指标，予以对症治疗。
2.5 诊断与鉴别诊断
WS临床症状不典型，仅靠问诊及体格检查很难确诊，脾扭转伴发胰尾扭转也多是只有急腹症症状。该病的诊断主要依靠影像学检查完成，其中腹部彩超可以检查左上腹（脾区）是否存在正常脾脏影像，脾脏有无增大，以及在腹腔其他部位是否出现软组织肿块；CT检查能显示脾脏的大小、位置、密度及脾蒂血管有无异常；CT增强检查可观察脾脏的血供情况及脾动静脉的形态，脾蒂血管漩涡征是脾扭转的特异性征象。本病需要与以下情况或疾病相鉴别。
（1）脾脏切除术后，当患者既往因脾外伤、脾局部感染、脾脏良恶性肿瘤或囊肿等情况行脾脏切除手术，临床上体格检查或影像学检查也可表现脾区空虚，无正常脾脏。且脾切除术后患者免疫功能低下，易伴发感染引起腹部症状，临床需询问病史予以鉴别。
（2）其他腹腔血管扭转，如肠系膜扭转等，此类疾病临床表现为腹部不适或急腹症，CT增强检查可见相应血管的“漩涡征”图像，此时需要鉴别血管来源，观察脾脏位置、大小及血流灌注情况。
（3）腹部脏器肿块或肿瘤，游走脾由于活动度大，游走不定，体格检查易与胃肠道、左肾、胰腺、卵巢以及子宫肿块或肿瘤相混淆，需要影像学观察肿块有无脾蒂血管相连，借以鉴别二者。
（4）其他疾病引起的急腹症：如胰腺炎、胆囊炎、阑尾炎、肠梗阻、胃肠道穿孔等。由于脾扭转可导致脾供血障碍，常有恶心、呕吐、剧烈腹痛、压痛、反跳痛等急腹症表现。影像学中超声及CT等检查可观察脾脏及其他腹腔脏器情况，即可鉴别。
（5）脾扭转伴发胰尾扭转时，血清淀粉酶和（或）脂肪酶可能会升高，需要与急/慢性胰腺炎、胰腺损伤、胰腺囊肿、胰腺癌、胃十二指肠等疾病鉴别，超声、CT及MR通过观察脾蒂血管和胰尾有无扭转，即可鉴别。
3. 结论
综上所述，WS是一种罕见的疾病，临床症状及实验室检查均没有明显特异性，当出现脾扭转合并胰腺扭转时，容易危及生命及误诊，需要借助影像学检查，其中CT平扫和增强是该病目前最为有效、直观的诊断方法，可为患者争取治疗时间。
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图 5 课题组使用CD-130BX/μCT微纳三维分析仪对岩矿样品进行扫描
Figure 5. The research group used the CD-130BX/μCT micro-nano 3D analyzer to scan rock and ore samples
表 1 工业CT总结
Table 1 Summary of industrial CT
CT种类 理论方法 传播速度km/s 操作难度 精度 经济成本 地震波CT 射线理论 5.5-7 中 高 高 电磁波CT 射线理论 约3×105 中 较高 中 电阻率CT 高密度电法 — 易 中 低 
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表 2 CT技术在研究不同材料孔隙结构中的应用
Table 2 Application of CT technology to study the pore structure of various materials
孔隙结构 孔隙半径R/μm 使用CT种类 结论 页岩孔隙结构 4～40×10-3 X-CT 岩心不同部位形成不同数量的孔隙空间 煤岩孔隙结构 0.1～100 X-CT 孔隙结构与煤岩的体积分形维数有关 黄土孔隙结构 2～6 Micro-CT 孔隙体的渗透率随孔隙度的增大而增大
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