Macari Michael, Chandarana Hersch, Balthazar Emil, Babb James
Department of Radiology, Abdominal Imaging Section, Tisch Hospital, New York University Medical Center, 560 First Avenue, Ste. HW 207, New York, NY 10016, USA.
AJR Am J Roentgenol. 2003 Jan;180(1):177-84. doi: 10.2214/ajr.180.1.1800177.
We evaluated the capability of CT to depict findings that allowed differentiation of small-bowel ischemia from intramural hemorrhage.
Findings of 35 CT examinations (19 patients with small-bowel ischemia and 16 patients with intramural hemorrhage) were analyzed by two abdominal radiologists for the degree of wall thickening, location and length of involvement (short, <or = 15 cm; medium, 16-30 cm; or long, >30 cm), presence of hemoperitoneum, and pattern of attenuation. Patency and caliber of the superior mesenteric artery and vein were noted. Diagnosis was confirmed by laboratory findings, clinical parameters, and follow-up examinations, or at surgery. A Mann-Whitney U or Fisher's exact test was used to compare the two conditions for the following features: wall thickening, location and length of involvement, presence of hemoperitoneum, and appearance of the target sign.
Among the 35 examinations, 18 abnormal segments with intramural hemorrhage and 19 abnormal segments with ischemia were identified. (Two patients with intramural hemorrhage each had two segments involved.) Mean bowel wall thickness was 11.7 mm (range, 4-25 mm) in patients with intramural hemorrhage and 4.0 mm (range, 1-9 mm) in patients with ischemia. Length of involvement was short in 14 segments with intramural hemorrhage and medium in four segments with intramural hemorrhage; none of the segments with intramural hemorrhage had long involvement. Among the segments with ischemia, length of involvement was medium in three and long in 16; none of the ischemic segments had short involvement. Fifteen (94%) of 16 segments with intramural hemorrhage and six (32%) of 19 segments with ischemia had hemoperitoneum. Seven of the 18 segments with intramural hemorrhage and nine of the 19 with ischemia had a target sign. Segments with intramural hemorrhage exhibited a higher statistically significant degree of wall thickening (p < 0.001), a shorter length of involvement (p < 0.0001), and a higher incidence of hemoperitoneum (p < 0.001) than did segments with ischemia. The two groups were not statistically different in location of involvement (p = 0.12) or in the incidence of the target sign (p = 0.18).
Although some of the CT features overlap, a short segment involvement with wall thickening of 1 cm or greater is typical of intramural hemorrhage; a long segment involvement with wall thickening of less than 1 cm is typical of ischemia.
我们评估了CT描绘能区分小肠缺血和壁内出血的表现的能力。
两名腹部放射科医生分析了35例CT检查结果（19例小肠缺血患者和16例壁内出血患者），观察肠壁增厚程度、受累部位及长度（短，≤15cm；中，16 - 30cm；或长，＞30cm）、腹腔积血情况及衰减模式。记录肠系膜上动脉和静脉的通畅情况及管径。诊断通过实验室检查结果、临床参数、随访检查或手术得以证实。采用Mann - Whitney U检验或Fisher精确检验比较两种情况在以下特征方面的差异：肠壁增厚、受累部位及长度、腹腔积血情况和靶征表现。
在35例检查中，识别出18个壁内出血异常节段和19个缺血异常节段。（两名壁内出血患者各有两个节段受累。）壁内出血患者的平均肠壁厚度为11.7mm（范围4 - 25mm），缺血患者为4.0mm（范围1 - 9mm）。壁内出血的14个节段受累长度短，4个节段受累长度中等；壁内出血节段均无受累长度长的情况。在缺血节段中，3个节段受累长度中等，16个节段受累长度长；缺血节段均无受累长度短的情况。16个壁内出血节段中的15个（94%）和19个缺血节段中的6个（32%）有腹腔积血。18个壁内出血节段中的7个和19个缺血节段中的9个有靶征。壁内出血节段的肠壁增厚程度在统计学上显著更高（p＜0.001），受累长度更短（p＜0.0001），腹腔积血发生率更高（p＜0.001），与缺血节段相比。两组在受累部位（p = 0.12）或靶征发生率（p = 0.18）方面无统计学差异。
尽管一些CT特征存在重叠，但受累节段短且肠壁增厚1cm或更厚是壁内出血的典型表现；受累节段长且肠壁增厚小于1cm是缺血的典型表现。
