Wiesner Walter, Khurana Bharti, Ji Hoon, Ros Pablo R
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Radiology. 2003 Mar;226(3):635-50. doi: 10.1148/radiol.2263011540. Epub 2003 Jan 15.
Bowel ischemia may be caused by many conditions and manifest with typical or atypical and specific or nonspecific clinical, laboratory, and radiologic findings. It may mimic various intestinal diseases and be confused with certain nonischemic conditions clinically and at computed tomography (CT). Bowel ischemia severity ranges from mild (generally transient superficial changes of intestinal mucosa) to more dangerous and potentially life-threatening transmural bowel wall necrosis. Causes of critically reduced blood flow to the bowel are diverse, ranging from occlusions of mesenteric arteries or veins to complicated bowel obstruction and overdistention. CT can demonstrate changes in ischemic bowel segments accurately, is often helpful in determining the primary cause of ischemia, and can demonstrate important coexistent findings or complications. Unfortunately, common CT findings in bowel ischemia are not specific, and specific findings are rather uncommon. Therefore, it often is a combination of nonspecific clinical, laboratory, and radiologic findings-especially detailed knowledge about the pathogenesis of acute bowel ischemia in different conditions-that helps most in correct interpretation of CT findings. To improve understanding of this complex heterogeneous entity, this article provides an overview of the anatomy and physiology of mesenteric perfusion and discussions of causes and pathogenesis of acute bowel ischemia, CT findings in various types of acute bowel ischemia, and potential pitfalls of CT.
肠缺血可能由多种情况引起，并表现出典型或非典型、特异性或非特异性的临床、实验室及影像学表现。它可能酷似各种肠道疾病，在临床及计算机断层扫描（CT）检查时与某些非缺血性疾病相混淆。肠缺血的严重程度从轻度（通常为肠黏膜短暂的浅表改变）到更危险且可能危及生命的透壁性肠壁坏死不等。导致肠道血流严重减少的原因多种多样，从肠系膜动脉或静脉闭塞到复杂的肠梗阻及过度扩张。CT能够准确显示缺血肠段的改变，常常有助于确定缺血的主要原因，并能显示重要的并存表现或并发症。遗憾的是，肠缺血常见的CT表现并不具有特异性，而特异性表现相当少见。因此，通常是将非特异性的临床、实验室及影像学表现相结合，尤其是对不同情况下急性肠缺血发病机制的详细了解，对正确解读CT表现最有帮助。为增进对这一复杂异质性疾病的理解，本文概述了肠系膜灌注的解剖学和生理学，讨论了急性肠缺血的病因及发病机制、各类急性肠缺血的CT表现以及CT检查的潜在陷阱。
