Hansmann J, Eichholz J
Diagnostische und Interventionelle Radiologie, Theresienkrankenhaus Mannheim, Deutschland.
Radiologe. 2012 Sep;52(9):849-66. doi: 10.1007/s00117-011-2278-8.
The barium meal with plain X-ray films of the small intestine has for decades been the undisputed gold standard in imaging of the small intestine. More recently, X-rays and fluoroscopy with an overall accuracy of 73% have been replaced by multislice computed tomography (MSCT) or modern magnetic resonance imaging (MRI). Ultrasound is suitable for the orienting investigation of the small intestine in the context of general abdominal sonography as well as for dedicated examinations with a sensitivity of 67-96% and a specificity up to 97%. The endoscopic examinations of the small bowel, such as video capsule endoscopy and double-balloon enteroscopy are expensive and time-consuming techniques, which provide valuable information in special indications. Other than with the stomach or colon, the diagnostics of primary small intestine tumors plays a relatively subordinate role due to the low incidence of 3-5% of all gastrointestinal (GI) neoplasms but with a high sensitivity of 84% and a specificity of up to 97% for computed tomography (CT) and MRI. Predominant questions are those concerning ileus or the diagnostics of passage disturbances after preceding operations, to depict bowel obstructions, adhesions or the involvement of the small bowel in peritoneal carcinomatosis. The sensitivity per lesion in the initial evaluation of Crohn's disease (CD) is 47-68% for capsule endoscopy, 43% for MRI and 21% for CT enterography. In cases of known CD, the sensitivity is 70% for capsule endoscopy and 79% for MRI. A further indication is the evaluation of acute or occult gastrointestinal bleeding.
几十年来，小肠钡餐造影及普通X线片一直是小肠成像无可争议的金标准。最近，总体准确率为73%的X线和荧光透视已被多层螺旋计算机断层扫描（MSCT）或现代磁共振成像（MRI）所取代。超声适用于在一般腹部超声检查中对小肠进行定向检查，也适用于专门检查，其敏感性为67%-96%，特异性高达97%。小肠的内镜检查，如视频胶囊内镜检查和双气囊小肠镜检查，是昂贵且耗时的技术，在特殊情况下能提供有价值的信息。与胃或结肠不同，原发性小肠肿瘤的诊断相对次要，因为其在所有胃肠道（GI）肿瘤中的发病率仅为3%-5%，但计算机断层扫描（CT）和MRI对其诊断的敏感性高达84%，特异性高达97%。主要问题涉及肠梗阻或既往手术后通道障碍的诊断，以描绘肠梗阻、粘连或小肠在腹膜癌中的受累情况。在克罗恩病（CD）的初始评估中，胶囊内镜对每个病变的敏感性为47%-68%，MRI为43%，CT小肠造影为21%。在已知CD的病例中，胶囊内镜的敏感性为70%，MRI为79%。另一个适应症是评估急性或隐匿性胃肠道出血。
