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使用水灌肠多层螺旋CT对手术结肠进行成像，重点关注手术吻合口。

Imaging the operated colon using water-enema multidetector CT, with emphasis on surgical anastomoses.

作者信息

Tonolini Massimo, Ippolito Sonia

机构信息

Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.

出版信息

Insights Imaging. 2018 Aug;9(4):413-423. doi: 10.1007/s13244-018-0612-7. Epub 2018 Apr 9.

DOI:10.1007/s13244-018-0612-7
PMID:29633171
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6108969/
Abstract

UNLABELLED

Water-enema multidetector CT (WE-MDCT) provides a detailed multiplanar visualisation of mural, intra- and extraluminal abnormalities of the large bowel, relying on preliminary bowel cleansing, retrograde luminal distension, pharmacological hypotonisation and intravenous contrast enhancement. In patients with a history of colorectal surgery for either carcinoma or Crohn's disease (CD), WE-MDCT may also be performed via a colostomy, which allows depicting the anatomy and position of the residual large bowel and evaluates the calibre, length, mural and extraluminal features of luminal strictures. Therefore, WE-MDCT may prove useful as a complementary technique after incomplete or inconclusive colonoscopy to assess features and suspected abnormalities of the surgical anastomosis, particularly when endoscopic or surgical interventions are being planned. This pictorial essay presents the WE-MDCT technique and pitfalls, the expected appearances after different colic surgeries and the imaging features of benign anastomotic disorders (fibrotic stricture, kinking, inflammatory ulcer) and of locally recurrent tumours and CD.

TEACHING POINTS

• Water-enema multidetector CT (WE-MDCT) effectively visualises the operated colon • Complementary to endoscopy, WE-MDCT may helpfully depict abnormalities of surgical anastomoses • WE-MDCT allows assessment of strictures' features and abnormalities of the upstream bowel • Technical pitfalls, normal postsurgical findings and benign anastomotic disorders are presented • WE-MDCT allows detecting relapsing Crohn's disease, recurrent and metachronous tumours.

摘要

未标注

水灌肠多层螺旋CT（WE-MDCT）依靠初步肠道清洁、逆行管腔扩张、药物性低张和静脉内对比增强，对大肠壁内、腔内和腔外异常提供详细的多平面可视化。对于有因癌或克罗恩病（CD）行结直肠手术史的患者，也可通过结肠造口进行WE-MDCT检查，这有助于描绘残留大肠的解剖结构和位置，并评估管腔狭窄的管径、长度、壁和腔外特征。因此，在结肠镜检查不完全或结果不明确后，WE-MDCT作为一种补充技术，可能有助于评估手术吻合口的特征和可疑异常，特别是在计划进行内镜或手术干预时。本文通过图片展示了WE-MDCT技术及陷阱、不同结肠手术后的预期表现，以及良性吻合口病变（纤维化狭窄、扭结、炎性溃疡）、局部复发肿瘤和CD的影像特征。

教学要点

• 水灌肠多层螺旋CT（WE-MDCT）能有效显示手术过的结肠 • 作为内镜检查的补充，WE-MDCT有助于描绘手术吻合口的异常情况 • WE-MDCT可评估狭窄的特征及上游肠管的异常情况 • 介绍了技术陷阱、术后正常表现和良性吻合口病变 • WE-MDCT可检测复发性克罗恩病、复发性和异时性肿瘤

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/e3fe5d811dc8/13244_2018_612_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/ead2b062ed87/13244_2018_612_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/cc56a5ed4a58/13244_2018_612_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/a13647f21ca5/13244_2018_612_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/b646a9c8c5e7/13244_2018_612_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/fa0bf031e917/13244_2018_612_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/3181096a874f/13244_2018_612_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/07a808d7e674/13244_2018_612_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/e3fe5d811dc8/13244_2018_612_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/ead2b062ed87/13244_2018_612_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/666326c2bf12/13244_2018_612_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/02e6fdb4dad7/13244_2018_612_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/e09aff20eda8/13244_2018_612_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/cc56a5ed4a58/13244_2018_612_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/a13647f21ca5/13244_2018_612_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/b646a9c8c5e7/13244_2018_612_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/fa0bf031e917/13244_2018_612_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/3181096a874f/13244_2018_612_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/07a808d7e674/13244_2018_612_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c37e/6108969/e3fe5d811dc8/13244_2018_612_Fig11_HTML.jpg

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