Research On The Application Of Multislice Computed Tomography (MSCT) In The Diagnosis Of Small Intestine Diseases

Objective:The incidence of small intestine chronic hemorrhagic diseases is at a low rate and the causes and symptoms for these diseases are hard to define. Besides, the tortuous intestine tubes are often overlapping and wriggling. All the factors mentioned above made it difficult for the diagnosis of small intestine diseases in clinical practice. By contrast, the MSCTE is characterized by the following advantages. The image can be quickly made through multi-channels, the scope of a single scanning is wide, many images can be made through one single intravenous injection and they will be handled effectively thereafter. All these advantages will make it easy for the lesion of the intestinal wall, the lesion outside the gut cavity and the lesion far away from the visceral organs to be seen. This paper will make a comparison between the CT enterography (CTE) in the diagnosis of small intestine chronic hemorrhagic diseases and the endoscope and the clinical surgical pathology, which will show the value of the CT enterography (CTE) in the diagnosis.Methods:A retrospective study was made on30patients who were diagnosed as patients of small intestine chronic hemorrhagic diseases during a time span of two years from July2012to July2012. All the patients in this group were examined by both the small intestinal endoscope and biopsy or clinical surgical pathology. The reason for the patients to be taken as subjects is that they were examined by both the CTE and the small intestinal endoscope. The exclusion criterion is acute hemorrage dieases and acute abdomen patients. In CTE inspection, isotonic mannitol was taken orally for several times by the patients. With the isotonic mannitol full of the small intestine, patients were examined by the GE Lightspeed64-slices spiral CT. Both total abdominal plain scan and enhancement scan are applied to observe the intestinal wall thickening, the reinforcement degree of the intestinal mucosa, intestinal wall stratification, stricture of the gut cavity, strengthening of abdominal aorta and of the artery and vein in the mesentery, and the distribution of the vessels in the mesentery. All these mentioned above will make the imaging diagnosis based on the CTE possible. Small intestinal endoscope examination was made by Toshiba Olympus endoscope. Endoscope of the small intestine can be divided into two kinds. One is taken through the mouth, the other the anus. Usually the one through the anus is taken first. By repeated dragging and hooking, it will reach the middle and lower part of the small intestine. If a lesion is found, there is no need to take the endoscope through the mouth. Otherwise, after combined anesthesia, the patients will be examined by the endoscope through the mouth, which will usually reach the middle and lower part of the small intestine. Then a conclusion of the position and attributes of the lesion will come after comparing and contrasting the two methods and the clinical pathology results.Results:Among the30patients, tumors17and arterialvenous malformation diseases3,and inflammatory diseases4,and another6cases.the precision rate of defining the lesion by the CTE is80%(24/30), while the precision rate by the small intestine endoscope is90%(27/30). The lesions neglected by the CTE include one cases of small intestine diverticular, one case of capillary telangiectasia, one cases of small intestinal mucosa congestion edema, one cases of eosinophils inflammation of the intestinal tract, and2cases of small polyp in the intestinal tract。The reason for the neglect of the small intestine diverticular is that the small intestine is circular and it has similar structure to that of the small intestine diverticular; the reason for the neglect of capillary telangiectasia and small intestinal mucosa congestion edema might be that the dilation of the capillary and the congestion edema is slight, thus making it hard to be discovered by the CTE. Among the3cases which were neglected or undiscovered, one is small intestine stromal tumor, one is arteriovenous malformation, and one is concurrent infection of the small intestine diverticular. All these three lesion located at the jejuno-ileum. The reason for the neglect might be that the endoscope through the mouth and the anus didn’t meet, thus making it neglected. The differences between the two methods of examination in accurate diagnosis didn’t have statistical meaning (P=0.6876>0.05). With the help of the isotonic mannitol, the CTE shows its advantage in displaying the small intestine, while the endoscope shows its advantage in diagnosing tiny lesion of small intestine. To conclude, the two methods can complement with each other in diagnosis of small intestine chronic hemorrhagic diseases.Conclusion:CTE can complement or replace the endoscope in diagnosing small intestine hemorrhagic diseases. What’s more, it is better in diagnosing the lesion in the jejuno-ileum than the endoscope. In particular, it is cheaper and easy to operate and cause less pain to the patients. Therefore, CTE is an effective method in diagnosing small intestine hemorrhagic diseases. Objective:Small bowel obstruction can cause the change of dissection and function in the intestinal tube as well as physicadisturbance on the body. Besides, the clinical manifestation is very complicated and changeable. The effective treat of the small bowel obstruction mainly depends on the quick and correct diagnosis. Previously, the iconography examination mainly depends on the X-ray abdominal radiography. But with the development of CT, it has become the main method in determining the position, the shape and the causes of the intestine obstruction. CT is regarded as the best way to know whether patients need expectant treatment or close follow-up or they should receive immediate operation treatment. This paper tries to analyze the characteristics of multi-slice computed tomography diagnosis in the small bowel obstruction through the analysis of30cases of small bowel obstruction confirmed by clinical diagnosis and operation.Methods:Collect30cases of small bowelobstruction clinical or operation confirmed from January,2011to July,2012in our hospital, among which include18males and12females. Their ages are between31to77, and the average age is52. The clinical manifestations are abdominal pain, abdominal distension, vomit, melena, and the stopping of exhaust defecation. Among these cases, there are8ones which have previous operation and1case which has previous external injury. The flight lead should be1while the slice thickness should be5mm. Because the patients of this group should have clinical fasting, gastrointestinal decompression, or they receive emergency treatment, so they didn’t take contrast agent, and the small bowel contents can act as the natural contrast agent,so only5cases taked isotonic solution of manicol liquid. There are22cases which have received plain scan and8cases which receive plain and enhancement scan.Results:1. The existence of obstruction:the sensibility of CT is100%in these30cases. Intestinal tube has segmental or universal expansion, effusion, pneumatosis, and the expansion of small intestine diameter is over2.5cm, and22cases among these have positive transitional zone.2. The determination of the obstruction:According to the standards of diagnosis and depending on multi-planar reconstruction, there are11high obstructions,19low obstructions. While the result of operation or clinical confirmed result is14high obstructions and16low obstructions, there are3cases of misdiagnosis, and the accuracy rate is90%. 3. The causes of obstruction:the accuracy rate of the causes of the disease is86.7%. In the30cases, there are12cases of pathologically or clinically confirmed adhesive obstruction,8neoplastic obstruction,3intussusceptions obstruction (including2ones caused by neoplastic obstruction),3intestinal twist obstruction,2cases caused by the blood supply,1case caused by internal heynia,l external injury,2tumor suppressor obstruction. There are4misdiagnosis, among which include2cases which misdiagnose adhesive obstruction as neoplastic obstruction,1internal heynia obstruction as mesentery twist,1ileocecal junction lipoma intussusceptions as intussusceptions. The obstruction caused by different reasons has different manifestation in the CT. In the adhesive obstruction, there are10cases of the sink of the proximal intestine and intestinal tube expansion of the distal intestine,2cases of angle sign,9partial adhesive band syndromes. In the obstruction caused by tumor, there are5cases in which soft tissue mass or uneven thickening of the intestinal wall can be seen in the position of obstruction. There are2cases of obstruction caused by intussusceptions which in turn is caused by tumor. There are4cases of lymphadenovarix near the mesentery or intrahepatic metastasis. In the obstruction caused by intussusceptions, the circle-like change in the enteric cavity and the entanglement of low density y mesentery can be seen. All in all, in these cases examined by the multi-slice computed tomography, the sensitivity of the examination is100%and the accuracy of determination of the position is91%, the cause of the desease is86%. The CT manifestation of small bowel obstruction is that intestinal tube has segmental or universal expansion, effusion, pneumatosis. Different reasons have different manifestations in CT.Conclusion:the positive rate can reach100%in the diagnosis of small intestine obstruction by using multi-slice computed tomography. it has also high sensitivity in determining the causes and positions of obstruction, so multi-slice computed tomography is an very effective way. A better understanding and careful analysis of small bowel obstruction in the CT manifestation is very helpful in accurate diagnosis, and thus an immediate clinical decision can be made.