The Clinical Research Of Multi-slice Spiral CT In Intestinal Imaging

Background and Purpose:Small intestine is the longest part of the digestive tract, Small intestine is always a dead zone of the image diagnosis because of its lengthy,tortuosity and overlap. The traditional gastroenterography brought a revolutionary change For the diagnosis and treatment of the alimentary canal diseases, but the small intestine always rarely benefit. Currently the diagnosis of small bowel diseases is still mainly relies on the imaging examination. Application of multi-slice spiral CT examination brought a new method for the small intestine examination. The purpose of This study to discuss the value and usefulness of improved multislice CT enterography (MSCTE) with orally administered isosmotic mannitol (2.5%) as negative contrast in demonstrating normal and abnormal small bowel. Our hospital has improved the above method, with clinical experience and research, according to anatomical and physiological characteristics of the small intestine, evaluate the mean expantion degree and measure the thickness of the duodenum and jejunum, stomach, ileum and colon to contrast analysis in statistics, To discuss The clinical research of Multi-slice Spiral CT in intestinal imaging.Materials and methods:(1)Twenty adult volunteers who take the MSCTE examination from February 2009 to May 2010, there were 10 male and 10 female patients and mean age at presentationwas 50 years (range 30 to 70 years). Seventeen patients (85%) had symptoms consistent with abdominal mass, abdominal pain, intermittent melena, fever and so on. Sixty Adult volunteers were randomly divided into two groups by randomized method (improved method one,improved method two),Through comparative analysis of two methods to determine the improved MSCTE method.(2) Sixty adult volunteers who take the MSCTE examination from February 2009 to May 2010, there were 33 male and 27 female patients and mean age at presentationwas 47 years (range 35 to 70 years). Thirty-four patients (57%) had symptoms consistent with abdominal mass, abdominal pain, intermittent melena, fever and so on. Sixty Adult volunteers were randomly divided into two groups by randomized method (conventional method, improved method).(3)Twenty adult volunteers who take the gastrointestinal imaging examination from May 2009 to May 2010,there were 10 male and 10 female patients and mean age at presentationwas 38 years (range 36 to 42 years). Three patients (15%) had symptoms consistent with abdominal pain, intermittent melena, fever and so on.(4) The application of MSCTE eighteen cases were detected by MSCTE, including six cases of small intestinal stromal tumor, one case of Ileal hemangioma, one case of ileocecal lymphoma and three cases of descending colon tumors (including one case of adenocarcinoma, one case of stromal tumor, one case of adenoma), one case of transverse colon cancer, one case of Ileocecal intestinal abscess, one case of Crohn disease recurrence and sinus formation, one case of duodenal diverticulum, one case of intestinal stone; One case of small intestine cavernous hemangioma; One case of small bowel obstruction; excluding two cases of segmental abnormal enhancement of intestinal. The detection accuracy and positioning diagnosis accuracy of MSCTE is 100%. Which tumors were pathologically confirmed by pathology, the other cases were analyzed comprehensively through clinical data.(5)A11 subjects are all asked for empty stomach for twelve hours,carry out the examination at the morning next day under abrosia. The gastrointestinal imaging examination require the intestinal preparation with magnesium sulfate and folium sennae, carry out the examination at the morning next day under abrosia.Ask their hypersensitiveness details carefully, the patients had ailments such like glaucoma, prostatic hypertrophy and dysuria were not able to take the intramuscular injection of anisodamine (654-2). The patients had symptoms such like acute ileus can not accept the examination.(6)CT scanning Take advantage of GE Lightspeed 64-slice spiral CT, Stellent binoculars high-pressure injector of U.S. Medrad Corporation. The scanning range is from the Liver diaphragm to the upper edge of pubic symphysis. Scanning parameters: tube voltage 120kV, auto mA, reconstruction slice thickness 5mm, matrix 512 x 512, pitch 0.984, collimation width 64×0.625mm, measuring ROI area is 2 square mm. Scanning and then dual-phase scanning, inject 100ml Iohexol (350mg I/ml) to the elbow vein at 4ml/s flow rate, a dose of 1.5ml/kg. After injection, when aortic CT value is 200HU, it can trigger (diagnosis time delays 5 s) the arterial phase scanning automatically, usually 25-30s; in the late 40s based on the arterial line, the venous phase scanning starts, usually 65-70s. Retrospective image thickness is 0.625mm, in AW4.3 workstation manipulate MPR,MIP and VR post-processing.(7) According to the X-ray anatomy will be divided small intestine into six groups:group one is duodenum, group tow is the proximal jejunum, group three is the distal jejunum, groups four, five, and six is the ileum. The images were retrospectively analyzed by three or more radiologists, and make the qualitative and quantitative analysis to the expansion degree and the thickness of the jejunum and ileum. According to the double-blind method, two groups of images were observed to score (table one). The gastrointestinal tract is divided into the stomach, duodenum, jejunum, ileum, caecum, ascending colon, transverse colon and descending colons, the sigmoid colon and rectum. Observe its distended situation and separately written is 0,1,2,3 points, respectively say moderate filling bowel section parts accounting for assessed bowel segment of 30%,below 30%,30% and <50%,≥50% and <80%,≥80%.Three radiologists altogether to retrospectively analyzed the image, evaluation and measurement expansion degree and the wall thickness.(8) All data were analyzed statistically by spss13.0 package, there is a manifest significant differencen when P<0.05. Take the average dilation of the small intestine to x2 test, select an image that is most representative, filling most satisfactory, for the same period of intestinal, draw the t Test for quantitative analysis to the jejunum, ileum wall thickness.Results:(1)The statistical quantitative analysis result of the Jejunum (group two,three) wall thickness shows that the method one can engorge the Jejunum much better, and the conventional method is poor at engorge the two,three group small intestine, there is a significant difference in statistics(P<0.05) The statistical quantitative analysis result of the Ileum (group four, five, six) wall thickness shows that, under the method one MSCTE, the average wall thickness of the small intestine is thinner than the method two, there was no manifest significant difference between two methods in wall thickness to the small intestine(P>0.05). The statistical quantitative analysis result of the small intestine distensibility shows that The method one can engorge the small intestine much better, and the conventional method is poor at engorge the two,three group small intestine, there is a significant difference in statistics. There was no significant difference between two methods in mean expantion degree to the other groups small intestine. Therefore, the method one identified as the improved MSCTE method.(2) The statistical quantitative analysis result of the small intestine distensibility shows that The improved method can engorge the small intestine much better, and the conventional method is poor at engorge the two,three group small intestine, there is a significant difference in statistics. There was no significant difference between two methods in mean expantion degree to the other groups small intestine. The statistical quantitative analysis result of the Jejunum wall thickness shows that, under the improved method MSCTE, the average wall thickness of the small intestine is thinner than conventional method's, here was a manifest significant difference between two methods in wall thickness to the small intestine (P=0.000). The statistical quantitative analysis result of the Ileum wall thickness shows that, under the improved method MSCTE, the average wall thickness of the small intestine is thinner than the conventional method's, there was no manifest significant difference between two methods in wall thickness to the small intestine(P=0.576).(3) The gastrointestinal Imaging shows that Duodenum and Jejunum has a low distensibility, the bowel wall are a little thick (2.10 mm and 2.30 mm), particularly to the duodenum. Jejunal's dilation a bit weak, thicker wall, mucosa is quite clear. Stomach, ileum and colon are filling satisfied.(4) The application of MSCTE One case of the distal ileum hemangioma, the hemangioma's CT manifestations showed the bowel wall partial thickened, the wall thickness is about 10 mm, a visible enhancement, and with a thick mesangium arterial thickening connected. Small intestine interstitialoma six cases, including two cases in the jejunumin, four cases in ileum, all performed a lobulated soft tissue mass, uniform density of tumor, a manifest enhancement, we can see the tumor artery in the VR reconstruction image.one case of ileocecal junction's lesion, shows ileocecal junction bowel wall thickening, the serosa shows a leaking like change, was misdiagnosed as ascending colon placeholder, According to improved method MSCTE and clinical data,verified the lesion is the small intestinal beside abscess, MIP and VR imaging showed that the draining thick vein surrounded by lesions. One case of crohn disease recurrence and fistula emerging, there is a fistula at the descending part of the duodenum and the transverse colon, the bowel wall close together is thickening, no abnormalities enhancement; one case duodenal diverticula, with performance of a vacuoles structure at the descending part of duodenum, can be seen in gas-liquid flat. One case of small bowel obstruction is a low-set small bowel obstruction, middle ileum bowel wall local thickening, no abnormalities enhancement. Two cases of bowel wall segmental abnormal enhancement, do regular abdominal CT examination showed the bowel wall segmental enhancement and the MSCTE image shows absolutely normal, it is considered as a blood-flowing change. One case of the descending colon adenocarcinoma postoperative review, the gastrointestinal CT imaging shows the bowel wall near the anastomotic stoma is thickening show ulcer type, lesions thick about 13 mm, long diameter is about 26.0 mm, it is confirmed by the pathology result as a relapse for descending colon adenocarcinoma. One case of descending colon interstitialoma, performance for parenteral class round lumps, peripheral bowel wall thickening and the bowel lumen only mild narrowing, a manifest enhancement. One case of adenoma of descending colon, shows a round mass of the intestine, the tumor diameter is about 12 mm Clear boundary, the bowel wall surrounding the mass without thickening. One case of adenocarcinoma of transverse colon, shows the bowel wall is uneven thickening, the bowel lumen get a stenosis, we can see the expansion of the upper intestinal, and the mass is uneven moderate enhancement, VR reconstruction images show the tumor artery clearly. One case of the ileocecal junction leucoma, the bowel wall of the ileocecal junction segment is uneven thickening, corresponding lumen is stenosis, shows a mild-to-moderate uniform enhancement. One case of intestinal stone, located the middle of the ileum, the activity is strong, it also shift over with the time. One case of the small intestine multiple body hemangioma, under the MSCTE examination, the image shows that the lesions center can found multiple punctate calcification shadows, enhanced scan showed lesions had mild or no enhancementConclusions:1. The improved method (multislice CT enterography with orally administered isosmotic mannitol (2.5%) as negative contrast in demonstrating normal and abnormal small bowel) is superior to conventional method in expantion degree of small intestine,so we can easy to learning conditions of the small intestinal mucosa,folds,bowel wall,mesentery and the organs around the small bowel.2. The gastrointestinal imaging is superior to conventional method in expantion the stomach, bowel by the ways of extending the time of drinking water and the volume of water which the volunteers have.3. MSCTE with isosmotic mannitol as negative contrast for distending the small bowel have a remarkable effect, is a simple, rapid, noninvasive, effective and brand new method for evaluating small bowel diseases.