Study Of Computed Tomography Enterography With Water Enema Combined With Mesenteric CT Angiography In Small Bowel Disease

Objective To investigate the diagnostic value of Computed Tomography enterography with water enema(CTE-WE)combined with mesenteric CT angiography(CTA)in the diagnosis of small bowel disease.Materials and methods 89 patients with suspected small bowel disease were collected in our hospital from March 2016 to February 2017,including male 32 and female 57,age 2~77,mean age,49.1 years.patients were asked to oral 2.5% isotonic mannitol aqueous solution 1800 ml(For children,cut these serving sizes in half)in the 30 minutes within 6 times,and were intramuscular injection anisodamine 10 mg at the beginning of oral solution 25 minutes.the patients were enjoined to move to the CT scan bed and take left posterior after intramuscular injection anisodamine 30~40 minutes,and then slowly transfused the warm water 600-700 ml.through the anus.All patients underwent continuous double-phase scanning with multi-slice spiral CT.The Multi-planar recombination(MPR)was performed in the portal vein.The small intestine was mainly subjected to standard MPR,coronal and sagittal reconstruction.The colon was mainly treated with MPR oblique sagittal,Oblique coronal and oblique axial reconstruction.The maximal mesenteric artery and vein were reconstructed by maximal density projection(MIP)technique in arterial phase and portal vein images.The volume reconstruction(VR)is then performed on the cross-sectional images of the arterial phase.Provisions of the same section of the bowel appears to be single or multiple lesions are recorded as a section,the same paragraph there are two types of lesions are recorded as two,and so on.By the two senior diagnostic experts with the image analysis,divergence of views through the discussion to reach a consensus:(1)The arterial phase,portal cross section and MPR images were used to observe the wall and mucosa of the small intestine and large intestine,and whether the lymph nodes,mesentery and omentum were changed.(2)Location of small bowel disease: First,according to Cole grouping method to locate the lesion,and then use the arterial phase image reconstruction of the mesenteric artery branch of the lesion to determine the location and evaluate the involvement of large and small segments of the disease;(3)According to the degree of length and overlap,the small intestine was divided into intensive,homogeneous and discrete type.The maximal diameter of the small intestine of the duodenum,jejunum and ileum was measured,and evaluating whether the large intestine range is comprehensive.Small intestine filling was assessed using a 4-point method: l points = poor;2 points = medium;3 points = good;4 points = excellent.(4)Combined with digestive tract endoscopy,surgery or endoscopic biopsy specimens of pathological and clinical(clinical symptoms,signs,treatment,biochemical tests,follow-up)to determine the image diagnosis.Results Of the 89 patients,96.6%(86/89)were well tolerated,61(68.5%)were excellent,23(25.9%)were well filled,5 cases(5.6%)were filled in medium.Jejunum filling is relatively poor,the lower part of the ileum filling the best.86 cases(96.6%)comprehensive evaluation of large intestine.89 cases(100.00%)ileocea showed good.Small intestine distribution: 7 cases were dense type,26 cases were isolated,27 cases were homogeneous.In this study,CTE was found in 46 cases and 75 section of abnormal,43 cases of normal.CT with Water enema(CT-WE)were found in 33 cases and 60 sections.A total of 39 abnormalities were found in mesenteric CTA.CTE-WE found a total of 61 cases and 137 sections abnormalities,28 cases were normal.In CTE found 46 cases of abnormal,CT-WE found 22 cases and 38 sections of abnormalities,accounting for CTE abnormalities found 47.8%(22/46).At the same time involving the large intestine,small intestine for similar lesions in 17 cases and 57 sections,accounting for CTE found 36.95%(17/46)of the total abnormalities.Of the 43 cases where CTE was not found abnormal,CT-WE found 13 cases and 18 abnormalities,accounting for 30.2%(13/43)of the total number of normal CTE,accounting for 13.1% of the total number of total lesion intestine(18/137).The difference of CTE-WE and CTE between intestinal diseases was statistically significant(P <0.05).CTE-WE combined with mesenteric CTA found 63 cases of abnormal and 26 cases of normal.In the CTE-WE found in 61 cases of disease.Mesenteric CTA showed abnormalities in 37 cases,accounting for CTE-WE detected the total number of lesions of 60.7%.In the 28 cases where CTE-WE did not find the lesion,the mesenteric CTA was found to be abnormal in 2 cases,accounting for 7.1% of the total number of CTE-WE detected lesions;CTE-WE combined with mesenteric CTA and CTE-WE detection rate was not statistically significant(P = 0.50).Endoscopic,surgical findings and pathology confirmed a clear lesion 34 cases and 38 sections.Using Cole grouping method to accurately locate 21 small intestine lesions,the accuracy rate of 55.2%.Conclusion(1)By reducing the oral mannitol isotonic and enema water,and to extend the time of intramuscular injection of antispasmodic agents to start scanning to reduce the small intestine Reduce that the small intestine is squeezed by excessive expansion of the stomach and large intestine,and coordination of stomach,small intestine,large intestine filling between the contradictory relationship,So that the small intestine,large intestine were well filled with display.(2)End ileum and ileoceae are common parts of intestinal lesions,this study using oral water and water enema two contrast agent introduction,so that the terminal ileum,ileoceae reached 100% showed good.(3)CTE-WE to achieve the small intestine and large intestine at the same time filling shows the expansion of the scope of the evaluation of intestinal diseases,especially for large and small intestine at the same time involved in the detection of multiple lesions.(4)CTE-WE achieved the small intestine and large intestine filling display.,extended the scope of the evaluation of intestinal diseases,especially for large,small intestine at the same time involved in the detection of multiple lesions.(5)CTE-WE not only detect small intestine lesions and small intestine,large intestine at the same time involved in lesions,but also conducive to the discovery of unexpected colon disease.(6)CTE-WE combined with mesenteric CTA can provide vascular signs of intestinal-related lesions,which can conducive to complete display of disease image performance and the establishment of image diagnosis.