| 兰晓杰,李琦.十二指肠球部溃疡CT表现[J].中国医学影像技术,2020,36(7):1041~1045 |
| 十二指肠球部溃疡CT表现 |
| CT manifestations of duodenal bulbar ulcer |
| 投稿时间：2019-07-06 修订日期：2020-02-07 |
| DOI：10.13929/j.issn.1003-3289.2020.07.024 |
| 中文关键词: 十二指肠溃疡 诊断 体层摄影术,X线计算机 |
| 英文关键词:duodenal ulcer diagnosis tomography, X-ray computed |
| 基金项目:重庆市科学技术委员会基础科学与前沿技术研究项目（cstc2017jcyjAX0281）、重庆市卫生计生委2017年医学科研计划项目（2017MSXM010）。 |
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| 中文摘要: |
| 目的 观察十二指肠球部溃疡的CT表现。方法 回顾性分析经胃镜确诊的44例十二指肠球部溃疡（溃疡组）和51例无十二指肠球部溃疡患者（对照组）的上腹部平扫及增强CT，比较组间十二指肠球部肠壁厚度、肠壁强化程度[动脉期及门静脉期CT值与平扫CT值的差值（ΔCT动脉期和ΔCT门静脉期）]、强化方式、黏膜面CT表现及周围脂肪间隙改变，绘制差异有统计学意义的参数诊断溃疡的ROC曲线，计算其AUC，评价其诊断效能；计算溃疡组CT漏诊率。结果 溃疡组十二指肠球部肠壁厚度[（7.52±2.30）mm]大于对照组[（2.89±0.75）mm，t=12.76，P<0.01]，2组肠壁ΔCT动脉期及ΔCT门静脉期差异均无统计学意义（t=-0.27、0.80，P均>0.05）。溃疡组十二指肠球部肠壁分层样强化、黏膜面不规则及周围脂肪间隙模糊发生率高于对照组（χ2=56.12、65.94、45.71，P均<0.01）。根据十二指肠球部肠壁厚度、强化方式、粘膜面CT表现及周围脂肪间隙改变诊断溃疡的AUC分别为0.99、0.90、0.93及0.84。溃疡组CT漏诊36例，漏诊率81.82%（36/44）。结论 肠壁增厚、分层样强化、黏膜面不规则伴周围脂肪间隙模糊为十二指肠球部溃疡的典型CT表现，准确识别有利于降低漏诊率。 |
| 英文摘要: |
| Objective To observe CT manifestations of duodenal bulbar ulcer. Methods Data of upper abdomen plain and enhanced CT of 44 patients with duodenal bulbar ulcer (ulcer group) and 51 patients without duodenal bulbar ulcer (control group) confirmed with gastroscopy were retrospectively analyzed. The wall thickness, enhancement degree (CT value difference between arterial phase or portal phase and plain scan[ΔCT arterial phase, ΔCT portal phase]), enhancement pattern, CT manifestations of mucosal surface and changes of peripheral fat space of duodenal bulbar intestinal were analyzed and compared between 2 groups. Then ROC curves of parameters statistically different between groups for diagnosis of ulcer were respectively drawn, and AUC was calculated to evaluate the relative diagnostic efficacy. Furthermore, the missed rate of CT diagnosis of ulcer group was calculated. Results The wall thickness of duodenal bulbar in ulcer group ([7.52±2.30]mm) was greater than that in control group ([2.89±0.75]mm, t=12.76, P<0.01), while there was no statistical differences of ΔCT arterial phase nor ΔCT portal phase between 2 groups (t=-0.27, 0.80, both P>0.05). Layered enhancement, irregular mucosal surface and blurred fat space around duodenal bulbar were more common in ulcer group (χ2=56.12, 65.94, 45.71, all P<0.01). AUC of the wall thickness, enhancement pattern, CT findings of mucosal surface and changes of peripheral fat space of duodenal bulb in diagnosis of ulcer was 0.99, 0.90, 0.93 and 0.84, respectively. CT missed diagnosed 36 cases of duodenal bulbar ulcer, and the rate of missed diagnosis was 81.82%(36/44). Conclusion Thickened duodenal bulb intestinal wall, layered enhancement pattern, irregular mucosal surface and blurred fat space around are typical CT manifestations of bulbous ulcer. Accurate recognition of CT manifestations of bulbous ulcer is helpful to reducing missed diagnosis. |
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