Multi-Detector Row Spiral CT Imaging Features of Intestinal Volvulus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Juan ¹ , CHEN Guangwen ² , SONG Bin ² , WU Bi ² , LI Zhenlin ²

1.Department of Radiology, The Fourth People’s Hospital of Sichuan Province, Chengdu 610014, China;;
2.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Volvulus; Bowel obstruction; Bowel wall thickening; Tomography/X-ray computed; Reconstruction

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Objective To investigate the imaging features of intestinal volvulus on multi-detector row spiral CT (MDCT). Methods Thirty-one patients with surgically confirmed intestinal volvulus were included in this study. Nine patients received MDCT plain scan, 22 received contrast enhanced MDCT scan and 5 of them had additional CT angiography. Two abdominal radiologists analyzed the MDCT imaging features of intestinal volvulus observed, such as the location, direction of rotation, degree of volvulus, appearance rate of the “whirl sign” and the “beak sign”, bowel wall thickening and ascites and the possible causes of volvulus, which were recorded with review of surgical findings.
Results The location of volvulus included duodenum (1 case), jejunum (23 cases), ileum (3 cases), entire small intestine (2 cases) and sigmoid colon (2 cases). The location of volvulus was correctly diagnosed based on MDCT findings in 27 patients (27/31; 87.0%). The direction of volvulus was correctly diagnosed for all patients based on MDCT findings (clockwise in 11 cases and counterclockwise in 20 cases). The degrees of volvulus assessed on MDCT findings were respectively 180° in 13 cases, 360° in 12 cases, 540° in 2 cases, 720° in 2 cases and 900° in 2 cases, as compared with surgical findings of 180° in 17 cases, 360° in 10 cases, 540° in 1 case, and 720° in 3 cases. The diagnostic accuracy of MDCT for assessing the degree of volvulus was 74.2%. The “whirl sign” and “beak sign” appeared in 18 and 20 patients, respectively. Bowel wall thickening and ascites were showed in 9 patients. In 5 patients with reconstructed images, the images obtained by maximum intensity projection (MIP) and volume rendering (VR) techniques showed the abnormality of mesenteric vessels in all patients, and the multi-planar reconstruction (MPR) image of one patient showed the “whirl sign” and the “beak sign”. The causes of intestinal volvulus were identified on MDCT in 10 patients. Conclusion The “whirl sign” and the “beak sign” are the characteristic images of intestinal volvulus on MDCT. Bowel wall thickening and ascites may indicate the hemody-namic images impairment of volvulus. MDCT plays valuable role in the diagnosis of intestinal volvulus.

Citation： XU Juan ,CHEN Guangwen,SONG Bin,WU Bi,LI Zhenlin. Multi-Detector Row Spiral CT Imaging Features of Intestinal Volvulus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(8): 672-676. doi: Copy

1.	赵文良, 王纪龙, 吴仁民, 等. 肠扭转的CT诊断 [Ｊ]. 上海医学影像, 2008； 17(2): 142-143.
2.	Sandhu PS, Joe BN, Coakley FV, et al. Bowel transition po-ints: multiplicity posterior location at CT associated with small-bowel volvulus [Ｊ]. Radiology, 2007; 245(1): 160-167.
3.	苏纪亭. 肠扭转的诊治 [Ｊ]. 河南外科学杂志, 2009； 15(2): 90-91.
4.	张文奇, 王善军, 洪伟丰, 等. 小肠扭转的螺旋CT诊断 [Ｊ]. 放射学实践, 2007; 22(8): 850-852.
5.	Safioleas M, Chatziconstantinou C, Felekouras E, et al. Cli-nical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases [Ｊ]. World J Gastroenterol, 2007; 13(6): 921-924.
6.	唐年寿. 小肠扭转误诊为急性阑尾炎1例 [Ｊ]. 中国社区医师, 2003; 19(9): 44.
7.	李银业, 李宜杰, 窦斌, 等. 肠扭转的CT诊断(附16例分析) [Ｊ]. 医学影像学杂志, 2008; 18(1): 34-36.
8.	殷胜禄, 刘保池, 丁一. 肠扭转109例临床分析 [Ｊ]. 临床和实验医学杂志, 2008; 7(10): 77-78.
9.	卢晗, 张卫民, 黄博. 小肠扭转误为肿瘤性病变一例 [Ｊ]. 放射学实践, 2004; 19(10): 708.
10.	姜世平, 李志远, 李耿. 胆结石致肠梗阻伴小肠扭转一例报道 [Ｊ]. 腹部外科, 2004; 17(1): 43.
11.	何国生. 洗胃致小肠扭转1例 [Ｊ]. 辽宁医学杂志, 2004; 18(6): 315.
12.	Park JS, Cha SJ, Kim BG, et al. Intrauterine midgut volvulus without malrotation: diagnosis from the ‘coffee bean sign’ [Ｊ]. World J Gastroenterol, 2008; 14(9): 1456-1458.
13.	孙凤霞, 刘平, 王飞. 旋转不良伴中肠扭转的X线、CT表现 [Ｊ]. 河南科技大学学报(医学版), 2008; 26(3): 183-185.
14.	Khurana B. The whirl sign [Ｊ]. Radiology, 2003; 226(1): 69-70.
15.	罗敏, 胡道予. 多层螺旋CT对肠扭转的诊断价值 [Ｊ]. 医学影像学杂志, 2007; 17(2): 164-167.
16.	Duran C, Oztürk E, Uraz S, et al. Midgut volvulus: value of multidetector computed tomography in diagnosis [Ｊ]. Turk J Gastroenterol, 2008; 19(3): 189-192.
17.	Blake MP, Mendelson RM. The whirl sign: a non-specific finding of mesenteric rotation [Ｊ]. Australas Radiol, 1996; 40(2): 136-139.
18.	纪建松, 王祖飞, 徐兆龙, 等. 肠扭转的CT表现 [Ｊ]. 中华放射学杂志, 2005; 39(11): 1185-1187.
19.	陈光文, 宋彬, 吴苾. 肠壁增厚的CT表现及诊断意义 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(12): 943-949.
20.	陈光文, 宋彬, 吴苾, 等. 多层螺旋CT对非肿瘤性肠壁增厚的应用价值 [Ｊ]. 中国普外基础与临床杂志, 2009； 16(2): 164-169.
21.	滕陈迪, 黄崇权, 张丽敏, 等. 多层螺旋CT 肠系膜血管成像的临床应用 [Ｊ]. 放射学实践, 2008; 23(12): 1347-1350.
22.	朱晓梅, 唐立钧, 徐怡, 等. 多排螺旋CT血管成像容积再现显示腹腔干及其分支变异的研究 [Ｊ]. 南京医科大学学报（自然科学版）, 2008; 28(3): 394-395.
23.	吴苾, 宋彬. 影像学新技术在消化系统的临床应用 [Ｊ]. 中国普外基础与临床杂志, 2007； 14(2): 222-229.
24.	刘磊, 寇如刚, 杨可乐, 等. 16层螺旋CT肠系膜上动、静脉成像诊断小肠扭转的前瞻性研究 [Ｊ]. 临床放射学杂志, 2007; 26(3): 274-277.
25.	石海峰, 杨小庆, 杨明. 64排螺旋CT后处理技术诊断机械性肠梗阻 [Ｊ]. 中国医学影像技术, 2009； 25(1): 103-106.

1. 赵文良, 王纪龙, 吴仁民, 等. 肠扭转的CT诊断 [Ｊ]. 上海医学影像, 2008； 17(2): 142-143.
2. Sandhu PS, Joe BN, Coakley FV, et al. Bowel transition po-ints: multiplicity posterior location at CT associated with small-bowel volvulus [Ｊ]. Radiology, 2007; 245(1): 160-167.
3. 苏纪亭. 肠扭转的诊治 [Ｊ]. 河南外科学杂志, 2009； 15(2): 90-91.
4. 张文奇, 王善军, 洪伟丰, 等. 小肠扭转的螺旋CT诊断 [Ｊ]. 放射学实践, 2007; 22(8): 850-852.
5. Safioleas M, Chatziconstantinou C, Felekouras E, et al. Cli-nical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases [Ｊ]. World J Gastroenterol, 2007; 13(6): 921-924.
6. 唐年寿. 小肠扭转误诊为急性阑尾炎1例 [Ｊ]. 中国社区医师, 2003; 19(9): 44.
7. 李银业, 李宜杰, 窦斌, 等. 肠扭转的CT诊断(附16例分析) [Ｊ]. 医学影像学杂志, 2008; 18(1): 34-36.
8. 殷胜禄, 刘保池, 丁一. 肠扭转109例临床分析 [Ｊ]. 临床和实验医学杂志, 2008; 7(10): 77-78.
9. 卢晗, 张卫民, 黄博. 小肠扭转误为肿瘤性病变一例 [Ｊ]. 放射学实践, 2004; 19(10): 708.
10. 姜世平, 李志远, 李耿. 胆结石致肠梗阻伴小肠扭转一例报道 [Ｊ]. 腹部外科, 2004; 17(1): 43.
11. 何国生. 洗胃致小肠扭转1例 [Ｊ]. 辽宁医学杂志, 2004; 18(6): 315.
12. Park JS, Cha SJ, Kim BG, et al. Intrauterine midgut volvulus without malrotation: diagnosis from the ‘coffee bean sign’ [Ｊ]. World J Gastroenterol, 2008; 14(9): 1456-1458.
13. 孙凤霞, 刘平, 王飞. 旋转不良伴中肠扭转的X线、CT表现 [Ｊ]. 河南科技大学学报(医学版), 2008; 26(3): 183-185.
14. Khurana B. The whirl sign [Ｊ]. Radiology, 2003; 226(1): 69-70.
15. 罗敏, 胡道予. 多层螺旋CT对肠扭转的诊断价值 [Ｊ]. 医学影像学杂志, 2007; 17(2): 164-167.
16. Duran C, Oztürk E, Uraz S, et al. Midgut volvulus: value of multidetector computed tomography in diagnosis [Ｊ]. Turk J Gastroenterol, 2008; 19(3): 189-192.
17. Blake MP, Mendelson RM. The whirl sign: a non-specific finding of mesenteric rotation [Ｊ]. Australas Radiol, 1996; 40(2): 136-139.
18. 纪建松, 王祖飞, 徐兆龙, 等. 肠扭转的CT表现 [Ｊ]. 中华放射学杂志, 2005; 39(11): 1185-1187.
19. 陈光文, 宋彬, 吴苾. 肠壁增厚的CT表现及诊断意义 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(12): 943-949.
20. 陈光文, 宋彬, 吴苾, 等. 多层螺旋CT对非肿瘤性肠壁增厚的应用价值 [Ｊ]. 中国普外基础与临床杂志, 2009； 16(2): 164-169.
21. 滕陈迪, 黄崇权, 张丽敏, 等. 多层螺旋CT 肠系膜血管成像的临床应用 [Ｊ]. 放射学实践, 2008; 23(12): 1347-1350.
22. 朱晓梅, 唐立钧, 徐怡, 等. 多排螺旋CT血管成像容积再现显示腹腔干及其分支变异的研究 [Ｊ]. 南京医科大学学报（自然科学版）, 2008; 28(3): 394-395.
23. 吴苾, 宋彬. 影像学新技术在消化系统的临床应用 [Ｊ]. 中国普外基础与临床杂志, 2007； 14(2): 222-229.
24. 刘磊, 寇如刚, 杨可乐, 等. 16层螺旋CT肠系膜上动、静脉成像诊断小肠扭转的前瞻性研究 [Ｊ]. 临床放射学杂志, 2007; 26(3): 274-277.
25. 石海峰, 杨小庆, 杨明. 64排螺旋CT后处理技术诊断机械性肠梗阻 [Ｊ]. 中国医学影像技术, 2009； 25(1): 103-106.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multi-Detector Row Spiral CT Imaging Features of Intestinal Volvulus

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