迴盲瓣－電腦斷層攝影表現

本研究的目的，是使用電腦斷層攝影(CT)來評估正常的迴盲窩及迴盲瓣，我們將曾接受過CT檢查的無迴盲窩病變90人及有迴盲窩病變10人之CT片，3位放射線科專科醫師作回顧性覆審。依迴盲瓣在CT所呈現的不同影像而分成4種類型。第Ⅰ型成Ⅴ字型的瓣膜樣式，第Ⅱ型爲看到迴盲腸瓣膜的肌肉，第Ⅲ型看不到瓣膜，只看到末端迴腸及盲腸靠近之處，第Ⅳ型屬於找不出第Ⅰ至Ⅲ型，有些甚至分不出盲腸及末端迴腸。第Ⅰ及Ⅱ型均可表示迴盲瓣的位置，而第Ⅲ及Ⅳ型則無法判定。在無迴盲腸窩病變之組別中，第Ⅰ型54人(60%)，第Ⅱ型25人(28%)，第Ⅲ型10人(11%)，第Ⅳ型1人(1%)。所以無迴盲窩病變可認出迴盲腸瓣膜的機率很高爲88%(79/90)。在第Ⅰ及Ⅱ型中，有9例可見瓣膜的脂肪浸潤，而1例可見瓣膜的脂肪瘤。造成CT影像呈現第Ⅲ及Ⅳ型的原因，包括跳切(Skipped Slice)，假影，右側大腸袋萎縮或不明顯，腫塊效應，腸旋轉不良，可動性盲腸(mobile cecum)，手術切除等。在有迴盲腸窩病變的之組別中，包括原發性盲腸癌3例，遠端迴腸淋巴瘤1例，原發性卵巢癌轉移3例及闌尾膿瘍3例。Ⅰ及Ⅲ型各1例，其餘皆爲第Ⅳ型。在迴盲腸窩病變中90%不能正確指認迴盲瓣但其中44%經病經證實瓣膜仍是完整無病灶。故可能是周圍的腫瘤或發炎反應，引起迴盲腸及瓣膜的痙攣收縮，或腫塊效應而致誤判。

關鍵字

迴腸；腹部電腦斷層攝影

並列摘要

The computed tomographic (CT) scans in 90 patients without ileocecal (IC) pathology and 10 patients with IC abnormalities were retrospectively reviewed. We classified IC valve into four types according to the manifestation of CT images. Type Ⅰ was transverse Ⅴ-shaped, presenting as longitudinal scan of the central lumen of IC sphincter. Type Ⅱ was the muscle density presenting as the hypertrophy muscle of IC sphincter. Type Ⅲ just demonstrated the connection of the terminal ileum and colon, but IC valve and muscle were not found. The others could not tell terminal ileum from cecum and were graded as type Ⅳ. Type Ⅰ & Ⅱ represented IC valve, and were identified in 88% (79/90). The reasons of type Ⅲ & Ⅳ without IC pathology would be further discussed. In the group with pathology in the IC fossa, 90% (9/10) IC valve could not be identified, and 44% (4/9) of IC valve proved still intact in the microscopy. The attributive factors of these false positive cases should probably be displacement or spasm of IC valve in the vicinity of tumor or inflammation.

並列關鍵字

Ileum ； abdomen, CT

國際替代計量

迴盲瓣－電腦斷層攝影表現

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