CT BNG CP

BS TH NGC HIU
BS V TN C

GII THIU

Bng cp: du hiu trm trng vi gi, khng do chn thng

Cn chn on nhanh, chnh xc, iu tr kp thi
CT l phng tin ph bin, nhanh, hiu qu, chnh xc
Cn c k thut chp CT ph hp.

K THUT
Ct mng cho CT mch mu, si niu, si mt
Khng tim tng phn TM: trong trng hp:
Si h niu, ng mt
Tn thng ng vi, xut huyt
nh gi m trong u gan, thng thn

Tim tng phn TM: trong hu ht cc trng hp

Liu 1.5-2 ml/kg hoc tnh theo nng iod
Tc tim thay i
3 mL/s, kim 20G: khi ch quan tm th TM
4-5 mL/s, kim 18G: khi chp c th M, bnh l mch mu

K THUT- Cc th sau tim

Th M
M sm:15-20s, cht tng phn ch c trong M, cha vo m.
Ch nh: bnh l M, XH, thiu mu rut, u ty ni tit
M tr: 35-40s, cu trc M cp mu tng quang, tng quang nh TM
ca.
Ch nh trong xc nh bn cht u gan, ty
TM ca: 60-70s, th nhu m gan, tng quang nh TM gan.
Ch nh trong a s trng hp
Thn : 80-100s, tng quang v v ty thn. nh gi tn thng thn

Mun:
3ph: th cn bng trong nh gi u gan
10ph: kho st hemangioma khng in hnh v car. ng mt
15ph: nh gi bi tit h niu, ch s washout u thng thn

TIP CN C CT BNG CP
Tm cc du hiu tng qut:

Thm nhim m
Dy thnh rut
Gin rut
Dch bng
Kh t do

Xc nh, loi tr cc bnh l thng gp

Cc du hiu tng qut

Kh t do
Thng l thng rut

Thm nhim m:
Thng ch ra v tr v bn cht tn thng
Nguyn nhn trung tm hay gn vng thm nhim m nht

Dch bng
Khng c hiu
nh gi m dch, c th phi hp siu m

Cc du hiu tng qut

Gin rut
Do tc hay lit rut
Tm quai rut xp: gi tc rut hay VPM

Dy thnh rut
Thm nhim m nhiu, khng tng xng dy thnh- gi vim
Khu tr, khng u, khng ng tm- gi c tnh
Dy u, ng tm, ng nht: thng lnh tnh
tr car. bit ha tt, lymphoma.
Dy lan ta >5cm: thng do thiu mu, vim, nhim
kiu tng quang gip thu hp

Lu ngh tip cn dy thnh rut

Bowel wall thickening at CT: simplifying the diagnosis, Insights Imaging 2014

CC BNH L THNG GP
Vim rut tha
Cc VRT
Vim ti tha
Vim hch mc treo, hi manh trng
Vim bm m
Nhi mu mc ni
Bnh Crohn
Car RT, manh, i trng thng
Tc rut
Thiu mu mc treo
Xut huyt tiu ha
Thng rut
Vim ti mt
Vim ty cp
V phnh MC
Bnh mch mu gan lch

VIM RUT THA

K thut:
Thng thng: Th TM, vng bng, chu
C cn dng cht tng phn?
Khng: 90% sens
C: 98% sens

Cc du hiu VRT
Ti RT
Ngoi RT

Du hiu ti rut tha

ng knh ngoi - ngoi
10 mm (610 mm: khng xc nh)

Thnh
Dy 2-3 mm; tng quang; tch lp; hi trong thnh

Si phn:
C 1/3 BN
c hiu thp
Tng kh nng thng

Du hiu ngoi rut tha

Du hiu manh trng
Dy thnh nh manh trng
dy lan ta, t c hiu hn

Du hiu vim HCP

Thm nhim m quanh rut tha

Dch, p xe
Hch
Vim dy cc cu trc ln cn: i trng ln, chu hng, hi trng cui,
bng quang

So snh cc du hiu VRT

4 du hiu quan trng nht :
Rut tha ln
Dy thnh
Tng quang thnh
Thm nhim m chung quanh

Kt qu khng xc nh
Thng c nhiu du hiu gi RT
Kt qu khng xc nh: khi ch c
mt du hiu hay du hiu nghi ng
30% BN CT khng xc nh b VRT
Tiu chun mi i vi RT k khng
xc nh: k sau khi tr i thnh
phn c th xp >6.6mm (se
84.0%, a sp 88.7%, ac 87.4%).

Lu ngh c KQ CT VRT BN c triu chng

Proposed Algorithm for Interpretation of Appendicitis CT

in Symptomatic Patients- AJR 2005

VRT mn tnh
nh ngha
au ko di 3 tun, mt sau ct RT
GPB: vim hot ng mn tnh hay x

Khng phn bit c vi VRT cp

Thnh dy nh
Tng quang thnh
Khng c hoc thm nhim m nh

Mucocele RT
Khi dch gii hn r vng manh
trng
in hnh khng vim quanh RT
tng quang, ng vi thnh
Nt dy thnh khu tr gi
mucinous cystadenocarcinoma

Bin chng VRT

Hoi t
Thng
p xe quanh rut tha
Vim phc mc
Tc hi trng do vim quanh rut tha
Gieo rc nhim trng theo h TM ca- mc treo: vim
tc TM, tng p ca, p xe gan

VIM TI THA
1025% bn c ti tha
Thng i trng chu hng
i trng (P) thng t gii hn
K thut
# VRT
C th thy trn CT khng tim tng phn nu m

VIM TI THA
Du hiu CT

Thm nhim m quanh i trng: 98%.

Dy ng tm thnh rut > 4 mm #70%
Thy c ti tha > 80%
T dch t
Bng kh ngoi rut
Khi vim, p xe.

Bin chng:

Vim rut tha th pht

Tc rut
R
Thng vo trong phc mc

Vim ti tha

Dy thnh i trng vi nhiu ti tha, ti tha vim, thm nhim m

Thy c RT bnh thng

VIM HCH MC TREO

VIM HI MANH TRNG
(+) khi hch to hay dy thnh hi manh trng
RT v m mc treo bnh thng

VIM BM M
L m m nh nh ra khi thanh mc i trng, c th xon,
vim th pht
Bnh t gii hn (+) quan trng
:
Khi m m nh, vin m cao trn thanh mc
ng, nt m cao trung tm do huyt khi
Dy thnh rut ln cn, thm nhim m mc treo, dy phc mc
khu tr

NHI MU MC NI
Do xon mt phn mc ni
Bnh t gii hn
Du hiu CT:
Vng m mc ni vim, gii hn r, thm nhim chung quanh
Rut v rut tha bnh thng

Vim bm m, nhi mu mc ni

BNH CROHN
Hay gp hi trng cui v i trng (P)
C th lin quan rut tha chronic granulomatous
appendicitis

CARCINOMA RT, MANH, I TRNG THNG

chnh ca VRT, vim ti tha
Du hiu CT:

Dy thnh manh trng hay y RT dng nt, khng ng tm

Vng chuyn tip t ngt
Hch ln
Gy tc VRT th pht
C th thng gi VRT

TC RUT
4%- 20% BN au bng cp
CT tr li cc cu hi:

C tc rut?
V tr tc?
Nguyn nhn?
Mc nng?
C TR quai kn, TR tht, thiu mu rut?

TC RUT
(+) = quai rut gin (>2.5cm)+ xp on xa
V tr tc= chuyn tip: k thut MPR
Tm du phn trong rut non
i t d dy xung hay trc trng ln

nng: Mc xp on xa, gin on gn

Hon ton: on xa xp hon ton, cht cn quang trong lng
rut khng qua c ch tc sau 3-24g
Khng hon ton: on xa khng xp hon ton, cht cn quang
qua ch tc chm, t

TC RUT
Nguyn nhn
Ti thnh rut: u, vim, hematoma, thiu mu
Ngoi rut: dnh, thot v, hematoma, lc ni mc
Trong lng rut: si mt, cht b, d vt

*Tc do dnh # 60-80%:

Vng chuyn tip t ngt, khng thy nguyn nhn
in hnh c du m chim

TC RUT
TR quai kn, TR tht
TR n gin: c th mt hay nhiu im dc quai rut
TR quai kn: 2 im k nhau
TR tht: c nh hng mch mu. a s TR quai kn

TC RUT
TR quai kn, TR tht
TR quai kn:
Quai rut dch hnh ch U, C gy gin on gn
Hai on xp (n v i) k nhau v tr xon
Du m chim
Mch mu mc treo hnh nan hoa
Bt thng ng i mch mu mc treo
TR tht: Du hiu thiu mu rut

THIU MU MC TREO
Ng. nhn:
Tc ng, tnh mch cp, mn tnh
Gim ti mu
Khc: tc rut, u, vim, chn thng, do

Hu qu: RL thong qua hoi t xuyn thnh

K thut CT:
Khng thuc: XH, x va, cc mu ng
Th M, TM
Ti to MPR, 3D

Thiu mu M
MDCT mch mu: sens 96%
hn ch: thromboembolie nh/ nhnh ngoi vi
Du hiu c hiu:
Thnh rut khng tng quang, tng quang chm, khng cn xng
Huyt khi tc mch trong mm

Du hiu khng c hiu:

Thnh rut: Dy tch lp, tng m

Gin, tc rut
Dch bng, ph, XH mc treo
Kh trong thnh rut, TM ca

Thiu mu M

MIP tc nhnh hi trng

Hp nhiu on SMA.
Quai hng trng nhi mu (*) thnh rut khng tng quang,
kh trong thnh rut, m quanh rut v cc mch thng

Thiu mu TM
Huyt khi TM cp:
t gp, t vong cao
Triu chng khng c hiu, thng tr
Yu t thun li:
Bm sinh, di truyn
Tng p TM ca, vim, PT, chn thng, thuc nga thai
V cn

CT:
Dy thnh rut nng
Ph mc treo nng
Nhiu mm bng h

Thiu mu mc treo khng tc nghn

Do cung lng tim, V
Dng chy chm co mch tng thiu oxy rut
CT:
Dy thnh rut lan ta, tng quang
Xp lng + tng quang IVC, AO
Bt tng phn mnh thn, mc treo.

Thiu mu i trng thng do gim ti mu, gim HA

CT: dy thnh do ph lp di nim
ph rut do bi hon V nhanh: p TM trung tm:
Ln IVC, ph quanh khong ca, dch sau phc mc
Khng tng quang thnh rut non

XUT HUYT TIU HA

CT thun li:
Ph bin
Xm ln ti thiu
Kho st ton b rut v cc cu trc khc: mt, ty

XHTH di: CT dn c cng nhn l la chn u tin cho

chn on v iu tr
XHTH trn: CT hu ch trong mt s trng hp
Se, sp: 33%- 42% v 89%- 100%
Rt ngn thi gian chn on
Hn ch, loi b cc th thut xm ln v tn km hn

XHTH- MDCT
K thut: nhiu th
Trc tim: Pht hin tng m c sn trong lng rut
Th M, TM (th rut), +/- th mun
Cc du hiu XHTH cp
XH hot ng
XH mi
Nguyn nhn XH

Cc du hiu XHTH
1. XH hot ng
Tch t dn cht cn quang trong lng rut
Ta mu (c cht tng phn) trong lng rut th M
tng m thay i hnh dng

in hnh pht hin XH hot ng > 0.30.5 ml/min

> chp mch (0.5 ml/min)
< x hnh vi 99m Tc (0.1 ml/min)

 XH hot ng

Thot mch thuc cn quang hot ng bnh nhn XHTH do lot

t trng.
CT th ng mch thy thot mch thuc cn quang trong t trng
Chp ng mch gan chung thy thot mch thuc cn quang
(mi tn) t mt nhnh t trng nh (u mi tn)

Cc du hiu XHTH
2. XH mi: cc mu ng
Khi ngng XH hoc cha n ngng pht hin (1)
Tng m trong lng rut
Ngng chn on XHTH mi > 60 HU
Mu ng ch im (Sentinel clot):
Khi mu m cao nht # gn v tr XH nht
* Lu ca s hp

Cc du hiu XHTH
3. Nguyn nhn
Mch mu: thng gp nht, 3060% lon sn mch
U: 510%
Trn (15), di (612)
1, vim thc qun
2, gin TM
3, ung th dd
4, lot dd
5, vim dd, t trng
6, vim i trng
7, lon sn mch
8, bnh l mch mu
9, ti tha
10, u i trng
11, lot trc trng

12, tr XH.

 Angiodysplasia

 Lot t trng v u i
trng chu hng

 Chy mu ng mt

THNG RUT
Do lot d dy, vim ti tha, vim, thiu mu rut, chn
thng, u, tc rut
CT:
Vim phc mc
Kh trong bng.
Xc nh v tr thng:
T dch, kh, thm nhim m, dy thnh rut, tng quang phc mc
khu tr
V tr kh t do:
Quanh gan, d dy: thng do thng d dy, t trng
Vng chu : gi thng i trng, rut tha

MPR, ung tng phn (+)

Thng t trng

VIM TI MT

Ti mt cng
Thnh dy >3mm, tng quang
Ri lon ti mu gan khu tr
Du hiu t c hiu:
Dch, thm nhim m quanh ti mt
Tng m dch mt

Bin chng
Hoi t, thng
Vim ti mt sinh hi

VIM TY CP
CT
nh gi giai on
XH, hoi t, lan rng
Nguyn nhn: si mt, u
Bin chng mch mu: gi phnh,
huyt khi
BT n 28% (trng hp nh)
Vim ty vng #1018%
K thut
Khng thuc: si, xut huyt
M, TM: nh gi nhu m, lan rng,
bin chng

V PHNH MC
a s v vo sau phc mc bn (T) trong phc mc
Tam chng: au bng, khi p theo mch, gim HA.
K thut:
Nhiu th:
BN huyt ng n nh
Bm vn tc nhanh, lt ct mng, MPR
BN nng, CT khng cn quang

V PHNH MC
Trc tim:
Thm nhim m quanh MC
Mu quanh MC
Du hnh lim: XH trong huyt khi hay trong thnh MC
Mt lin tc ng vi ni mc
Sau tim
Vng hoi t thnh khng tng quang, m thp
Thot mch cht cn quang

BNH MCH MU GAN- LCH

Huyt khi M, TM gan, lch, ca c th biu hin au bng
cp
Nhi mu:
Vng gim m , khng tng quang hnh chm ngoi vi
Nhi mu gan him do 2 ngun cp mu
Nhi mu lch c th ton b

PROTOCOL CT BNG CP
Khng tim
Si niu qun

Vim ti mt, si OMC

TM

+
qua gan, ty

VRT, ti tha

Tc rut, thng rut*

Thiu mu rut

Xut huyt tiu ha

+
qua ty

Vim ty cp
V phnh MC bng*

mun

Thng qui (khng khu tr)

*Trong cc c th ch chp khng thuc

+/-