Nov metody vyeten tenkho a tlustho steva vod

Nov metody vyeten tenkho a tlustho steva vod

Nov metody vyeten tenkho a tlustho steva vod vod retrogrdn ileoskopie enteroskopie enterln kapsle (WCE) USG pas GIT RTG enteroklza CT enteroklza/enterografie

MR enteroklza/enterografie PET/CT Klasick Klasick RTG RTG metody metody + + USG USG pas GIT - prvn metoda vyeten TK - nzk diagnostick hodnota - dnes: ilezn stavy (pooperan obdob) RTG enteroklza - 70.-90. lta - zlat standard - hodnocen slizninch zmn - invazivn, radian zt - vylouen obstrukce ped WCE USG - zsadn msto ve vyetovacm algoritmu - 1. vyetovac metoda ve zdravotnickm zazen - kontroln vyeten Maglinte DD: Small bowel imaging a rapidly changing field and a challenge to radiology. Eur Radiol 2006 Feb

Modern Modern metody metody Vpoetn tomografie - 1973 prvn CT obstrukn stavy, akutn zntliv komplikace - 1989 helikln a nsledn multidetektorov technologie zsadn pelom v monostech zobrazen GIT - 1998 (4 slice) 2005 (64 slice) Magnetick rezonance - ultrafast sequences rychl akvizice k vylouen pohybovch artefakt hor rozliovac schopnost x soft tissue contrast dynamick studie bez radian zte PET/CT - onkologick indikace

Maglinte DT: Advances in alimentary tract imaging, World J Gastroenterol 2006 May 28 Monosti Monosti perorln perorln ppravy ppravy distenze rozloen bez stimulace peristaltiky dn nebo minimln resorpce ve stev tolerance a aplikovatelnost ve vtm mnostv dostupnost a cena

specifik kritria: CT v souasnosti se preferuj neutrln ped hyperdenznmi MRI magnetick vlastnosti (T1 hypo, T2 hyper) PET/CT bez kompetice s FDG aplikace: NJ sondou per os Pprava ped vyetenm: 8-12 hod. hladovn pln dostauje Rollandi et. al. npl tranku zpomaluje npl TK Maglinte DD: Advances in alimentary tract imaging, World J Gastroenterol 2006 May 28 CT CT enteroklza enteroklza rok rok 1992 1992 NJ sonda pod skiaskopickou kontrolou npl 1500 2500 ml, teplota kontrastnho mdia 37C

- manuln asov a fyzicky nron - injekn pumpa (200 ml/min) reflexn hypotonie izo/hypoosmolrn ltky - 0,5% methylcelulza, PEG - BaSO4, jodov k.l. ptl, absces, low grade obstrukce TK spazmolytikum (20 mg Buscopanu i.v.) tsn ped akvizic dat nejkvalitnj distenze TK nejlep hodnocen stevn stny diagnostika intermitentnch poruch pase invazivita pi zavdn NJ sondy hor tolerance radian zt Schmidt S. et al.: CT enteroclysis: technique and clinical applications, Eur Radiol (2006) CT CT enterografie enterografie pouze pit kontrastnho mdia

1500 2500 ml, 45-60 min ped vy. 500 ml v krtkm ase + zbytek frakcionovan hyperosmolrn roztoky (voda se rychle vstebv) - manitol, sorbitol, laktulza spazmolytikum (20 mg Buscopanu i.v.) krtce ped akvizic snen radian zte

neinvazivn, jednoduch a levn pprava kompromisn een ? metoda prvn volby hor distenze vt objem nebo hyperosmolrn ltka Zhang LH et al.: Multi-detector CT enterography with iso-osmotic mannitol as oral contrast for detecting small bowel disease. World J Gastroenterol. 2005 Apr 21 Kontrastn Kontrastn mdium mdium -- distenze distenze voda ideln prostedek (poivateln, nezvadn, dostupn, levn) vstebvn vody v tenkm stev voda + hydrofiln izoosmolrn ltky ( absorpce vody) - karboxymetylcelulza - LBG (locust bean gum lusk rohovnku) polysacharid

- PEG (polyetyln glykol) - BaSO4 voda + hyperosmolrn ltky ( absorpce + sekrece vody) - manitol - sorbitol voda + makromolekulrn ltka + cukern alkohol - nap. roztok 0,5% LBG + 2,5% manitol Waleed Ajaj et al.: Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension. Eur Radiol.2003 Vliv Vliv osmolarity

osmolarity na na distenzi distenzi osmolarita velmi dleit pro distenzi TK i pes redukci objemu lze zachovat dostatenou distenzi monost regulace osmolarity (manitol 1,5% - 5%...) vy osmolarita zvyuje riziko nedoucch ink Waleed A. et al. Oral contrast agents for small bowel distension in MRI: influence of the osmolarity Eur Radiol. 2005 MR MR enteroklza/enterografie enteroklza/enterografie nov technologie (hardware i software) ultrafast sequences vysok tkov kontrast monost dynamickch a perfznch studi hodnocen aktivity Crohnovy choroby bez radian zte event. pi skiaskopick kontrole Perorln pprava

shodn s CT kvalitn hodnocen lumen, stny i extramurlnch zmn metoda prvn volby u dt, mladch nemocnch a asto kontrolovanch ? nov zlat standard pi dg. Crohnovy choroby Wiarda DM et al.: MR Enteroclysis of inflammatory small-bowel diseases. Am J Roentgenol. 2006 Aug Crohnova Crohnova choroba choroba obecn obecn stna - zeslen - enhancement - stratifikace - fibrotizace mesenterium

hypervaskulariza ce (comb sign) - desmoplzie - lymfadenopatie Crohnova Crohnova choroba choroba minimal changes skip leasions postien recidiva po tranku resekci typick

zmny Komplikace Komplikace absces stenozujc forma pseudotumor fistulizace 5.5. 2006 meziklikov absces 4.6.2006 progrese pvodnho abscesu po 30 dnech konzervativn lby

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