肠系膜脂膜炎的多层螺旋CT诊断

Multislice helical CT findings of mesenteric panniculitis

目的探讨多层螺旋CT(MSCT)对肠系膜脂膜炎的诊断价值。方法回顾性分析9例肠系膜脂膜炎的CT表现与诊断,其中3例经组织病理学证实,其余按照CT标准做出诊断。应用MSCT进行腹部平扫和双期增强扫描,并采用1.25 mm层厚和1 mm重组间隔获得最大密度投影(M IP)和多平面重组(MPR)图像,评价肠系膜、邻近肠管及血管改变。结果所有肠系膜脂膜炎均起自系膜根部,围绕系膜血管,2例见血管远端明显变细。6例病变可见假包膜征。肠系膜脂膜炎CT值平扫为-47~36 HU,增强后动脉期为-41~39 HU,门脉期为-41~45 HU,差异无统计学意义(P值均>0.05),平扫时肠系膜脂膜炎密度明显高于腹膜后正常脂肪密度(-91^-115 HU),差异有统计学意义(P<0.01)。5例肠系膜脂膜炎病变内可见界限清楚的小结节,增强明显。结论多层螺旋CT是诊断肠系膜脂膜炎非常有用的影像手段。

Objective To evaluate the multisliee helical CT （MSCT） manifestations of mesenteric panniculitis. Methods Nine patients with mesenteric panniculitis, which were diagnosed according to the CT criteria （3 cases had histopathologic results）, were analyzed retrospectively in this study. Biphaseenhanced abdominal CT examination was performed with LightSpeed Plus or LightSpeed 16 canners. Maximum intensity projection （MIP） and multiplanar reformation （MPR） were generated by using 1.25 mm thickness and 1 mm reconstruction interval on Light Speed 16 scanner and to assess the changes of mesentery, jejunal loops and mesenteric vessels. Results Well-encapsulated fatty mass of mesentery were found to extend from mesenteric root to the jejunum in all patients with mesenteric panniculitis. Distal portion of superior mesenteric vessels were narrowed in 2 cases. The CT values of mesenteric panniculitis were -41 -36 HU on plain CT scan, -41 -39 HU on arterial phase and -41 -45 HU on portal venous phase after contrast injection . There was no difference on CT values of mesenteric panniculitis before and after enhancement （P 〉 0. 05 ） and CT values of mesenteric panniculitis on unenhanced scan were significantly higher than those of the same patients＇ retroperitoneal fat （ - 91 - - 115 HU ） （ P 〈 0. 01 ）. Well-defined nodules with soft-tissue density within mesenteric panniculitis were revealed and had obvious enhancement after contrast administration in 5 cases. Conclusion Multislice helical CT is very useful for the diagnosis of mesenteric panniculitis.