多层螺旋CT对非肿瘤性肠壁增厚的应用价值

Value of Mult-Slice Spiral CT for Nontumorous Bowel Wall Thickening

目的探讨由非肿瘤性疾病引起的肠壁增厚的多层螺旋CT(MSCT)的表现及其诊断价值。方法回顾分析284例经手术、内镜取活检或临床证实的非肿瘤性肠壁增厚患者的CT资料,重点观察肠壁增厚的部位、范围、增厚方式、程度、密度、强化方式以及相关肠外异常。结果在284例患者中,肝硬变109例,急性胰腺炎54例,肠梗阻36例,炎症性肠病14例,缺血性肠病12例,放射性肠炎13例,结核12例,免疫系统疾病10例,感染性肠炎3例,急性阑尾炎3例,低蛋白血症5例,其他少见病8例,正常变异5例;1例高密度,144例等密度,127例低密度,5例脂肪沉积,7例肠壁积气;轻度强化249例,显著强化32例,不强化3例;271例均匀性增厚,13例不均匀性增厚;279例轻度增厚,5例显著增厚;局灶性8例,节段性64例,弥漫性212例;相关肠外异常包括:肠系膜脂肪肿胀218例,腹水189例,淋巴结肿大5例,肠周脓肿2例,肠系膜血管病变25例和实质器官受累169例。结论多层螺旋CT对于诊断由非肿瘤性疾病引起的肠壁增厚具有重要价值。多种非肿瘤性疾病可以引起肠壁增厚,仔细观察肠壁增厚的特征有助于疾病的诊断和鉴别诊断。

Objective To investigate the mult slice spiral CT （MSCT） imaging manifestations of bowel wall thickening due to nontumorous causes, and to address the value of MSCT scanning in assessing nontumorous bowel wall thickening. Methods The MSCT findings of 284 patients with bowel wall thickening due to nontumorous causes confirmed by surgery, biopsy, or clinical follow-up were retrospectively analyzed. The location, range, symmetric or asymmetric, degree, attenuation, presence or absence of enhancement and associated perienteric abnormalities of thickened bowel wall were involved. Results All nontumorous disease caused bowel wall thickening include liver cirrhosis （109 cases）, acute pancreatitis （54 cases）, bowel obstruction （36 cases）, inflammatory bowel disease （14 cases）, isehemic bowel disease （12 cases）, radiation enterocolitis （13 cases）, tuberculosis （12 cases）, immune reaction （10 cases）, infective enteritis （3 cases）, acute appendicitis （3 cases）, hypoproteinemia （5 eases）, non-common disease （8 cases） and normal variants （5 cases）. The attenuation pattern of the thickened bowel wall include high attenuation （1 case）, iso-attenuation （144 cases）, low attenuation （127 cases）, fat deposition （5 cases） and pneumatosis （7 cases）. The enhancement pattern of the thickened bowel wall included gentle enhancement （249 cases）, notable enhancement （32 cases） and unenhancement （3 cases）. Degree of bowel wall thickening included mild thinckening （279 cases） and marked thickening （5 cases）. The range of bowel wall thickening was focal （8 cases）, segmental （64 cases） and diffuse （212 cases）. The associated perienterie abnormalities of thickened bowel wall included swelling of fat （218 cases）, ascites （189 cases）, lymphadenopathy （5 cases）, peirenteirc abscess （2 cases）, mesenterie vascular lesion （25 cases） and involvement of solid abdominal organs （169 cases）. Conclusion MSCT has an invaluable role in the diagnostic evaluation of nontumorous bowel wall thickening. A wide variety of nontumorous diseases may manifest with bowel wall thickening at MSCT. Paying attention to the characteristics of thickening of bowel wall will benefit the diagnosis and differential diagnosis of various intestinal diseases.