腹膜假性黏液瘤的MSCT诊断

MSCT Diagnosis of Pseudomyxoma Peritonei

目的分析腹膜假性黏液瘤(PMP)的多层螺旋CT(MSCT)表现,提高对其影像学认识。资料与方法回顾性分析9例PMP患者的MSCT资料,9例患者中经手术、病理证实者4例,经腹腔积液抽吸活检证实者5例;CT平扫5例,CT平扫+增强扫描4例。结果 9例患者中:(1)病灶延伸至肠管周围9例、膈下7例、腹腔实质脏器周围7例、盆腔7例、小网膜囊4例、双侧结肠旁沟4例、脾周围6例、胰腺周围5例,3例病灶蔓延至肝纵裂,1例病灶经脐向皮下蔓延;(2)病灶呈大小不等的囊状分布4例,囊壁钙化1例,片状分布5例,片状病灶中可见明显分隔4例,病灶CT值约8～37 HU,平均约17 HU,4例增强扫描病例中,病灶及其囊壁、分隔均未见明显强化;(3)肝脏边缘见"扇贝"样或"结节"状压迹者7例,脾边缘见4例,胰腺边缘见2例;(4)腹腔肠管受压向周围分散分布者3例,受压向中央聚拢者2例;(5)CT怀疑阑尾病变者3例;(6)伴有胸腔积液及心包积液者1例,伴有空肠不全梗阻者1例,无腹腔脏器转移病例。结论 PMP的MSCT征象具有一定特点,且MSCT可以明确显示其分布范围,是辅助诊断PMP的重要方法。

Objective To investigate the MSCT characteristics of pseudomyxoma peritonei（PMP）,and to improve the diagnosis.Materials and Methods Nine cases of pseudomyxoma peritonei proved by operation or biopsy were included in this study.Five cases underwent plain CT scanning and 4 cases underwent enhanced scanning.The MSCT findings were retrospectively analyzed.Results The MSCT findings included：（1） The lesions involved the surrounding small bowel in 9 cases,subphrenic space in 7 cases,organ surface in 7 cases,pelvic cavity in 7 cases,omentulum in 4 cases,paracolic sulci in 4 cases,longitudinal fissure of liver in 3 cases,subcutaneous tissue in 1 case;（2） The shape of lesions were cystic form（4 cases） and plate form（5 cases）.Four lesions showed septa.One lesion showed calcifications on the cyst wall.The CT attenuation of lesions were 8-37HU with the average of 17HU.The cyst wall and the septa of lesion showed no enhancment;（3）The lesions located at the edge of liver（7 cases）,spleen（4 cases）,pancreas（2 cases） and compressed the edge of organ with scallop or nodule shape.;（4）The small bowels were compressed to surrounding area in 3 cases,to midline area in 2 cases;（5）Three cases were suspected appendicitis on CT;（6） Complicated with hydrothorax and hydropericardium in 1 case,with the jejunum obstruction in 1 case.No metastasis was occurred.Conclusion MSCT can display the distribution of PMP clearly,and should be an important method in diagnosing pseudomyxoma peritonei.