小肠淋巴管扩张症在直接淋巴管造影及造影后CT平扫中的影像表现

The Imaging Manifestations of Direct lymphangiography and CT Findings after lymphangiography of Intestinal Lymphangiectasia

目的探讨小肠淋巴管扩张症在直接淋巴管造影和造影后CT检查中的影像表现,提高对此病的认识。资料与方法回顾性分析21例临床诊断为小肠淋巴管扩张症患者的临床和影像资料,所有病例均先行直接淋巴管造影后再行腹盆部CT平扫,5例在淋巴管造影前做过CT平扫加增强,3例淋巴管造影、CT平扫后进行了增强扫描,分析所有病例影像学表现。结果直接淋巴管造影显示腹膜后、髂部淋巴管走行迂曲,不同程度扩张,结构紊乱,动态观察向肠系膜反流4例,3例可见对比剂直接进入肠腔内。直接淋巴管造影后行CT平扫,21例均可见向对侧腰干反流,9例向肠干反流。15例患者有节段性肠壁增厚,8例增强扫描,显示5例小肠壁分层强化呈"晕轮征",2例增厚肠壁呈均匀性强化,1例肠壁未见增厚。结论直接淋巴管造影与造影后CT联合检查是诊断小肠淋巴管扩张症的重要方法。

Objective To investigate the imaging manifestations of direct lymphangiography and CT findings after direct lymphangiography in patients with intestinal lymphangiectasia and improve its diagnostic accuracy.Materials and Methods The imaging data of 21 patients with intestinal lymphangiectasia proved by pathology were analyzed retrospectively.All patients received abdominal and pelvic plain CT scan after direct lymphangiography.There were 5 cases accepted both plain and enhanced CT scan before direct lymphangiography,while,3 cases accepted contrast enhanced CT scan after direct lymphangiography and plain CT.All image characteristics were analyzed.Results Direct lymphangiography indicated lymphatic vessles in retroperitoneal and iliac areas tortuousing and dilating,there were 4 cases indicating contrast agent reflexing to mesentery by dynamic observing,as well as 3 cases indicating contrast agent entering intestinal lumen.The main findings of plain CT scan after direct lymphangiography included reflexing to lumbar trunks in 21 cases and to intestinal trunks in 9 cases.15 patients showed intestinal wall thickening segmentally.There were 5 cases indicating ＂halo sign＂in the wall of affected small bowel,2 cases had homogeneous enhancement in the affected intestinal wall,and 1 case showed no thickening in intestinal wall.Conclusion Direct lymphangiography combined with CT scan after direct lymphangiography are important methods for the diagnosis of intestinal lymphangiectasia.