腹部CT扫描对脐尿管占位性病变的诊断与鉴别

Diagnosis and differentiation of urachal space-occupying lesions with abdominal CT scans

目的评价腹部CT扫描对脐尿管占位性病变(USOL)的诊断与鉴别能力。方法 21例由手术病理证实的USOL患者,包括13例脐尿管囊肿(UC),6例脐尿管腺癌(UAC),1例脐尿管窦道(USP)以及1例脐尿管憩室(UD)均经腹部CT平扫与增强扫描。对USOL的部位、大小、形态、性质、Retzius间隙变化及强化型式逐例进行了回顾性分析。结果 21例患者的USOL均位于膀胱尖部中线部位。13例UC包括8例单纯性囊肿和5例合并感染。前者表现为囊壁薄,囊内容物CT值接近于水,后者表现为囊内容物CT值较高,且Retzius间隙内可见絮状密度增高影。6例UAC均表现为实性或囊实性肿块影,增强后呈不均匀强化。1例USP表现为腹膜前方条索状影开口于腹壁外。1例UD呈脐水平囊性肿物,憩室与膀胱交通,膀胱壁可见钙化。结论 USOL并不常见,CT是其赖以诊断与鉴别的主要方法之一,熟悉其影像特征并结合临床表现,术前确诊并不困难。

Objective To evaluate the capability of abdominal CT scans in diagnosing and differentiating urachal space-occupying lesions（USOLs）.Methods Twenty-one patients with USOLs including 13 urachal cysts（UC）,6 urachal adenocarcinomas（UAC）,1 urachal sinus-path（USP） and 1 urachal diverticulum（UD） underwent precontrast and postcontrast CT scans of the abdomen.The CT findings of location,size,shape,nature,Retzius space change and enhanced patterns were retrospectively analyzed.All the cases were confirmed by surgery and pathology.Results USOLs of 21 patients all located in midline part of urinary bladder top.Among 13 UC patients,simple cyst and associated infection cyst were found in 8 and 5 cases,respectively,the former appeared as thin cystic wall and intracystic liquid CT value was approaching to water,while the latter appeared as intracystic higher CT value and floccular hyperdense shadows in Retzius space.Six UAC appeared as solid or cystic-solid mass shadows and nonhomogeneous enhancement on enhanced images.One USP appeared as stripe shadow of peritoneal anteriority opened outside abdominal wall.One UD appeared as cystic mass shadow on umbilicus level and communicated with urinary bladder,whose wall calcification could be found.Conclusion USOLs are not frequent.CT is one of main modalities to diagnose and differentiate these diseases.If understanding their CT features and combining with clinical manifestations,the preoperative correct diagnosis is not difficult.