结核性腹膜炎CT表现及病理对照研究

CT and pathological features of tuberculous peritonitis

目的分析结核性腹膜炎CT的影像特征及其病理基础,评价CT在结核性腹膜炎诊断的应用价值,提高对结核性腹膜炎诊断符合率。方法 60例经病理证实结核性腹膜炎病例均使用Toshiba16层螺旋CT扫描,回顾性总结其影像特征。结果结核性腹膜炎的病理解剖特点可以分为渗出型(29例)、粘连型(21例)、干酪型(7例)、混合型(3例),以前两型为多见。渗出型主要表现是腹腔积液,粘连型则腹膜增厚粘连,干酷型为分房状肿块并增强扫描时肿块环形强化,混合型则为上述两种或三种类型的综合表现,所有类型均可伴有以下一至多种征象:不同程度的腹腔积液、肠壁增厚、网膜及肠系膜增厚、肠梗阻、脂肪间隙密度增高等。结论病理分型与CT增强表现是对应的,CT检查对结核性腹膜炎的诊断以及明确病灶范围具有重要的价值。

Objective To determine value of CT for diagnosing tuberculous peritonitis. Methods CT findings of 60 patients with pathologically proven tuberculous peritonitis were analyzed retrospectively. The corresponding pathologic findings were classified as exudative, adherent, caseous, or mixed types. Results The CT showed ascites in the exudative type and peritoneal thickening in the adherent type. Muhilocular rim-enhancing masses were found in the caseous type. The mixed type showed integrated CT findings of two or three types. All four types showed varying degree of ascites, thickening of intestinal wall, mesentery and omentum, intestinal obstruction, and increased peritoneal fat density. Conclusion CT appearance may reflect the pathological characteristics in different stages of tuberculous peritonitis and can lead to a correct diagnosis in most cases.