肠道脂肪瘤继发肠套叠的MSCT表现

MSCT Features of Intestinal Lipoma Causing Intussusception

目的分析肠道脂肪瘤继发肠套叠的多层螺旋CT(MSCT)和X线表现,以提高对该病的认识和诊断水平。方法回顾性分析经手术病理证实的7例肠道脂肪瘤继发肠套叠患者的临床及影像学资料。7例均行腹部平片、MSCT平扫及增强扫描,其中2例行胃肠道造影检查。结果肿瘤位于空肠3例;结肠4例,其中乙状结肠3例,肝曲1例。MSCT均显示肠套叠及其顶端的肿瘤,套叠长度8～69 cm(平均31.43 cm);肿瘤长径2.74～9.89cm(平均5.81 cm),6例呈卵圆形或圆形,1例呈分叶状;肿瘤CT值为-43～-93 HU(平均-73.14 HU),4例呈均匀脂肪密度,3例密度不均,增强扫描均无强化。腹部平片4例显示不全性肠梗阻,3例无阳性发现。2例胃肠道造影均发现肠套叠及其顶端的充盈缺损。结论肠道脂肪瘤继发肠套叠的CT表现具有一定特征性,MSCT曲面重组(curved planar reformation,CPR)可充分展现肠套叠及其顶端肿瘤的全貌,有助于临床制定合理的治疗方案。

Objective To analyze the multislice spiral CT （MSCT） and conventional radiographic findings of intestinal lipoma causing intussusception, in order to improve the diagnosis. Methods Clinical and imaging pathologic data of 7 patients with operation and pathology proved intestinal lipoma with intussusception were analyzed retrospectively. The patients included 3 males and 4 females, aged from 38 to 64 years, mean age of 54 years. All the patients underwent abdominal ra- diograph, MSCT plain scan and contrast medium enhancement scan, in which 2 cases underwent Gastrointestinal （GI） contrast examination. Results The location of the 7 tumors included the jejunum in 3 cases, the sigmoid colon in 3 cases （43%） and the hepatic flexure in 1 case. Abdominal MSCT revealed all 7 fat density tumors as the lead point at the invaginated bowel segments. The length of intussusceptions ranged from 8 to 69 cm （mean, 31.43 cm）. The tumors ranged from 2.74 to 9.89 cm in long dimension （mean, 5.81 cm）. 6 tumors were ovoid or spherical shape, whereas 1 tumors had a lobulated contour. The CT values of tumors ranged from -43 - -93 HU （mean, -73.14 HU） with no enhancement, 4 tumors present as homogeneous fatty density and 3 tumors were inhomogeneous. On abdominal radiographs, 4 cases showed incomplete bowel obstruction, 3 cases were negative. The two patients appeared a filling defect at the end of the invaginated bowel segments on GI images. Conclusion CT findings of intestinal hpoma with intussusception have some characteristics. MSCT curved planar reformation can reveal the overall perspective of the tumor and secondary intussusception, which be useful to make an appropriate clinical treatment planning.