结核性与癌性腹腔积液的CT征象比较

CT Features of Tuberculous Ascites and Cancerous Ascites

目的比较结核性与癌性腹腔积液的CT征象,提高两者的CT鉴别诊断水平。方法回顾性分析40例经临床病理证实的结核性腹腔积液(n=19例)和癌性腹腔积液(n=21例)的CT资料。比较两组间腹水量、CT值、腹水分布范围以及其它伴发CT征象(壁腹膜增厚形式及强化方式、大网膜改变、肠系膜改变、腹腔淋巴结改变)等差异性。结果 (1)结核性腹水组少量腹水占84.2%(16/19)、高密度腹水占89.5%(17/19);癌性腹水中大量腹水占71.4%(15/21)。两组间差异具有统计学意义(χ2=12.48,P=0.0004;χ2=32.68,P=0.00000);(2)结核性腹水组壁腹膜光滑均匀增厚且增强后明显强化者占88.9%(16/18),癌性腹水组壁腹膜呈不规则增厚伴轻度强化者占75%(15/20),两组间差异具有统计学意义(χ2=15.64,P=0.00008);(3)结核性腹水组大网膜呈饼样改变者占31.6%(6/19),而癌性腹水组占57.1%(12/21),两组间差异无统计学意义;(4)结核性腹水组肠系膜呈"放射状"改变者占47.4%(9/19),呈小结节改变者占42.1%(8/19)。而癌性腹水组分别为28.6%(6/21)和47.6%(10/21),两组间差异无统计学意义;(5)结核性腹水组腹腔内见增大淋巴结者占36.8%(7/19),癌性腹水组为62.0%(13/21),两组间差异无统计学意义。结论综合分析腹水量、CT值及腹膜增厚等表现,对结核性与癌性腹腔积液的CT鉴别诊断具有一定帮助。

Objective Compare the CT imaging features of tuberculous ascites and cancer- ous ascites are so as to improve the level of their diagnosis and differential diagnosis. Methods The clinical and imaging of 40 cases with tuberculous ascites （n= 19） and cancerous ascites （n=21） were collected and analysed. All cases identified by clinical pathology. The concentration of the observation fell on existence, attenuation and anatomic distribution of ascites; Associated with CT features of the form of peritonea, omentum, mesenterium alteration;Plain and enhanced characteristicy of lymphaden. Result （I）A few amount of ascites （84.2%, 16/19） and high density ascites （89.5%, 17/19） were often present in case of tuberculous ascites, a large amount of ascites （71.4%. 15/21 ） was often present in case of cancerous ascites. （2）Thickened parietal peritoneum with smooth surface （88.9%,16/18） and the thickened parietal peritoneum with nodular surface （ 11,1%, 2/18） was often seen in cases of tuberculous ascites. Visible enhancement in the enhancement of the parietal peritoneum. The thickened parietal peritoneum with nodular surface （75%, 15/20） was often seen in cases of cancerous ascites. Slight enhancement in the enhancement of the parietal peritoneum. （3） Thickened parietal omentum with caked sign （31.6%, 6/I 9） was seen in cases ot＇ tuberculous ascites and （57. 1%, 12/21） was seen in cases of cancerous ascites. （4） Thickened mesentery with intestinal loop adhesiou （47.4%, 9/1 9） and small nodular shadow （42.1%, 8/19） was seen in cases of tuberculous ascites, Thickened mesen- tery with intestinal loop adhesion （28.6%, 6/21 ） and small nodular shadow （47.6%, 10/21 ） was seen in cases of cancerous ascites. （5）Enlargement of lymph nodes in peritoneal cavity （36.8%, 7/19） was seen in cases of tuberculous ascites,including rim enhancement in 2 case （28.6%）, Enlargement of lymph nodes in peritoneal cavity （62.0%, 13/21 ） was seen in cases of cancerous ascites. Conclusion Comprehensive analysis of the amount of ascites, CT values ？？and peritoneal thickening performance of the CT differential diagnosis of tubercu- lous and malignant ascites has certainly help.