螺旋CT对临床少见阑尾疾病的诊断价值

The diagnostic value of 64-slice Spiral CT in uncommon disease of appendix

目的探讨64层螺旋CT对阑尾少见病变的诊断价值。方法分析经病理证实的23例阑尾少见病变的CT特征。结果本组阑尾少见病变有粘液囊肿7例,阑尾纤维化2例,腺癌9例,淋巴瘤3例,类癌1例,透明细胞肉瘤1例。阑尾粘液囊肿在CT上表现为边界清晰的类圆形囊性肿块,壁可伴钙化,合并感染时壁较厚,囊内容物不同密度可有差异,无强化。阑尾纤维化表现为阑尾壁显著增厚,管腔狭窄,周围脂肪层见放射条状影,其中1例伴阑尾腔内结石。阑尾粘液腺癌表现为阑尾较短,增粗,阑尾根部及阑尾壁偏侧结节样增厚并明显强化,其中可见粘液湖,不强化,其中2例伴肝脏多发转移,1例伴腹膜后淋巴结肿大。阑尾淋巴瘤CT表现为阑尾壁多发结节,边缘清楚,大小不一,互相融合成分叶状包块,轻度强化。1例阑尾类癌CT表现为阑尾区囊实性肿块,增强后实性部分轻度强化。1例阑尾透明细胞肉瘤CT表现为分叶状软组织肿块,边界清晰,增强后肿块明显强化,中央坏死区不强化。结论阑尾少见病变误诊率高,采用64层螺旋CT快速增强薄层扫描,利用多平面重组(MPR)及最大密度投影(MIP)技术,重建图像可以充分显示病变的影像学特征、与周围结构的关系以及远处转移病灶,有助于临床正确诊断和选择合理的治疗方案。

Objective To evaluate the diagnostic value of 64-slice Spiral CT in uncommon disease of appendix. Methods Imaging features of 64-slice Spiral CT for 23 patients with pathologically and surgically proved uncommon disease of appendix were retrospectively analyzed. Results Uncommon disease of appendix including 7 mucinous cysts, 2 fibrotic appendixes, 9 adenocarcinomaes, 3 lymphomaes, 1 carcinoid and 1 clear cell sarcoma were involved in our study. All lesions were well visualized on CT transverse plane and MPR, MIP reconstructed images. Mucinous cysts manifested as a round cystic mass with no enhancement, usually with a calcified wall. The density of the fluid varied with the con- tent. The inflamed wall thickened and mild enhanced. The flbrotic appendix represented as a thickened tubular structure, which mimics a mass with radiate stripe on transverse images. Appendicolith was shown in one case. The mucinous carcinoma demonstrated as a cystic solid mass with heterogeneous attenuation or marked asymmetric appendical wall thickening, mild local fatty infiltration, with moderate enhancement. Two cases accompanied by liver metastsis and one case by retroperiloneal lymphadenopathy. One case of lymphoma appeared as multiple nodules within the thickened wall of appendix with mild enhancement. One case of carcinoid showed a cystic-solid mass with moderate enhancement. One case of clear cell sarcoma showed a soft tissue mass with necrosis in the center, the solid component enhanced markedly. Conclusion The image features of uncommon diseases of appendix and its relationships with surrounding structures can be sufficiently demonstrated Using 64-slice Spiral CT enhancing and MPR, MIP techniques, which was valuable for qualitative diagnosis and clinical management.