部分脾动脉栓塞术后继发脾脓肿的CT表现研究

Research of CT feature of secondary splenic abscess after partial spleen artery embolism

目的探讨部分脾动脉栓塞术(PSE)后继发脾脓肿的CT表现,提高诊断与鉴别诊断的临床符合率。方法对16例PSE术后继发脾脓肿的患者进行64排CT检查,采用多平面投影(MPR)、最大密度投影(MIP)、容积再现(VR)、曲面重建(CPR)方式处理,对其影像学特征进行分析。结果本文16例PSE术后继发脾脓肿患者中单发者14例(87.5%),多发者2例(12.5%);病灶分布于脾脏各部,其中6例分布于脾门区,3例分布于周围区,7例分布于全脾范围内。CT平扫所见该组患者病灶密度大部分低于正常脾实质,CT平扫显示密度为均匀或不均匀,平扫15例病灶呈低密度,1例病灶呈等密度;边缘清楚者1例,边缘不清者15例;病变区密度不均13例,积气或(和)气-液平面影形成者11例,病变密度均匀3例。结论 CT可将PSE术后正常的病理生理变化与脾脓肿准确鉴别,术后定期复查CT,可提早发现脾脓肿。

Objective To investigate CT feature of secondary splenic abscess after partial spleen artery embolism（PSE）, and to improve clinical coincidence rate of diagnosis and differential diagnosis. Methods A total of 16 patients with secondary splenic abscess after PSE received 64-slice CT for examination, processed by multiple planar preconstruction（MPR）, maximum intensity projection（MIP）, volume rendering（VR） and curve planar reconstruction（CPR）. Their imaging characteristics were analyzed. Results Among 16 cases with secondary splenic abscess after PSE, 14 cases had single lesion（87.5%） and 2 cases had multiple lesions（12.5%）. Lesions situated various parts of spleen, as 6 cases in hilus lienis, 3 cases in peripheral area and 7 cases with full spleen range. CT plain scan showed lower lesion density than normal spleen parenchyma. CT plain scan also showed uniform or non-uniform density, as 15 cases with low density and 1 case with equidensity; 1 case with clear boundary, 15 cases with unclear boundary; 13 cases with non-uniform lesion density, 11 cases with pneumatosis or（and） gas-liquid level image, and 3 cases with uniform lesion density. Conclusion CT can provide accurate identification of normal pathological and physiological changes and splenic abscess after PSE. Regular postoperative examination can detect splenic abscess early.