MR小肠造影在儿童美克尔憩室合并症诊断中的价值

MR enterography for the diagnosis of symptomatic Meckel diverticulum in pediatric patients

目的探讨MR小肠造影在儿童美克尔憩室（MD）合并症中的诊断价值。方法回顾性分析2014年7月至2015年9月，经我院超声、核素检查或依据临床体征怀疑为有MD合并症的，16例患儿的临床及MR小肠造影（MRE）资料。其中男13例、女3例，临床首发症状为消化道出血、腹痛、呕吐、肠梗阻、肠套叠、发热等。2名高年资医师分析阅片，确定憩室部位、形态、内容物及周围组织结构的变化，并与手术结果进行对比。结果手术病理证实13例为MD，3例为肠重复畸形。16例均经MRE诊断为MD，误诊3例。13例憩室部位：右下腹2例、脐周4例、左下腹4例、中腹部2例、盆腔1例。憩室形态：呈含液含气盲袋样管状结构11例、实性包块2例。憩室壁增厚11例，DWI序列憩室壁扩散受限12例。增强后憩室壁强化程度高于邻近肠壁12例，憩室壁连续性中断1例。憩室腔内出血信号2例，对比剂外溢2例。憩室周边结构异常包括憩室周围脂肪层肿胀、邻近系膜水肿并异常强化、腹水、肠梗阻及肠系膜淋巴结增大。结论MRE诊断儿童MD合并症准确性高，由于其无电离辐射，有望成为该疾病的重要检查方法。

Objective To retrospectively investigate the value of MR enterography（MRE） for detecting symptomatic Meckel diverticulum（MD） in pediatric patients. Methods We retrospectively selected 16 patients from our MR database patients who underwent MRE between June 2014 and September 2015. They were referred for MRE because of suspected MD after negative or inconclusive upper sonography or scintigraphy or for exclusion diagnosis. There were 13 males and 3 females, with a median age of 2.2 years of age ranging from 0.4 to 8.2 years old. The first symptom included unexplained gastrointestinal bleeding, abdominal pain, small-bowel obstruction, intussusception, vomiting and fever. Two experienced radiologists determined the diverticulum＇s location, shape, contents and peripheral structural abnormalities. Results MD were diagnosed by MRE in all children. A total of 13 MD and 3 intestinal duplication cysts were pathologically confirmed. The diverticulum＇s location included： the right lower quadrant in 2 cases, around the navel in 4 cases, the left lower quadrant in 4 cases, the middle quadrant in 2 cases and pelvic cavity in 1 case. The diverticulum＇s presented as a blind-ending fluid-filled or gas-filled structure in 11 cases and a solid-appearing mass in 2 cases. The wall of the diverticulum showed restricted diffusion, increased mural enhancement comparable with that of adjacent small bowel in 12 cases, and interruption of the wall continuity in 1 case. Hemorrhage in diverticulum appeared as hyperintensity on T1WI images and/or hypointensity on T2WI images in 2 cases. Extravasation of intravascular contrast medium into the gastrointestinal tract due to active bleeding from a Meckel diverticulum was detected in 2 cases. Peripheral structural abnormalities included soft-tissue stranding, adjacent mesenteric stranding and enhancement, free fluid, small-bowel obstruction and enlarged lymph nodes. Conclusion MRE may play an important role in the diagnosis of suspected symptomatic Meekel diverticula, particularly given its lack of ionizing radiation.