多模态磁共振成像对回盲部肿块样病变的鉴别诊断价值

Multimodality MRI in differential diagnosis of mass-like lesions in the ileocecal region

目的探讨磁共振成像对回盲部常见肿块样病变的鉴别诊断价值。材料与方法回顾性分析我院经病理证实的64例回盲部常见肿块样病变患者的MRI资料,采用盲法分析病变的形态学特征、扩散加权成像(diffusion weighted imaging,DWI)及血供特点,比较回盲部慢性炎症、结核、肠癌及淋巴瘤4种病变的MRI信号差异。结果研究纳入慢性炎症25例,肠结核12例,肠腺癌21例,淋巴瘤6例。4种病变形态学表现、DWI及血供特点如下:(1)淋巴瘤组肠壁厚度高于慢性炎症组、结核组及肠腺癌组(P<0.05),腺癌组与慢性炎症组比较差异有统计学意义(P<0.05),腺癌组与结核组比较差异无统计学意义(P>0.05)。良性病变容易出现黏膜线样强化及同心环征(P<0.05)。(2)4种病变肠管表观扩散系数值依次减低,仅肠结核组与肠腺癌组内比较差异无统计学意义(P>0.05),其余4种病变两两比较差异均有统计学意义(P<0.05)。结论多模态MRI对回盲部肿块样病变的鉴别诊断有一定价值,可以作为CT不典型病变的重要补充手段。

Objective:To discuss the differential diagnosis value of MRI on common mass-like lesions in ileocecal region.Materials and Methods:MRI data of 64 consecutive patients with mass-like lesions in the ileocecal region confirmed by pathology were included in this retrospective study.The morphological features,DWI and blood supply were analyzed by blinded method.The differences between chronic inflammation,tuberculosis,cancer and lymphoma were compared.Results:The study included 25 cases of chronic inflammation,12 cases of intestinal tuberculosis,21 cases of intestinal adenocarcinoma and 6 cases of lymphoma.The morphological features,DWI and blood supply have some characteristics:(1)The intestinal wall thickness of lymphoma was higher than that of chronic inflammation,tuberculosis and adenocarcinoma group(P<0.05),there was difference between adenocarcinoma and chronic inflammation group(P<0.05),but no difference between adenocarcinoma and tuberculous group(P>0.05).Benign lesions were prone to mucosal linear enhancement and concentric ring sign(P<0.05).(2)The ADC value of chronic inflammation,tuberculosis,cancer and lymphoma decreased in turn,these four kinds of lesions were statistically different in group comparisons(P<0.05),except intestinal tuberculosis vs adenocarcinoma(P>0.05).Conclusions:The combination of multiple sequences of MRI had some value in differential diagnosis of mass-like lesions in the ileocecal region,and it can be used as an important complement to CT-atypical lesions.