多层螺旋CT对肠系膜脂膜炎的影像学特征及临床意义

Imaging Features and Clinical Significance of Multi-slice Spiral CT in Mesenteric Panniculitis

目的探究多层螺旋CT对肠系膜脂膜炎的影像学特征及临床意义。方法以2016年4月至2017年5月北京市和平里医院放射科收治的75例疑似肠系膜脂膜炎患者作为研究对象。患者均进行256层螺旋CT平面重建检查确诊,观察患者CT图像,根据其特征判断假肿瘤征、纤维组织结节、淋巴结增大、假包膜征、脂肪环征、囊变、钙化。门诊随访16个月,观察疾病发展情况。结果 75例患者中有55例患者行腹部CT平扫,10例进行CT平扫联合增强扫描,10例进行增强扫描。病变部位均在肠系膜。患者均为假肿瘤征:呈片状或包块影,肠系膜脂肪密度变大,其CT值超过正常腹膜后脂肪组织,未见强化,肠系膜血管被包绕。70例患者病变内出现纤维组织结节、淋巴结增大。患者均为假包膜征:病变周围存在不同厚度软组织密度带,边界清晰。51例患者可见脂肪环征,环状低密度影包绕于肠系膜血管及纤维组织结节、淋巴结周围;出现1例囊变、1例钙化;22例患者周围肠管被推移。随访39例,其中18例患者病变无明显变化,3例病变全吸收,13例病变部分吸收,5例病变进展。CT临床诊断灵敏度100%(5/5),特异性7.1%(5/70)。结论 256层螺旋CT能够准确诊断肠系膜脂膜炎存在假肿瘤征、假包膜征、脂肪环征,可作为首选无创影像学检查。

Objective To investigate the imaging features and clinical significance of Multi-slice spiral CT in mesenteric panniculitis.Methods Seventy-five patients with suspected mesenteric panniculitis admitted to the department of radiology,Beijing Hepingli Hospital from April 2016 to May 2017 were en rolled as subjects.All patients underwent 256-slice spiral CT reconstruction to confirm the diagnosis.According to CT imaging characteristics,the pseudo-tumor signs,fibrous tissue nodules,lymph node enlargement,pseudo-envelope sign,fat ring sign,cystic change,and calcification were judged.The patients were followed up for 16 months to observe the development of the disease in clinic.Results Of the 75 patients,55 patients underwent abdominal CT plain scan,10 underwent CT plain scan combined with enhanced sca n,and 10 underwent enhanced scan.The lesions were in the mesentery.The patients were all pseudo-tumor signs:flaky or mass-blocking shadow,the larger mesenteric fat density,the CT value over the normal retroperitoneal fat tissue,foggy,theunapparent enhancement,and the surrounded mesenteric blood vessels.Fibrous tissue nodules and lymph node enlargement occurred in 70 patients andall patients were pseudo-enveloped:soft tissue density bands in various thickness around the lesion with clear boundaries.In 51 patients,the fat ring sign was seen and the ring-shaped low-density shadow was wrapped around the mesenteric vessels and fibrous tissue nodules and lymph nodes.One case of cystic changes and one case of calcification occurred.In 22 patients,the peripheral intestine was removed.39 patients were followed up,of which 18 patients had no significant changes in lesions,3 lesions were completely absorbed and returned to normal,13 lesions were partially a bsorbed,improved,and 5 lesions progressed.The clinical diagnostic sensitivity of CT was 100%(5/5),and the specificity was 7.1%(5/70).Conclusions 256-slice spiral CT can accurately diagnose the presence of pseudotumor signs,pseudo-envelope signs,and fat ring signs in mesenteric panniculitis,which ca n be used as the first choice of non-invasive imaging test.