腹膜后纤维化的CT诊断及误诊分析

CT Diagnosis and Misdiagnosis Analysis of Retroperitoneal Fibrosis

目的:提高临床医师对腹膜后纤维化(retroperitoneal fibrosis, RPF)的认识及术前CT诊断准确率。方法:回顾性分析10例经病理活检证实的RPF的临床及CT影像资料,分析总结RPF的CT误诊原因。结果:(1)CT表现:10例均见腹主动脉周围有团块状软组织密度影包裹,与腹主动脉分界不清;5例累及髂血管,4例侵犯输尿管,6例腹主动脉管壁毛糙、管腔变窄,1例包绕下腔静脉;(2)CT诊断结果:诊断为RPF 4例;诊断为腹主动脉炎1例,输尿管肿瘤1例,腹部包块1例,转移瘤1例,淋巴瘤2例。结论:RPF的CT表现具有一定特征:腹主动脉周围软组织密度影包绕,常累及输尿管、下腔静脉、肾动脉等,增强扫描强化不明显或轻-中度强化。提高对RPF的CT表现认识,对减少误诊非常重要,结合患者症状体征及其他实验室检查对RPF的CT诊断有一定帮助。

Objective:To improve the diagnostic accuracy of preoperative CT examination of retroperitoneal fibrosis.Methods:The CT and clinical data of 10 cases with retroperitoneal fibrosis confirmed by operation and pathology were analyzed retrospectively.Results:(1)CT findings:CT sans showed soft tissue density around the abdominal aorta in 10 cases,and the boundary with the abdominal aorta was unclear.Iliac vessels involvement in 5 cases,inferior vena cava involvement in 4 cases,irregularly thickened abdominal aorta wall,and slightly narrowed lumen in 6 cases.Inferior vena cava involvement in 1 case.(2)CT diagnosis results:4 cases were diagnosed as RPF,1 case were misdiagnosed as abdominal aortitis,1 case was misdiagnosed as Ureteral tumor,1 case was misdiagnosed as abdominal mass,1 case was misdiagnosed Metastasis;2 cases were misdiagnosed as lymphoma.Conclusion:The CT features of retroperitoneal fibrosis were follows:soft tissue density around the abdominal aorta,with unclear boundary;invasion of ureter,with obvious dilation,the enhancement of the lesion was not obvious or slightly-moderately enhanced.Improving the understanding of CT findings along with the help of clinical data and examination results could be helpful for the diagnosis of retroperitoneal fibrosis.