儿童结核性腹膜炎的MSCT诊断价值

Value of multi-slice spiral CT in diagnosing tuberculous peritonitis in children

目的分析儿童结核性腹膜炎的多层螺旋CT(MSCT)表现,探讨CT诊断及鉴别诊断价值。方法回顾性分析经临床和/或病理证实的18例儿童结核性腹膜炎(TBP)的MSCT影像表现特点。观察腹膜结构(壁腹膜、大网膜、肠系膜)增厚情况、有无腹腔积液、有无其他系统(腹腔淋巴结、实质脏器或腹外系统)的异常改变。应用宝石能谱成像(GSI)综合分析平台将能谱CT检查获得的影像数据重建出相应的动、静脉期碘(水)基图,进一步分析其能谱曲线特点。结果CT对TBP的检出率为94.4%(17/18)。TBP的CT影像主要表现为壁腹膜光滑均匀增厚(13例)、大网膜污垢样改变(12例)、肠系膜污垢样改变(16例)、腹腔积液(18例)及腹腔淋巴结肿大(15例),且以上多种表现常同时出现。18例TBP均未累及腹部实质脏器;14例伴有肺部改变,5例合并结核性脑膜炎。网膜、淋巴结及肠系膜组织的能谱曲线随着不同能量的衰减趋势基本趋于一致,以增厚网膜的强化程度最高。结论儿童TBP的MSCT表现具有一定特征性,结合临床资料有助于提高病变的诊断准确性。CT能谱曲线可以提供有价值的半定量信息,可作为传统CT检查的补充,为其诊断提供新的方法。

Objective To analyze the MSCT features of tuberculous peritonitis in children and evaluate the value of MSCT in diagnosing and differentiating these lesions.Methods We conducted a retrospective analysis of MSCT imaging features in 18 children with confirmed tuberculous peritonitis confirmed by clinical and/or pathological examination.We observed CT features,including thickening of peritoneal structures(parietal peritoneum,greater omentum,and mesentery),ascites,abnormal chenges in other systems(abdominal lymph nodes,parenchymal organs,or extraabdominal systems).We utilized the gemstone spectral imaging(GSI)comprehensive analysis platform to reconstruct arterial and venous iodine(water)concentration maps from energy spectrum CT examination data and further analyzed energy spectrum curve characteristics.Results The CT detection rate of TBP was 94.4%(17/18).Thickening of the parietal peritoneum(13 cases),thickened omentum with nodularity(12 cases),thickened mesentery with nodularity(16 cases),ascites(18 cases),and abdominal lymph node enlargement(15 cases)were observed,often appearing simultaneously.None of the 18 cases involved abdominal parenchymal organs.Fourteen cases were accompanied by pulmonary changes,and five cases were complicated by tuberculous meningitis.The energy spectrum curves of omentum,lymph nodes,and mesangial tissue tended to be consistent with different energy attenuation trends,with the highest degree of enhancement in thickened omentum.Conclusion Tuberculous peritonitis in children exhibits specific CT appearances.CT examination,when combined with clinical manifestations,enhances diagnostic accuracy for these lesions.The CT energy spectrum curve can provide valuable semiquantitative information,serving as a complement to traditional CT imaging.