急性肠脂垂炎MSCT诊断与鉴别诊断

Diagnosis and different diagnosis of MSCT in acute epiploic appendagitis

目的:探讨MSCT对急性肠脂垂炎诊断与鉴别诊断的临床价值。方法:对33例因急性腹痛患者进行MSCT设备检查而诊断急性肠脂垂炎的病例及其随访图像进行回顾分析。全部病例均进行CT平扫,其中对比剂增强扫描7例,所有CT图像通过最大密度投影(MIP),平面重组(MPR)影像后处理技术进行三维成像。结果:33例中病灶位于乙状结肠旁29例(位于左下腹25例,右下腹回盲部区域4例),回盲部2例,结肠肝曲2例,伴肾、输尿管结石2例,结肠憩室3例。CT表现为结肠肠壁前方或后方戒指样或环形稍高密度影,19例病灶中央可见点状或条片状高密度影,9例伴有结肠壁轻度增厚,12例合并系膜感染,表现为周围系膜脂肪密度增高及条索影,增强后病灶边缘及中央可有轻度强化。周围系膜淋巴结未见明显肿大。腹腔无积液。25例患者1~53月后CT随访,影像表现为4例病灶无明显变化;19例病灶不同程度缩小,边界变清晰;2例病灶消失,其中1例在原病灶区出现钙化影;影像特征逐渐消失。结论:MSCT对急性肠脂垂炎的诊断及鉴别诊断有较高的临床价值。

Objective:To evaluate the value of MSCT in diagnosis of the acute epiploic appendagitis.Methods:MSCT was performed on 33 patients with clinically acute lower quadrant abdominal pain.MSCT findings were correlated with clinical manifestations and follow up.Results:The lesion abuts the sigmoid colon in 29 cases(25 in the left lower quadrant abdomen,4 in the right lower quadrant abdomen),ileocecal in 2 cases,hepatic flexure of the colon in 2 cases,urolithiasis in 2 cases and colonic diverticulum in 3 cases.All lesions were an oval with attenuation similar to that of fat and with surrounding inflammatory changes,that abuts the anterior colon wall.Enhanced CT scan of lesions show cricoid reinforcement.In 19 cases,dot or strip-like high density were observed in the center of the lesions.Colon wall thickening was present in only 9 cases.There were 12 cases with mesangial infection,which was manifested as increased fat density in the surrounding mesangial area.No significant enlargement of mesocolon lymph nodes in peripheral areas and no ascites.Fllow-up imaging features correlate with clinical improvement.Conclusions:MSCT is useful in diagnosis and different diagnosis and management of acute epiploic appendagitis.