急性原发性肠脂垂炎的MSCT特征及临床诊断价值

Features and Clinical Diagnostic Value of MSCT in Acute Primary Epiploic Appendagitis

目的分析急性原发性肠脂垂炎(APEA)的多层螺旋CT(MSCT)影像特征,探讨其临床诊断价值。方法回顾分析我院12例经MSCT检查和随访诊断为APEA患者的完整的临床和影像学资料,观察病灶的发病部位、形态、密度、大小、周围脂肪组织、邻近腹膜及肠壁等改变。结果12例APEA中,病灶位于乙状结肠旁4例,降结肠旁4例,升结肠旁1例,结肠脾曲1例;所有病灶均为单发,6例呈圆形或卵圆形,4例呈梭形,2例呈戒指样改变;病灶均呈中心密度较低、边缘密度较高的脂性密度,8例病灶中心呈点状、线样或圆形稍高密度影的“中心点征”,12例均呈边缘环形稍高密度;病灶直径约1.8cm~3.6cm;12例周围脂肪间隙模糊,可见絮片状稍高密度渗出影;6例病灶可见邻近腹膜增厚,仅2例病灶相邻结肠壁增厚,1例增强病灶边缘呈环形强化。结论APEA的MSCT影像学表现具有一定特征性(圆形、卵圆形、梭形或戒指样脂肪密度团块,“中心点征”及边缘环形稍高密度伴或不伴周围炎性渗出改变),联合多平面重建能准确诊断APEA并能清楚显示邻近腹膜及肠壁情况,为临床诊断提供重要价值。

Objective To analyze the MSCT imaging features in patients with acute primary epiploic appendagitis(APEA)and to explore the clinical diagnostic value.Methods The complete clinical and imaging data of 12 patients diagnosed with APEA by MSCT and follow-up in our hospital were analyzed retrospectively.The lesion site,shape,density,size,peripheral adipose tissue,adjacent peritoneum and intestinal wall changes were observed.Results In 12 cases of APEA,4 cases were located beside the sigmoid colon,4 cases were beside the descending colon,1 case was beside the ascending colon,1 case was beside the splenic curve.All lesions were single,6 cases showed round or oval,4 cases showed fusiform shape and 2 cases showed ring-like shape.All the lesions showed fatty density,the central density was lower,while the limbic density was higher,8 cases showed“central point sign”with point,linear or circular slightly high-density shadow at the center of the lesions,the edge of 12 cases showed a ring-shaped slightly high-density shadow.The diameters of the lesion were about 1.8 cm~3.6 cm.In 12 cases,the peripheral fat space was blurred,there were floc patches and slightly high-density exudation shadow.6 cases showed thickening of the adjacent peritoneum and only 2 cases showed thickening of the adjacent colon wall,the edge of the lesion showed annular enhancement in 1 case.Conclusion The MSCT imaging findings of APEA have certain characteristics(round,oval,fusiform or ring-like fat density mass,“center point sign”and marginal ring slightly high-density with or without inflammatory exudation changes).Combining the multiplanar reconstruction(MPR),APEA can be accurately diagnosed and can clearly show the conditions of adjacent peritoneum and intestinal wall,providing important value for clinical diagnosis.