拟诊为进展期卵巢癌的结核性腹膜炎CT征象探讨

Peritoneal tuberculosis mimicking advanced ovarian carcinoma: distinction based on CT findings

目的 探讨结核性腹膜炎的CT征象 ,提高对本病影像学表现的认识及术前诊断的正确性。方法 回顾性分析了 18例拟诊为进展期卵巢癌后 ,经病理证实或抗痨治疗疗效显著的结核性腹膜炎的CT表现。结果 CT扫描显示附件区有囊实性肿物 6例 ,片絮状物 7例 ,肿物的实性部分及片絮状物增强后均有中～明显的强化 ;腹膜轻度增厚、表面光滑 10例 ,不规则增厚 4例 ,片状钙化3例 ,增厚的腹膜强化明显 7例 ;网膜絮状增厚 11例 ,粗网状增厚 2例 ,饼状增厚 2例 ,增厚的网膜边缘模糊 ,有强化 ;肠系膜呈条索、结节状增厚 16例 ;腹水 18例 ,中～大量腹水 ,分布不均 ,其中 14例呈局限性包裹状 ;淋巴结肿大 9例 ,位于心包横膈组 ,8/ 8例增强扫描示淋巴结强化明显 ,≤ 1cm呈均匀强化 ,大者为环形强化。结论 对于结核性腹膜炎与进展期卵巢癌 ,须根据CT表现 ,结合患者病史、临床症状、查体及实验室检查结果 ,方可做出鉴别诊断。

Objective To evaluate the computed tomography (CT) findings of peritoneal tuberculosis mimicking advanced ovarian carcinoma for better understanding of the CT manifestations and accurate preoperative diagnosis. Methods CT findings of 18 cases with tuberculous peritonitis clinically simulating advanced ovarian cancer but pathologically proved otherwise were retrospectively reviewed. Results 1. Masses with solid and cystic structures were found in 6 cases and tumor-like flakes were found in 7 cases in the adnexal regions. The solid components and tumor-like flakes were moderately to markedly enhanced with dynamic CT scanning. 2. The peritoneum was smooth and slightly thickened in 10 cases; irregular thickening was seen in 4 cases, and patches of calcification in 3 cases. Thickened peritoneum with pronounced enhancement was noted in 7 cases. 3. Omentum with flake-like thickening was noted in 11 cases, coarse reticulate thickening in 2 cases and omental cakes in 2 cases. The margin of the thickened omentum with enhancement was ill-defined. 4. Nodular and stripe-like thickening of the mesentery was noted in 16 cases. 5. Ascites was present in all of the 18 cases, being encapsulated in 14 of them. 6. Lymphadenopathy was seen in 9 cases, all at located in the diaphragmatic levels. Enhancement of the lymph nodes was marked in 8 of the 8 patients examined. They appeared as ring-like (>1 cm in diameter) or uniform (≤1 cm in diameter) enhacement. Conclusion CT examination combined with clinical manifestations helps differentiate tuberculous peritonitis from advanced ovarian cancer.