56例结核性腹膜炎患者CT影像分析

目的 探讨结核性腹膜炎（TBP）特征性CT影像表现及治疗中影像动态变化的特点。方法 回顾性分析56例临床及病理确诊的TBP患者，观察分析CT影像特征，包括腹腔积液、腹膜（壁腹膜、肝包膜、大网膜及肠系膜）及腹腔淋巴结。56例均行CT平扫+增强扫描。治疗过程中收集动态复查CT影像。结果 腹腔积液45例，大量1例，中少量44例，限制性38例，CT值>20 HU者34例。壁腹膜增厚46例，肝脏边缘部腹膜均有受累，均匀增厚17例，扁丘状凸起或腹膜结核瘤29例，增强扫描结核瘤边缘强化，肝包膜或肝脏受累15例；网膜增厚35例，结节及斑片34例，网膜饼1例，增强扫描网膜饼呈轻度不均匀强化；肠系膜增厚41例，表现为斑片、结节及线状、星芒状条索状高密度影，与肠袢粘连，增强扫描肠系膜血管包埋其内，走形扭曲。腹腔及腹膜后淋巴结增大19例，伴钙化5例，簇集状排列，增强扫描环状或蜂窝状强化。17例完整的动态CT图像，腹腔积液吸收最快，网膜及肠系膜病变吸收稍慢，腹膜结核瘤缩小速度最慢。结论 TBP的CT诊断为多种征象的综合，中少量腹腔积液伴壁腹膜、网膜及肠系膜的增厚粘连是最为常见的影像表现；CT影像动态变化对临床评价疗效具有重要意义。

Analysis on CT imaging features in 56 cases with tuberculous peritonitis

Objective To investigate the CT imaging features of tuberculous peritonitis and dynamic changes.Methods We retrospectively analyzed the CT imaging findings of 56 cases who confirmed by pathology,clinical and laboratory findings including ascites,peritoneal involvement(parietal peritoneum,omentum and mesentery),and lymphadenopathy.All of 56 patients underwent CT plain and enhanced scan collecting dynamic CT images during the treatment.Results Forty-five cases presented with ascites including 1 case with large,44 cases with medium and small amount,38 with encapsulated effusion,which CT values was greater than 20 HU in 34 cases.Parietal peritoneum was thickened in 46 cases including uniform thickness in 17 cases,flat mound-like bulge or peritoneal tuberculosis tumor in 29 cases with peripheral enhancement,liver capsule or liver involved in 15 cases.Omentum thickening was seen in 35 cases,including nodular thickening in 34 and omental cake in 1 which presented with mild heterogeneousness on enhanced scan.Mesenteric thickening was seen in 41 cases expressing as nodules and linear,stellate-shaped high density,and intestinal loop adhesions.There were lymph node enlargement in 19 cases,calcification in 5 cases.The lymph nodes showed the appearance of a low attenuation center with ring contrast enhancement and honeycomb enhancement.Seventeen cases of complete dynamic CT images showed that peritoneal fluid absorption was fastest,followed by slower absorption of omentum and mesentery disease,peritoneal tuberculosis tumor shrunk slowest.Conclusion The CT diagnosis of tuberculous peritonitis is a comprehensive variety of signs,a small amount of ascites with peritoneal,omental and mesenteric thickening and adhesion is the most common imaging findings.Dynamic CT images in clinical can evaluate the efficacy.