硬化性肠系膜炎的CT和MRI诊断

目的探讨硬化性肠系膜炎的CT和MRI表现特征。方法回顾性分析6例经病理证实的硬化性肠系膜炎的CT和MRI表现。结果 6例硬化性肠系膜炎均起自肠系膜根部,包绕肠系膜血管。CT表现为肠系膜根部密度增高,边缘模糊,CT值-10～20HU,明显高于腹膜后脂肪组织密度(-120～-100HU)。MRI表现为不均匀长T1、长T2信号。增强呈轻度延迟期强化,肠系膜血管无浸润。结论硬化性肠系膜炎具有一定的CT和MRI表现特征,确诊需依赖病理。     

硬化性肠系膜炎CT诊断价值

目的探讨硬化性肠系膜炎CT诊断价值。方法回顾性分析8例经临床确诊硬化性肠系膜炎患者临床资料及CT图像,评价CT诊断价值。结果 1)临床资料:回顾性分析2000例住院患者腹部CT,发现8例硬化性肠系膜炎(8/2000=0.4%),发病率为0.4%;男5例(62.5%),女3例(37.5%);年龄:46~68岁,平均年龄(57.8±6.2)岁。5例患者可触及腹部包块(5/8=62.5%);2)影像资料:CT主要表现为卵圆形脂肪密度病灶,位于结肠的侧方或前方,周围系膜可见炎性渗出环形包绕,呈明显的高密度边缘征象,少数中央可见点状、条状高密度,为栓塞的血管或出血。增强扫描未见明确强化,内可见包绕走行血管影。邻近的肠壁此时可见增厚或受压,周围出现不成比例的脂肪绞缠征。CT平扫时正常腹膜后脂肪组织的CT值为-85~-121(-106±-12.5)HU,硬化性肠系膜炎病变处CT值为-54~-38(-48±-7.6)HU,正常部位脂肪组织明显低于病变部位密度(2=18.67,P0.05)。结论硬化性肠系膜炎具有典型的临床表现及特征性的CT征象,CT为其首选的检查手段,可对该病做出明确诊断。     

肠系膜脂膜炎的多层螺旋CT诊断

目的 探讨多层螺旋CT（MSCT）对肠系膜脂膜炎的诊断价值。方法 回顾性分析9例肠系膜脂膜炎的CT表现与诊断，其中3例经组织病理学证实，其余按照CT标准做出诊断。应用MSCT进行腹部平扫和双期增强扫描，并采用1．25mm层厚和1mm重组间隔获得最大密度投影（MIP）和多平面重组（MPR）图像，评价肠系膜、邻近肠管及血管改变。结果 所有肠系膜脂膜炎均起自系膜根部，围绕系膜血管，2例见血管远端明显变细。6例病变可见假包膜征。肠系膜脂膜炎CT值平扫为-47-36HU，增强后动脉期为-41-39HU，门脉期为-41-45HU，差异无统计学意义（P值均〉0．05），平扫时肠系膜脂膜炎密度明显高于腹膜后正常脂肪密度（-91--115HU），差异有统计学意义（P〈0．01）。5例肠系膜脂膜炎病变内可见界限清楚的小结节，增强明显。结论 多层螺旋CT是诊断肠系膜脂膜炎非常有用的影像手段。     

腹部局限性透明血管型Castleman病的MDCT表现

目的 探讨腹部局限性透明血管型Castleman病(HV-CD)的MDCT特征性表现.方法 回顾性分析经手术病理证实的11例腹部HV-CD患者术前CT平扫及动态增强资料.结果 11例中,9例病变位于腹膜后,2例位于肠系膜.CT平扫:11例均呈软组织密度肿块,平扫CT值为(46±4) HU,部分肿块内部可见斑片样、放射状低密度影及斑点样、树枝样钙化灶.2例局部边界不清.5例周围可见增大的淋巴结.4例周围腹膜局限性增厚.动态增强扫描:9例动脉期、门静脉期明显强化,CT值平均增加(80±14) HU,强化程度接近大动脉,延迟期强化程度退出;2例呈中度强化,且延迟期为著;1例动脉期边缘强化明显;病变内低密度区未强化;11例病变周围均可见供血及引流血管.结论 腹部HV-CD的MDCT表现有一定的特征性,尤其是病变内的钙化及强化程度具有诊断价值.     

继发性非结核性肠系膜炎螺旋CT表现

目的探讨小肠系膜、横结肠系膜和乙状结肠系膜继发性非结核性炎症的螺旋CT表现。资料与方法回顾性分析32例经病理和/或腹腔穿刺/临床实验室检查证实的继发性非结核性肠系膜炎患者的CT资料,着重观察肠系膜炎性改变的CT表现特征。结果肠系膜脂肪密度增高32例(100%,32/32),条索影9例(28.1%,9/32),结节影2例(6.1%,2/32),系膜血管增粗29例(90.6%,29/32),系膜淋巴结增大5例(15.6%,5/32),其短径均<1 cm。结论继发性非结核性肠系膜炎CT表现有系膜脂肪密度增高、条索影、结节影、系膜血管增粗以及系膜淋巴结增大。继发性非结核性肠系膜炎多见于邻近有炎性病灶的病例。     

肠系膜脂膜炎MSCT影像特征分析

目的分析肠系膜脂膜炎(MP)MSCT的表现特征,提高对其诊断的正确率。方法回顾性分析49例MP的MSCT表现特点,按照CT标准并结合临床做出诊断。CT平扫34例,平扫加双期增强扫描15例,并采用1.25mm层厚和1mm重建间隔获得最大密度投影(MIP)和多平面重建(MPR)图像。结果 49例病变均位于小肠系膜,包绕肠系膜血管;炎症渗出型47例,CT平扫均呈不均匀脂肪密度,CT值-74～-23HU,明显高于腹膜后正常脂肪密度(-116～-92HU),其中13例增强扫描,病灶无明显强化;脂肪坏死型和纤维化型各1例,表现为脂肪包块内出现肿块,前者为囊性肿块,后者为软组织肿块,增强扫描软组织肿块中度强化,静脉期CT值上升约40HU。49例中,出现"假包膜征"32例,"脂环征"36例,"小结节"21例,肠系膜血管狭窄2例。结论 MP的MSCT表现具有特征性,是MP非常有价值的诊断手段。     

空肠炎症性纤维性息肉1例

患者 女,69岁.2月前出现腹痛伴排便不畅.实验室检查:大便潜血(+),轻度贫血,CEA(-).CT示:盆腔左侧空肠远段见一半球形软组织密度肿块突向肠腔,基底宽,密度不均,大小约2.4 cm×2.2 cm×1.8 cm,增强后动脉期轻度不均匀强化,静脉期及延迟期呈缓慢渐进性富血供强化,且密度趋向均匀(各期CT值分别约为30、40、60 HU及80 HU)(图1~4);多平面重建示肿块表面可见明显强化的完整黏膜线,且浆膜面光滑,周围脂肪间隙清晰(图5,6),肿块旁肠壁内见斑片状液体密度影,小肠系膜区可见多枚长卵圆形均匀强化的肿大淋巴结(图5).     

多层螺旋CT检查肠系膜脂膜炎的临床价值分析

目的探讨多层螺旋CT在诊断肠系膜脂膜炎中的应用价值。方法对45例肠系膜脂膜炎患者的临床表现及影像学资料进行了分析,评价肠系膜病变组织及与邻近腹膜后正常脂肪组织的CT值差异情况。结果 45例肠系膜脂膜炎均累及小肠系膜,直达小肠肠袢,表现为小肠系膜的云雾状密度增高影,且与周围正常腹腔和腹膜后脂肪有较清楚的界限,平扫CT值-40HU~-70HU;32例可见类似肿瘤的"假包膜征"形成。26例可见"脂肪环征"(fat ring sign),其中10例可见钙化。23例脂膜炎病变内小结节,边界清晰,且可见淋巴结门影,其内密度均匀,增强示明显强。肠系膜病变部位的CT值(-60.32±15.23)HU与腹膜后正常脂肪组织(-102.35±7.78)HU相比存在显著差异。结论多层螺旋CT诊断肠系膜脂膜炎具有一定特征,可对病变大小、范围及血管受累情况等进行评估。     

原发性肺上皮-肌上皮癌CT表现一例

本文报道了1例原发性肺上皮-肌上皮癌,患者女,51岁,以无明显诱因腰痛为主要临床表现。CT检查显示右肺下叶近内基底段类圆形软组织密度影,密度均匀,边界清,有轻度分叶,大小2.8 cm×2.2 cm×2.5 cm,相邻支气管及血管受压,平扫CT值为34 HU;增强扫描病灶明显强化,动脉期可见多发不规则血管影,动脉期CT值为67 HU,静脉期为99 HU,相邻血管可见贴边征,纵隔及肺门未见肿大淋巴结影。病理诊断:原发性肺上皮-肌上皮癌。     

硬化性肠系膜炎MSCT误诊原因分析

目的 总结临床和CT误诊的硬化性肠系膜炎(SM)患者的MSCT征象及鉴别诊断要点,减少其误诊率.方法 回顾性分析23例临床与CT均误诊的SM患者的临床及MSCT资料,分析SM误诊为其他疾病的种类、原因与鉴别征象.结果 SM主要被误诊为肿瘤、感染性炎症等,误诊的主要原因和鉴别诊断征象为:(1)无特异性临床症状与体征;(2)肠系膜呈雾状密度增高,但与周围正常脂肪分界清楚可与感染性炎症鉴别;(3)"肿块状假囊征"具有把周围结构推移的"占位效应",但血管常包绕其内,且血管或结节周围的"脂肪环征"可与含脂肪性肿瘤鉴别;(4)肠系膜根部形成软组织肿块,但肿块内可见"脂肪环征"及轻度强化可与淋巴瘤与类癌鉴别.结论 SM临床与影像均易误诊,认识和识别MSCT鉴别诊断征象能减少对该病的误诊.     

MR findings in a rare case of sclerosing mesenteritis of the mesocolon

Sclerosing mesenteritis is a rare, usually benign disorder of the mesentery. Depending on the predominant tissue component (inflammation, fat, or fibrosis), it is known as mesenteric panniculitis or retractile mesenteritis. We present a rare case of retractile mesenteritis of the mesocolon as a cause of severe abdominal pain. US, CT, and MRI were the imaging modalities used. We emphasize the MR finding of a fibrous capsula in retractile mesenteritis, as this is to our knowledge the first study to describe this entity. This finding may be valuable for establishing a diagnosis of sclerosing mesenteritis, as well as for differentiating this disease from other mesenteric diseases.     

MRI and colour-Doppler in sclerosing mesenteritis

We present a case of sclerosing mesenteritis with fibrofatty thickening of the mesentery. Ultrasonography showed an echodense mesenteric mass and colour-Doppler displayed patent mesenteric vessels with high vascular resistance. On CT, low-density areas suggesting fatty infiltration were seen in the mesentery. MRI showed low-signal areas suggesting a fibrous component of the mesenteric mass and GRASS imaging confirmed normal patency of the mesenteric vessels. Correspondence to: M. F. Bellin     

CT and MR features of sclerosing mesenteritis mimicking a mesenteric metastasis from the carcinoid tumor

Sclerosing mesenteritis is a rare and benign inflammatory entity characterized by fibrofatty thickening of the mesentery. To our knowledge, there are only a few reports on the features of sclerosing mesenteritis on magnetic resonance (MR) imaging and computed tomography (CT). In this present case, MR imaging demonstrated tissue characterization of fibrosis, and partial maximum intensity projection (MIP) and three-dimensional angiography images obtained using multislice CT clearly revealed the extent of the tumor and the vascular appearance affected by the mass. However, a mesenteric metastasis from the carcinoid tumor may show such imaging features. Therefore, when encountering such a case, we suggest that a tentative diagnosis of sclerosing mesenteritis be made, followed by a biopsy for intraoperative histopathologic analysis to avoid aggressive surgery.     

Sclerosing mesenteritis

Sclerosing mesenteritis is a rare benign process involving mesenteric fat that has non-specific histology and imaging characteristics, which are critical to the diagnosis. It has two different pathological variants: mesenteric panniculitis (acute or subacute) and retractile mesenteritis (chronic). This case study illustrates the radiological findings of sclerosing mesenteritis, describes certain signs that suggest the diagnosis and reviews recent published literature.     

Misty mesentery: a pictorial review of multidetector-row CT findings

The term "misty mesentery" indicates a pathological increase in mesenteric fat attenuation at computed tomography (CT). It is frequently observed on multidetector CT (MDCT) scans performed during daily clinical practice and may be caused by various pathological conditions, including oedema, inflammation, haemorrhage, neoplastic infiltration or sclerosing mesenteritis. In patients suffering from acute abdominal disease, misty mesentery may be considered a feature of the underlying disease. Otherwise, it may represent an incidental finding on MDCT performed for other reasons. This article describes the MDCT features of misty mesentery in different diseases in order to provide a rational approach to the differential diagnosis.     

Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions.

Multi-detector row computed tomography (CT) offers important advantages over more conventional imaging methods in the evaluation of the mesenteric vasculature. It allows faster scanning, which practically eliminates motion and breathing artifacts, as well as thinner collimation. These advances, coupled with rapid intravenous administration of contrast material, allow excellent opacification of the mesenteric arteries and veins. This improves the quality of the three-dimensional (3D) data sets, which in turn leads to improved 3D vascular maps and more accurate assessment of various conditions such as arterial or venous encasement in patients with pancreatic cancer, mesenteric ischemia, or inflammatory bowel disease. Three-dimensional multi-detector row CT also allows better visualization of arterial and venous branching, thereby improving detection of more distal vascular involvement. In addition, 3D multi-detector row CT may help detect hemodynamic changes in patients with active inflammation and hyperemia of a bowel segment because it can be used to measure bowel wall enhancement over time. Carcinoid tumors that have infiltrated the mesentery have a characteristic CT appearance, and other conditions such as lymphoma or sclerosing mesenteritis can also manifest as an infiltrating mass that envelops mesenteric vessels. Three-dimensional multi-detector row CT represents a significant advance in CT technology and can help ensure prompt, accurate evaluation of the mesenteric vasculature.     

肺硬化性血管瘤的CT诊断价值

目的：探讨CT对肺硬化性血管瘤（PSH）的诊断价值。方法：回顾性分析12例经手术病理证实的PSH的CT表现,4例行CT平扫和增强扫描,8例仅行CT平扫。结果：12例病灶呈圆形或类圆形,8例密度均匀（8/12,66.7%）,边缘光滑,其中2例出现轻度分叶（2/12,16.7%）;4例密度欠均匀（4/12,33.3%）,边缘可见点状钙化,其中2例可见＂空气新月征＂（2/12,16.7%）。12例平扫平均密度值约50HU,4例增强扫描均显著强化,密度值达90～110HU。结论：CT在一定程度上有助于PSH的诊断,但该病确诊仍依赖病理学检查。     

The CT appearances of sclerosing mesenteritis and associated diseases

Sclerosing mesenteritis is characterized by non-specific inflammation of the mesenteric fat associated with variable amount of fibrosis. The aetiology is unclear; the pathogenesis is obscure, and even its nomenclature remains variable. It is a rare condition with imaging features that can be mistaken either for a mesenteric neoplasm or for a wide variety of non-neoplastic inflammatory conditions. Knowledge of the imaging features of this condition may prevent unwarranted aggressive therapy. This review discusses the pathogenesis, clinical manifestations of this condition, as well as illustrating the characteristic computed tomography (CT) features of sclerosing mesenteritis. A rational approach to the differential diagnosis is discussed.