小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.

Abstract：

Objective To investigate the CT manifestations of Meckel's diverticulum and its complications in children. Methods Retrospective analysis of Clinical and CT findings in 25 cases with pathologically proved Meckel's diverticulum. The unenhanced and contrast-enhanced CT were obtained in all patients. Results (1)The direct signs: the diverticulum cannot be shown in 5 cases; the diverticulums were found around the navel or in lower right abdomen in 20 cases. The blind-ending fluid-filled or gas-filled structures were found in 9 cases, with heterogeneous ring-enhancement. The tubercle-like structures were detected in 11 cases, which showed no enhancement in 4 cases, and homogeneous enhancement in 3 cases,and heterogeneous enhancement in 4 cases. (2) The indirect signs included intestine obstruction in 8 cases,swelling fat layer surrounding the diverticulum in 9 cases, free gas around the diverticulum in 3 cases,thickened mesentery in 8 cases, ascites in 4 cases, and intussusception due to inverted Meckel's diverticulum with "target sign" in 1 case. (3) CT classification: with diverticulitis or diverticular bleeding in 20 eases; with intestine obstruction or intussusception in 8 cases; bands-caused obstruction in 7 cases;intussusception in 1 case; with perforation in 3 cases. Conclusion Meckel's diverticulum and its complications have typical CT findings, and CT can clearly demonstrate diverticulum's shape, margin,internal components and surroundiug tissues.     

小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.     

儿童主动脉憩室的CT影像学表现

【摘要】目的：分析和总结儿童主动脉憩室的CT影像学特点。方法：回顾性分析2013年1月－2017年5月本院87例主动脉憩室患儿的CT资料,所有患者均行多层CT检查,其中26例进行了手术治疗。结果：87例中Kommerell憩室47例（连接处狭窄26例）,导管憩室40例。按主动脉弓及憩室位置分型：①右位主动脉弓伴憩室75例,其中憩室位于气管右侧67例（右弓右降）、左侧8例（右弓左降）;②左弓伴憩室9例,其中右侧憩室1例（左弓右降）、左侧憩室8例（左弓左降）;③双主动脉弓一侧闭锁伴憩室3例。憩室直径4.8~12.1mm。所有右弓、双弓及左弓右降伴右侧憩室的患者均有不同程度气道受压推移、变窄,同时伴食道受压向前、局部含气消失者32例。左弓左降伴憩室的患者无明显气管受压表现。43例患者合并其它异常,包括心血管异常31例、支气管肺发育异常5例、骨骼异常8例、占位4例、消化道畸形和膈疝各1例。结论：儿童主动脉憩室可有多种表现,与成人患者间有一定差异,CT检查可准确诊断本病。     

小儿美克尔憩室的超声诊断

目的：探讨出现临床表现的儿童美克尔憩室的超声影像特点及超声诊断价值。方法：回顾性分析超声诊断儿童美克尔憩室35例,经手术病理证实33例与超声诊断一致,诊断符合率94.3%（33/35）。结果：美克尔憩室出现并发症时,患儿将出现临床症状,此时超声可检查到憩室,表现为壁较正常肠壁增厚,固定的肠管结构,一端与小肠相通,另一端为盲端。结论：小儿美克尔憩室出现并发症后,在超声图像上具有特异性,可作为本病诊断的首选方法。     

十二指肠乳头旁憩室的CT表现特征

目的:探讨十二指肠乳头旁憩室的CT表现特点,提高诊断正确率。方法:回顾性分析上腹部CT检查中发现十二指肠乳头旁憩室23例,并进行上消化道造影进一步证实。结果:23例中低年资医生漏诊8例,高年资医生均诊断为十二指肠憩室。CT表现十二指肠框内圆形、半圆形囊袋状,突出于肠管小弯侧壁外,囊袋内可见气液平面,残留内容物较多时呈网状阴影,增强后囊壁强化与十二指肠壁强化一致。结论:十二指肠乳头旁憩室上腹部CT检查有一定的特征性,当疑为本病时,可进一步作上消化道造影或内镜检查。     

结节性甲状腺肿及其合并症的CT表现

目的 探讨CT对结节性甲状腺肿(nodular goiters,NG)及其合并症的诊断价值.方法 回顾分析我院2007年～2011年经手术病理证实的178例NG及其合并症的CT表现.结果 178例NG及其合并症中,单纯NG51例(28.7％),NG伴腺瘤111例(62.4％);合并桥本甲状腺炎12例(6.7％))合并甲状腺癌15例(8.4％),15例均为甲状腺乳头状癌,其中既合并腺瘤又合并癌的有8例(4.5％),既合并腺瘤又合并桥本甲状腺炎的3例(1.7％).CT对NG的诊断符合率约为94.4％,NG合并腺瘤诊断正确率约93.7％,而NG合并桥本甲状腺炎或甲状腺癌的CT诊断符合率分别为0及33％.178例NG中65例(36.5％)甲状腺病灶内出现钙化,甲状腺良性病变相关钙化60例(33.7％),与癌相关的钙化只有5例(33.3％),良恶性病变的钙化率差异无统计学意义(P＞0.05).结论 单纯NG及NG合并良性病变CT表现具有一定的特征,NG是否合并甲状腺癌CT诊断仍较困难.     

麦克尔憩室及并发症的MSCT表现

目的:探讨麦克尔憩室及并发症的多层螺旋CT(MSCT)表现,提高对该病的诊断水平.方法:回顾性分析64例经手术病理证实的麦克尔憩室及其并发症的M SCT表现,包括憩室的位置、大小、憩室壁厚度、强化、供血动脉等,并与病理结果进行对照分析.结果:64例中MSCT检出麦克尔憩室56例(87.5％).56例中,最常见部位是右下...     

99mTcO4-异位胃粘膜显像诊断小儿美克尔憩室

目的:探讨99mTcO4异位胃粘膜显像对小儿美克尔憩室的临床诊断价值.方法:对32例疑美克尔憩 室患儿行99mTcO4-异位胃粘膜显像,以腹部出现异常放射性核素浓聚影为阳性.阳性者全部行手术治疗;阴性者行内窥镜或其它检查.结果:32例患儿中核素浓聚影阳性者10例,经手术病理证实9例为异位胃粘膜,1例为肠重复畸形.结论:...     

气管小憩室CT表现

【摘要】目的：分析气管小憩室的CT表现,提高对本病的认识。方法：回顾性分析81例气管小憩室的CT表现及42例随访病例的CT改变。结果：81例气管小憩室均位于气管右后方6～7点处。81例气管小憩室中,类圆形75例,三角形3例,不规则形3例。81例共86个小憩室,其中单发者73例(73个),多发者8例(13个)。86个气管小憩室平均最大径为2.2mm。本组86个小憩室中64个可见开口与气管相通（64/86）,41个窄开口使小憩室呈瓶颈样改变(41/64),23个宽开口使小憩室呈凹槽样改变(23/64)。42例随访病例的CT表现:小憩室消失1例,小憩室变大7例,小憩室生成7例,小憩室消失后再度出现3例。结论：CT能准确清晰显示气管小憩室的形态、位置、数目、大小和开口。典型的气管小憩室形态改变为烧瓶状和凹槽状。通过CT可观察到气管小憩室的发生、发展、消失及消失后再生的复杂过程。     

多层螺旋CT对气管憩室诊断的价值

目的探讨多层螺旋CT对气管憩室诊断应用价值。方法回顾性分析经临床证实的气管憩室92例CT表现。结果憩室大小0.3~3.5cm,平均约1.2cm,其中2.0cm以上19例。憩室形态不规则53例,类圆形17例,椭圆形14例,小泡状8例;憩室囊腔内呈分房样或蜂窝状改变并见嵴状、皱襞样结构或分隔线改变28例,憩室并发感染并见液平1例。结论多层螺旋CT对气管憩室诊断具有实用价值。     

小儿肝母细胞瘤的CT表现及临床应用价值

目的：探讨肝母细胞瘤的临床及CT表现,以提高其诊断准确率。方法：回顾性分析经手术及病理证实的肝母细胞瘤13例,结合文献回顾性分析肝母细胞瘤的临床和CT表现。结果：肿瘤主体位于肝右叶10例,肝左叶2例,跨左右叶1例。肿块最大径约11~24cm,平均16cm。8例轮廓光滑,边界清楚,包膜较完整,5例部分边界不清。CT平扫肿瘤呈低、等混杂密度肿块,肿瘤内见裂隙状或不规则更低密度区,7例可见瘤内小斑点状或弧形钙化;增强扫描动脉期13例肿瘤呈不均匀性强化,分隔及周边的结节明显强化,但强化程度低于正常肝组织。坏死或液化区均无明显强化。门脉期8例瘤内分隔延迟强化。3例侵犯门脉血管。结论：CT能较好的描述肿瘤的范围、包膜的完整性,对肝内血管和下腔静脉的侵犯情况提供了较多的信息,对临床治疗方案的制定和预后起重要的作用。CT上肝母细胞瘤有一定的特征性,结合患者年龄、AFP可提供诊断的准确率。     

肝吸虫病的CT表现特征

目的 :分析肝吸虫病导致肝胆管病变的CT表现特征。方法 :回顾性分析 12 8例肝吸虫病患者CT表现及临床资料。结果 :CT主要表现为肝边缘部小胆管小囊状、细枝状扩张 ( 65例 ) ;近肝门侧胆管树枝状扩张 ( 4 1例 ) ;肝实质结节或小斑片低密度灶 ( 6例 ) ;胆囊内条片状软组织影 ( 1例 )。结论 :肝边缘部细枝状、小囊状扩张为肝吸虫病CT表现特征 ;肝内结节、斑片低密度灶可能与炎性肉芽肿及胆管周围炎有关。肝吸虫病具有特征性CT表现 ,CT是肝吸虫病早期诊断有效的检查方法。     

SARS胸部表现和并发症的CT研究

目的 探讨CT扫描在SARS诊断中的作用。方法 82例SARS患者行螺旋CT扫描112次，其中胸部106次，头颅5次，腹部1次。采用标准肺窗、纵隔窗摄片观察。结果82例中病变位于双侧肺野66例(80．49％)，单侧16例(19．51％)。病变累及4～6个肺野的54例(65．85％)，下肺野63例(76．83％)。病变形态表现为胸膜下局灶性实变影26例(31．71％)，斑片状实变影53例(64．63％)，大片实变影9例(10．98％)，磨玻璃样模糊影31例(37．80％)，肺泡实质影14例(17．07％)，间质改变16例(19．51％)。发生并发症6例(7．32％)，其中1例同时并发肺、脑部结核及纵隔气肿；余5例分别为肺部继发感染2例，肺霉菌、气胸、脓胸各1例。根据上述所见，作者提出了SARS的相对特征性肺部表现：(1)病灶呈多发性、两侧性分布，以两下肺多见。(2)斑片状、大片实变影，胸膜下局灶性实变和磨玻璃样模糊影，伴有支气管充气征。(3)肺泡内点状高密度影。(4)胸部X线检查和CT扫描动态观察中发现病灶大小、数量及分布部位有迅速变化和进展(即在24～48h内有动态变化)。上述征象提示为SARS病毒引起的肺部表现可能。结论 CT扫描检查是一种敏感的检查方法，能较准确地评估SARS患者肺部病变的演变过程和及时发现所出现的并发症。     

儿童结肠息肉的CT影像学表现

目的:探讨儿童结肠息肉的特征性CT表现.方法:通过对2010年7月-2015年11月间病理诊断为结肠幼年性息肉的病例进行回顾性分析.结果:搜集的122例患儿中,发生在升结肠22例,横结肠18例,降结肠13例,乙状结肠28例,直肠41例,＜5 mm的32例,5～10 mm的53例,＞10 mm的37例,结肠息肉可以表现为在充气肠管轮廓内的结节样软组织密度影.息肉CT平扫表现为等密度结节,局部与邻近肠管关系密切,增强后呈辐轮状强化表现,辐轮CT值约77～92 HU之间,辐轮中心强化小血管影CT值约98～165HU之间,并延续至肠壁血管,辐轮间稍低密度影未见明显强化,CT值约23～27 HU之间.在搜集的122例患儿中有105例患儿的结肠息内表现为这种特征性的辐轮状强化,占到总例数的86％.结论:儿童结肠息肉具有特征性的辐轮状CT增强表现,可以作为与其他肠道病变进行鉴别的重要依据.     

Radiologist's perspective for the Meckel's diverticulum and its complications

The Meckel''s diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel''s diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel''s diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.The Meckel''s diverticulum is the commonest congenital anomaly of the gastrointestinal tract. It is a true diverticulum having all the layers of the intestinal wall.^1,2 It occurs as a spectrum of abnormalities that result from the persistence of the vitellointestinal duct, which includes the umbilico-ileal fistula, umbilical sinus, umbilical cyst and, rarely, a thin fibrous band connecting the ileum to the umbilicus. Meckel''s diverticulum is named after Johann Friedrich Meckel the Younger, who first described its embryological origin in 1809.³ In general, it is usually asymptomatic with a 4.2–6.4% lifetime risk of complication.⁴ The Meckel''s diverticulum manifests more commonly in children. However, complications can occur in adults, including gastrointestinal bleeding, intussusception, obstruction and diverticulitis. The well-known “rules of 2” state that the Meckel''s diverticulum occurs in about 2% of the population, it is about 2 inches in length, is usually located within 2 feet of the ileocaecal valve and usually presents before 2 years of age.⁵ The diagnosis of the Meckel''s diverticulum-related diseases is often challenging with imaging playing the pivotal role in their prompt recognition and differentiation from other common conditions that can have a similar clinical presentation. The purpose of this article is to review embryology, pathology, clinical and radiological manifestations along with varied complications of the Meckel''s diverticulum with emphasis on differentiating them from their common mimickers.