肠系膜脂膜炎CT诊断

目的 探讨肠系膜脂膜炎的CT特点,提高CT诊断水平.方法分析7例按照CT诊断标准诊断为肠系膜脂膜炎患者的临床资料和CT表现.结果 7例表现为围绕小肠系膜根部边界清楚的脂肪肿块,增强扫描未见强化.病变与腹腔脂肪和腹膜后脂肪分界清楚.7例可见"假包膜"征,5例见"脂肪环"征.2例病灶内可见肿大淋巴结影,2例可见腹膜后淋巴结肿大,4例有腹部手术史, 1例合并胰头癌.结论肠系膜脂膜炎CT表现具有一定特征,CT是诊断肠系膜脂膜炎有效的影像手段.     

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。     

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。     

肠系膜脂膜炎的MSCT诊断及鉴别诊断

目的 :探讨肠系膜脂膜炎(mesenteric panniculitis,MP)的MSCT诊断及鉴别诊断的价值。方法:回顾性分析8例MP患者的MSCT表现,均行全腹部CT平扫加双期增强扫描,并按CT诊断标准作出诊断。结果:8例均可见系膜密度增高伴脂肪组织肿块影,6例增强扫描病灶未见强化;2例伴软组织密度结节,增强扫描明显强化。7例见"脂肪环征",4例见"假包膜征",2例压迫邻近肠管,2例腹腔内见淋巴结影。结论:MSCT对MP的诊断有一定特征性,是诊断本病较为理想的影像学方法。     

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。     

肠系膜脂膜炎的CT及MRI诊断

目的:探讨CT及MRI对肠系膜脂膜炎(MP)的诊断价值,提高诊断水平。方法:回顾性分析21例MP的CT及MRI表现,分析其CT及MRI特点,并结合临床综合诊断。其中14例行MSCT腹部平扫及双期增强扫描,7例行MRI平扫及动态增强扫描。结果:21例均起自肠系膜根部,包绕肠系膜根部大血管,由肠系膜根部向两侧腹部生长,以向左侧多见,5例病灶境界欠清,其余境界较清晰,CT平扫病灶呈不均匀脂肪密度,CT值-54~-26 HU,境界较清者病灶呈脂肪性肿块,欠清者病灶呈磨玻璃样改变,较周围正常脂肪密度增高,增强扫描病灶强化不明显。MRI上T_2压脂序列病灶信号较周围正常脂肪信号高。14例可见假包膜征,9例可见脂肪环征。结论:MP的CT及MRI表现具有一定特征,CT及MRI是诊断该病的有效影像手段。     

肠系膜脂膜炎的CT表现与鉴别诊断

目的 :观察肠系膜脂膜炎的CT表现,明确其特征性征象,为临床诊断提供依据。方法 :回顾性分析8例肠系膜脂膜炎患者的CT资料,对病变的发生位置、范围及内部特征进行观察。结果:所有病变均位于肠系膜根部周围,6例见明显的"假包膜征",8例见"脂环征",3例见明显的"木梳征"。结论:CT是肠系膜脂膜炎首选的检查方法,当有典型的CT表现时可提示诊断。     

肠系膜脂膜炎的CT影像学表现及鉴别

目的分析肠系膜脂膜炎的CT影像学表现及与其他表现类似疾病的鉴别要点,提高对本病的认识。资料与方法搜集20例肠系膜脂膜炎病例,1例手术证实,其余经临床综合诊断,对所有病例的CT影像学资料进行回顾性分析。结果 20例均发生于小肠系膜,表现为起自肠系膜根部,沿肠系膜血管向腹部延伸的片状影或块状影,可直达肠袢,CT值为-82～-19 HU,增强扫描无明显强化,边缘清晰,周围肠袢可被推移,20例均见结节影及假包膜征,15例可见脂环征。结论多数肠系膜脂膜炎病例可依据CT影像资料明确诊断或与其他疾病鉴别,少数没有特征性表现并难以鉴别的病例可采用手术或穿刺活检明确诊断。     

多层螺旋CT在伴随疾病与肠系膜脂膜炎关系中的价值

目的 探讨多层螺旋CT(MSCT)在伴随疾病与肠系膜脂膜炎关系中的作用.方法 回顾分析经影像及临床随访或病理诊断的肠系膜脂膜炎250例,其中单纯性肠系膜脂膜炎149例,具有伴发疾病的肠系膜脂膜炎101例,测量假包膜CT值、病变脂肪CT值、周围正常脂肪CT值,并计算假包膜发生率、相对脂肪增值及体质量指数,计数并统计分析....     

超声与CT在肠系膜脂膜炎诊断中的临床价值

目的探讨超声与CT在肠系膜脂膜炎临床诊断中的应用价值。方法总结8例肠系膜脂膜炎的超声表现并与CT检查进行对比研究。结果 8例肠系膜脂膜炎超声均表现为肠系膜根部增厚、回声不均匀增强,病变边界不清,形态不规则,整体呈现为模糊的"毛玻璃样"改变;CT平扫均表现为较脂肪密度稍高的云雾状影,周边可见纤细假包膜,并可见软组织结节影。二者共同表现为增厚的肠系膜包绕在肠系膜血管周围,肠系膜血管无受压移位。结论肠系膜脂膜炎患者超声与CT表现具有一定的特征性,二者结合能够提高本病的诊断。     

64层螺旋CT对急性肠系膜血管栓塞的诊断价值分析

目的 探讨64层螺旋CT血管造影对急性肠系膜血管栓塞(AMI)的诊断价值.方法 回顾性分析经64层螺旋CT全腹平扫加多期动态增强扫描诊断的15例AMI.其中,肠系膜上动脉栓塞3例(完全栓塞1例,不完全栓塞2例),肠系膜上静脉栓塞12例.结果 15例AMI直接征象:动脉期显示肠系膜上动脉完全或部分充盈缺损,可诊断为肠系膜上动脉完全或部分栓塞(3例).静脉期显示肠系膜上静脉完全或部分充盈缺损,可诊断为肠系膜上静脉完全或部分栓塞(12例);间接征象“缆绳征”12例,肠系膜水肿10例,肠管壁增厚12例,肠管扩张、积液8例,肠壁强化减弱7例,其中2例可见节段性未强化区,腹水6例,肾前筋膜增厚4例,肠壁积气2例.平扫肠系膜上动脉或上静脉高密度征7例(静脉栓塞6例,动脉栓塞1例),肠系膜上静脉栓塞累及门静脉、脾静脉6例,其中4例在增强扫描时,可见肝脏异常低灌注区.结论 64层螺旋CT平扫加多期动态增强扫描对急性肠系膜血管栓塞的诊断及时准确,应作为临床怀疑肠系膜血管疾病首选检查方法,值得推广应用.     

多层螺旋CT在肠系膜缺血诊断中的应用

目的：探讨多层螺旋CT（MSCT）对肠系膜缺血的诊断价值和临床意义。方法：对43例怀疑肠系膜缺血患者行MSCT检查,包括平扫、动脉期和门静脉期扫描,采用容积成像（VR）、多平面重组（MPR）和最大密度投影（MIP）进行动脉和门脉成像,评价并分析异常的MSCT征象。结果：肠系膜上动脉栓塞7例,管腔内血栓影,肠管扩张积气、积液;肠壁无强化,5例肠壁变薄,2例肠壁水肿增厚。肠系膜上静脉血栓形成36例,肠管扩张积气、积液33例;肠壁水肿增厚伴密度改变（面包圈征）25例;肠系膜血管增粗,脂肪渗出（缆绳征）17例;肠系膜血管走行异常（漩涡征）9例;肠系膜静脉管腔内充盈缺损36例,管壁强化（靶征）27例。结论：MSCT扫描与三维重组技术相结合能准确诊断肠系膜缺血并明确其缺血程度、范围,是一种有效的、无创的影像学检查手段。     

Vascular contact with soft tissue: a sign of mesenteric masses at computed tomography

PURPOSE: To evaluate prevalence of mesenteric vascular contact at routine computed tomography (CT) and evaluate its value for distinguishing missed mesenteric masses from adjacent bowel. MATERIALS AND METHODS: We identified 18 abdominopelvic CT scans of 9 patients in whom mesenteric masses were missed on the prospective CT reports. We recorded the long-axis diameter of the masses, time interval to eventual detection, and presence of vascular contact (fat plane obscuration) with a mesenteric vessel greater than 1 mm in diameter. We also retrospectively identified 129 consecutive abdominopelvic CT scans of nononcology patients and recorded all locations of vascular contact between a mesenteric vessel greater than 1 mm in diameter and adjacent bowel. RESULTS: In the 18 CT examinations where mesenteric masses were missed, the mean long-axis diameter was 2.9 cm, and time between the initial CT scan and first discovery was 12 months. Mesenteric vessels contacted the masses in 17 (94%) of 18 scans. In the 129 nononcology patients, vascular contact was rarely seen with bowel distal to the proximal jejunum (6 had vascular contact with distal jejunum, 5 with ileum, and 0 with colon). However, the third and fourth duodenal portions showed vascular contact with the superior mesenteric vessels in 36 (28%) and 12 patients (9.4%), respectively, and with the inferior mesenteric vessels in 58 patients (48%). CONCLUSIONS: At CT, mesenteric vessels greater than 1 mm in diameter rarely contact bowel other than the duodenum and proximal jejunum; however, they often contact mesenteric masses. At CT scan review, inspection of the mesenteric vessels may facilitate mesenteric mass identification.     

少脂肪性肾血管平滑肌脂肪瘤的CT诊断与鉴别

目的:探讨少脂肪性肾血管平滑肌脂肪瘤(AML)的CT表现,提高对该病的诊断水平。方法:回顾性分析12例经手术病理证实并行CT平扫及双期增强扫描的少脂肪性肾AML CT表现,着重分析病灶的大小、部位、轮廓、密度以及动态增强扫描表现等。结果:12例12个病灶均表现为实性肿块,CT平扫7个病灶呈均匀略高密度,2个病灶呈等密度,3个病灶内示散在小结节状低密度影,9例肿块呈类圆形,3例呈不规则形,全部肿块与肾实质分界清楚,8例肿块突向肾轮廓外1/3~1/2,9例病灶在CT增强扫描肾皮质期明显强化,6例为均匀强化,3例病灶内散在低密度灶未见强化,7例在肾实质期呈相对低密度,2例仍强化明显,3例双期增强均扫描表现为病灶内轻度条片状强化。结论:少脂肪性肾AML有一定的CT表现特征,有利于和肾细胞癌相鉴别。     

肾脏淋巴瘤的影像诊断

目的探讨肾脏淋巴瘤的CT、MRI及PET/CT特征。资料与方法回顾性分析18例经病理证实的肾脏淋巴瘤患者的临床及影像学资料。17例患者行CT检查,1例仅行平扫,其余16例行平扫及增强扫描,3例同时行PET/CT检查;1例患者行MRI平扫及增强扫描。结果 18例中表现为多发结节型6例,单发结节型3例,邻近腹膜后侵犯型5例,肾周型3例,弥漫浸润型1例。结论 CT、MRI及PET/CT均能显示肾脏淋巴瘤病变。肾脏内多发、单发肿块或腹膜后肿块直接侵犯,CT平扫表现为均匀等或稍低密度,MRI呈等T1、等T2信号,轻度强化是肾脏淋巴瘤的普遍特点,有一定的特征性。PET能更敏感地发现其他器官的隐匿性病灶。     

CT定位诊断腹腔内卵巢源性和小肠系膜源性囊性病变的价值

目的探讨螺旋CT对腹腔内卵巢源性和小肠系膜源性囊性病变的定位诊断价值。资料与方法回顾性分析18例临床资料和CT资料完整的卵巢源性和小肠系膜源性囊性病变,均经手术病理证实。着重观察肿块与十二指肠水平段的关系、肠系膜上血管有无移位、系膜血管有无包绕、生殖血管有无增粗、肿块有无卵巢血管蒂,以及肿块的后方有无空肠和回肠等。结果(1)5例小肠系膜囊性病变中,肿块上缘位于十二指肠上缘上方层面3例,肠系膜上血管移位4例,系膜血管包绕4例,肿块后方无空/回肠5例。(2)13例卵巢源性病变中,肿块上缘位于十二指肠上缘上方层面5例,肠系膜上血管移位4例,一侧生殖静脉增粗8例,卵巢血管蒂征显示8例,病变后方显示空/回肠11例。结论依据观察肿块上缘与十二指肠上缘的关系,肠系膜血管有无包绕,生殖血管有无增粗,卵巢血管蒂征的有无,肿块后方有无空肠和回肠显示等征象,以及肿块的CT特点,可对腹腔内卵巢源性和小肠系膜源性囊性病变作出定位诊断。     

绞窄性肠梗阻的螺旋CT增强扫描征象分析

目的:分析螺旋CT增强扫描图像上绞窄性肠梗阻的征象,提高对绞窄性肠梗阻术前诊断的准确性.方法:64例手术证实的绞窄性肠梗阻病例纳入研究,男43例,女21例,年龄23～72岁,平均42岁.采用单排螺旋CT进行全腹部扫描,对比剂以2～3ml/s速度注射,注射后60s扫描,层厚10mm.参照术中所见,回顾性分析上述CT资料,包括:①间接征象:肠腔扩张积液,肠壁增厚及肠壁密度改变(靶征),肠系膜脂肪水肿及渗出(缆绳征),肠系膜血管增粗并肠系膜扭曲(漩涡征),肠壁间、肠系膜间及门静脉积气,腹水;②直接征象:肠系膜上动脉或上静脉充盈缺损.结果:正确诊断54例,正确率82.8％.CT显示肠腔扩张积液47例(73％),其中6例积液呈高密度提示肠腔内积血(9.3％);肠壁水肿增厚19例(29.6％),其中11例增强后肠壁密度不匀,呈“靶征”(17％),8例肌壁未见强化(12.5％);肠系膜脂肪水肿及渗出(缆绳征)43例(67％),肠系膜血管增粗并肠系膜扭曲呈“漩涡”状9例(14％),肠壁间积气、肠系膜积气各1例,门静脉积气2例,腹水31例(48.4％).肠系膜上动脉或上静脉充盈缺损3例.结论:绞窄性肠梗阻CT表现有一定特征,可做出提示性诊断.     

阔韧带平滑肌瘤的影像诊断(附九例报告)

目的 研究阔韧带平没肌瘤的影像诊断。方法 回顾性总结９例经手术和病理证实为阔韧带平滑肌瘤的Ｂ超、ＣＴ及ＭＲＩ表现。结果 ９例Ｂ超检查表现为盆腔内、子宫外实性肿块,呈低回声灶,４例内有斑点状液性暗区或不均匀光点,５例显示包膜,７例边界清晰。８例ＣＴ检查７例表现为实性肿块,边界较清晰,平扫密度较均匀,与子宫肌密度相当或稍低;１例为混合密度灶,可见液化、坏死与囊变;８例增强扫描实性部分均见明显强化,４例     

Medical-type peritoneal mesothelioma leading to death two months after onset of fever of unknown origin

In malignant mesotheliomas, cases involving the peritoneum as the primary site are rare, accounting for approximately 10% of all mesothelioma cases. We report a case of medical-type peritoneal mesothelioma leading to death 2 months after the onset of fever of unknown origin, along with a review of the literature. A 76-year-old man presented with a fever of unknown origin over 4 weeks. Thoracoabdominal computed tomography (CT) scan showed increased mesenteric adipose tissue density. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed diffuse hyperaccumulation in the mesentery and hyperaccumulation in the intraperitoneal and parasternal lymph nodes. A thoracoscopic biopsy of the parasternal lymph nodes revealed metastatic peritoneal mesothelioma. The treatment plan was discussed with him and his family, and the best supportive care was provided. 2 months later, he died from multiple organ failure. Underlying malignant tumors cause 38% of mesenteric panniculitis cases. Symptoms accompanied by lymphadenopathy within the area of mesenteric panniculitis are highly suggestive of malignancy. Peritoneal mesothelioma can be classified as (1) classical, which is accompanied by abdominal pain, ascites, and abdominal masses; (2) surgical, which is accompanied by hernia incarceration and intestinal occlusion; and (3) medical, wherein systemic symptoms, such as fever and weight loss, are primarily observed. The medical-type peritoneal mesothelioma, wherein systemic symptoms are primarily observed, has a poorer prognosis than the other types. FDG-PET/CT is an effective diagnostic modality for peritoneal mesothelioma and typically shows diffuse hyperaccumulation along the peritoneal surface.