肠系膜淋巴结结核的多期CT扫描特点及诊断分析

目的研究肠系膜淋巴结结核(Tuberculous mesenteric lymphadenitis,TMLN)的多期CT扫描特点及诊断价值。方法收集我院2014年1月-2015年10月期间儿科、呼吸内科和急诊科收治的35例TMLN患者,通过病历记录和CT影像资料整理,回顾性分析TMLN患者的多期CT扫描特点,并结合病理结果分析CT扫描的诊断价值。结果CT平扫和冠矢状位扫描下均可见肠系膜根部、肝门、胰头周围及腹膜后区淋巴结肿大,壁层腹膜增厚等病变特征;增强多期扫描35例TMLN患者中有71.43%(25/35)患者淋巴结病灶处在动脉期、门脉期、实质期均呈环形强化特征,明显高于非环形强化特征比重28.57%(10/35,其中均匀强化4例,不规则强化6例),差异显著(P0.05);随着注射造影剂延迟扫描,病灶及淋巴结与周围脏器关系的观察,其中24例可见系膜根部淋巴结肿大、脾胃间隙积液等病变特征,其中79.17%(19/24)例呈环形强化特征,20.83%(5/24)呈均匀或不规则强化特征,相较差异显著(P0.05)。结论TMLN在多期CT扫描下具有病灶处呈环形强化的显著特征,增强延迟扫描能较好的观察淋巴结肿胀及与周围结构的关系,对了解TMLN病变特征和临床诊断提供重要参考依据。

Multi-phase CT Scanning Features and Diagnostic Analysis of Tuberculous Mesenteric Lymphadenitis

Objective To study the multi-phase CT scanning features and diagnostic value of tuberculous mesenteric lymphadenitis.Methods A total of 35 TMLN patients treated in the departments of pediatrics, respiratory medicine and emergency of our hospital from January 2014 to October 2015 were collected for the study. The multi-phase CT scanning features of TMLN patients were analyzed retrospectively through medical records and CT imaging data, and the diagnostic value of CT scanning was analyzed by pathologic results.Results The lymphadenectasis,wall peritoneal thickening and other pathological features were shown in the mesenteric root, hepatic hilum, pancreatic head and retroperitoneal regions by the CT scanning and crown sagittal scan. There were 71.43% (25/35) of patients with lymph node lesions showing annular enhancement features in the arterial phase, portal phase and parenchymal phase in the multi-phase enhanced scan of 35 TMLN patients, which was significantly higher than the non-annular enhancement features with 28.57% (10/35, including 4 cases of uniform enhancement and 6 cases of irregular enhancement ) (P<0.05). With the delayed scan of contrast medium injection, it was convenient to observe the relationship between lesions, lymph nodes and peripheral organs, and there were 24 cases shown lymphadenectasis, spleen and stomach fluid and other lesions features in the mesangial root, among which 79.17% (19/24) cases were shown annular enhancement features and 20.83% (5/24) cases were shown homogeneous or irregular enhancement features (P<0.05).Conclusion TMLN has significant feature of annular enhancement in the lesion with multi-phase CT scanning. Enhanced delayed scan can better observe the relationship between lymph node swelling and the surrounding structure, which provides important reference for understanding the TMLN characteristics and clinical diagnosis.