肠系膜肿块的CT诊断

目的 分析肠系膜肿块的CT表现,探讨CT对其定位,定性及鉴别诊断的价值和限度,资料与方法 对经手术,病理,活检等证实的18例肠系膜肿块的CT表现,结合其手术病理及部分超声所见进行回顾分析。选用窗宽300-400HU,窗位0HU观察病灶及其邻近肠系膜。结果 18例肠系膜肿块中,16例发生在小肠系膜（回肠15例,空肠1例）,升,横结肠各1例,其中恶性淋巴瘤6例（非霍奇金病5例,霍奇金病1例）,淋巴管瘤,炎性假瘤各3例,转移瘤2例,血管外皮细胞肉瘤,平滑肌肉瘤,纤维瘤,单纯囊肿各1例,除2例淋巴瘤和1例转移瘤呈多个肠系膜肿块,部分病例伴有腹膜后肿块,其余病例均呈孤立性肿块（此为唯一的CT表现）。肿块推压肠管,部分被肠系膜肿块,部分病例伴有腹膜后肿块,其余病例均呈孤立性肿块（此为唯一的CT表现）,肿块推压肠管,部分被肠管包绕,邻近肠系膜模糊,“三明治”征多见于恶性淋巴瘤。结论 CT对肠系膜肿块有较大的诊断价值。结合病变的解剖,病理基础以及超声特征等,术前多可做出提示性甚至正确的定位,定性诊断,对少数难以确诊的病例,应行CT导引下穿刺活检确诊。

CT Diagnosis of Mesenteric Masses

Objective To analyze CT features of mesenteric masses and to evaluate CT in localizing and qualitative diagnosis of the disease. Materials and Methods CT manifestations in 18 patients with pathologically proved mesenteric mass were retrospectively analyzed, a comparison with surgical, pathological and sonographic findings was made. The observation was focused on the lesion and the adjacent mesentery by using 300~400 HU window width and 0 HU window level.Results Of 18 cases, the mass was originated from small intestine in 16, from ascending mesocolon in one and from transverse mesocolon in one. The lesions included malignant lymphoma (n=6, 5 non Hodgkin's disease and 1 Hodgkin's disease), lymphangioma (n=3), inflammatory pseudotumor (n=3), metastatic tumor (n=2), hemangiopericytosarcoma (n=1), liomyosarcoma (n=1), fibroma (n=1) and simple cyst (n=1). The only CT manifestation in 15 cases was solitary mass of soft tissue density, which oppressed the adjacent loops or was partly encased by the loops. The other three cases (two lymphomas and one metastatic tumor) presented as multiple mesenteric masses with or without retroperitoneal mass. "Sandwich" sign were seen in malignant lymphomas.Conclusion CT is of great value in diagnosing mesenteric mass. A combination of the knowledge of anatomy and pathology, the familiarity with sonographic features and the CT findings help make a correct diagnosis preoperatively. CT guided puncture biopsy should be carried out when the diagnosis is still uncertain.