CT淋巴管成像诊断原发性乳糜尿

目的 观察CT淋巴管成像(CTL)诊断原发性乳糜尿的价值。方法 分析37例原发性乳糜尿，比较CTL与直接淋巴管造影(DLG)所见淋巴管形态、淋巴回流，泌尿系统、胸腹盆部淋巴管异常及腹盆腔、腹膜后、肺、纵隔及骨骼等其他异常；以Kappa检验评价二者诊断原发性乳糜尿的一致性。结果 CTL显示对侧髂淋巴反流、对侧腰干反流及支气管纵隔干反流优于DLG(P均<0.05),诊断一致性中等(Kappa均>0.40);二者显示同侧及对侧肾脏淋巴反流几乎完全一致(Kappa均>0.80),而CTL能进一步显示肾脏及肾周异常淋巴管分布；DLG显示颈干及锁骨下干反流优于CTL(P<0.05),二者显示同侧髂、腰干及腹膜后淋巴管纡曲扩张差异均无统计学意义(P均>0.05),诊断一致性中等及以下(Kappa均<0.50)。CTL显示对比剂异常反流至胸部14例、腹盆部36例，5例复杂性淋巴管畸形及8例淋巴管瘤等；DLG仅显示7例胸部及5例腹盆部对比剂异常反流。结论 CTL显示肾脏反流、肾周异常淋巴管分布及对侧髂、腰干反流具有重要价值，而DLG显示胸导管末端反流更具优势；联合应用...

CT lymphangiography for diagnosis of primary chyluria

Objective To observe the diagnostic value of CT lymphangiography (CTL) for primary chyluria. Methods Data of 37 patients with primary chyluria were retrospectively analyzed. The morphology of lymphatic vessels, lymphatic reflux, lymphatic abnormalities in the urinary system, chest, abdomen and pelvis, and the presence of other abnormalities in the abdominopelvic cavity, retroperitoneum, lung, mediastinum and bone showed with CTL and direct lymphadenography (DLG) were comparatively observed. Kappa test was used to evaluate the concordance between CTL and DLG for diagnosing primary chyluria. Results CTL was superior to DLG for contralateral iliac lymphatic reflux, contralateral lumbar trunk lymphatic reflux and bronchial mediastinal trunk lymphatic reflux (all P<0.05), and the diagnostic concordances between CTL and DLG were moderate (all Kappa>0.40). CTL and DLG were highly consistent for ipsilateral and contralateral renal lymphatic reflux (both Kappa>0.80), while CTL could further reveal the distribution of abnormal lymphatic vessels in the kidney and perirenal areas. DLG was also superior to CTL for lymphatic reflux in the cervical trunk and subclavian trunk (P<0.05). No significant difference was found between CTL and DLG for showing ipsilateral iliac, lumbar trunk nor retroperitoneal lymphatic vessel dilatation (all P>0.05), and the diagnostic concordances between CTL and DLG were moderate or below (all Kappa<0.50). CTL showed abnormal reflux of lipiodol to the chest in 14 cases, to the abdomen and pelvis in 36 cases, complex lymphatic malformations in 5 cases and lymphangioma in 8 cases, whereas DLG only showed abnormal contrast medium reflux in chest in 7 cases and in abdomen and/or pelvis in 5 cases. Conclusion CTL was valuable for assessing renal lymphatic reflux and distribution of abnormal lymphatic vessels in the perinephric region, contralateral iliac and lumbar trunk lymphatic reflux, while DLG was superior to CTL for terminal reflux of thoracic duct.