腹部非急性胰腺炎相关性脂肪坏死CT表现及病理分析

目的探讨腹部非急性胰腺炎相关性脂肪坏死病灶CT征象及其病理基础。方法回顾性分析我院2009年3月至2015年3月间20例无急性胰腺炎病史,术后病理证实为腹部脂肪坏死的住院患者的CT影像资料,观察病灶及周围组织CT表现及强化特征并与病理对照。结果 (1)部位:20患者中16例发生于腹腔,4例发生于腹膜后。(2)CT表现:分为结节型(14/20)、脂质囊肿型(3/20)和网状疏松型(3/20)三种类型,以结节型(14/20)最为常见,结节型和脂质囊肿型病灶局限(最大径均值分别为1.8cm和2.5cm),网状疏松型病灶范围较大(最大径均值8.5cm)。14例结节型病灶中11例出现钙化,其中8例为环形钙化,3例为不规则形钙化;结节型病灶血供不丰富,仅4例轻度强化,10例未见明显强化。脂质囊肿型病灶3例均为薄壁含脂质囊肿(CT值-20HU),其中1例囊壁出现钙化,增强后3例均出现环形强化。网状疏松型3例均表现为混杂脂肪密度,呈边界清晰的网格状结构,无明显钙化,增强后轻度强化。结论腹部非急性胰腺炎相关性脂肪坏死CT表现具有一定特征性,能够反映其病理特征,对病灶的正确诊治具有重要意义。

CT Features and Pathological Analysis of Abdomen Fat Necrosis Correlated with Non-acute Pancreatitis

Objective To improve diagnostic accuracy of abdomen fat necrosis correlated with non-acute pancreatitis by studying its CT feature and pathological basis.Methods 20 in-patients of Nanjing Drum Tower Hospital with non-acute pancreatitis but pathological identified with abdomen fat necrosis were enrolled in a retrospective study from 2009 March to 2015 March.CT scan and contrast enhancement scan features of the lesions and their surroundings were compared with pathological results.Results 1.Disease region: 16 patients were in abdomen while 4 were in retroperitoneal. 2.CT feature: CT features were divided into three types, nodular type(14/20),lipid cyst type(3/20),mesh loose type(3/20).The nodular type and lipid cyst type had a limited scope, with maximum mean diameter 1.8cm and 2.5cm each. The mesh loose type had a dispersed range, with maximum mean diameter 8.5cm.Calcification was found in 11/14 nodular type patients. Annular calcification was found in 8 while irregular calcification in 3.The nodular type lesions were found with deficient blood supply.4 nodular type lesions with mild contrast enhancement were found while 10 with no contrast enhancement. The lipid cyst type lesions were with low CT value (< -20HU), 1 calcification in 3 patients, all annular enhancement after contrast injection in 3 patients. The mesh loose type lesions were with hybrid fat density, clear boundary grid structure, mild contrast enhancement.Conclusion CT features of abdomen fat necrosis correlated with non-acute pancreatitis were characteristic. They have great influence on improving diagnostic accuracy.