直接淋巴管造影后CT及增强CT对小肠淋巴管扩张症的诊断价值

目的探讨直接淋巴管造影后CT和增强CT对小肠淋巴管扩张症(IL)的诊断价值。方法回顾性分析28例IL患者的影像学资料。所有病例均接受直接淋巴管造影后再接受腹盆部CT平扫,4例于淋巴管造影前接受腹部增强CT检查,5例淋巴管造影及CT平扫后接受腹部增强CT扫描。结果患者中肠壁增厚、肠腔扩张15例,肠系膜水肿21例,胸、腹腔积液16例。直接淋巴管造影后CT显示不同程度淋巴管异常:对比剂漏入肠腔或分布于肠壁7例,肠系膜淋巴管扩张10例、碘油分布于胃壁1例、对比剂反流至肝门、脾门、胰腺周围、对侧髂淋巴管及胸腔21例。9例增强扫描患者中,肠壁分层强化呈"晕轮征"3例,肠黏膜明显线状强化7例。结论直接淋巴管造影后CT和增强CT对IL的诊断有重要价值,可观察胸、腹腔积液及脏器情况,并可用于复查。

Diagnostic value of CT and contrast enhanced CT after direct lymphangiography in intestinal lymphangiectasia

Objective To explore the diagnostic value of contrast enhancement CT and CT after direct lymphangiography in intestinal lymphangiectasia (IL). Methods Imaging data of 28 patients with IL were analyzed retrospectively. All the patients underwent direct lymphangiography and abdominal CT scan, 4 underwent contrast enhancement CT scan before direct lymphangiography and 5 after direct lymphangiography. Results Diffuse nodular small bowel wall thickening and edema were detected in 15 patients, mesenteric edema in 21 patients, and pleural and peritoneal effusions were observed in 16 patients. The abnormal findings of CT scan after direct lymphangiography included contrast-enhanced leakage into the intestinal lumen or distributed in the intestinal wall 7 cases, mesenteric lymph duct dilatation in 10, iodine oil distribution to the stomach wall in 1, contrast agent reflux to the hepatic portal, splenic hilum, around the pancreas, contralateral iliac lymph duct and thoracic cavity in 21 cases. Contrast enhancement CT scan showed "halo sign" of the small bowel wall in 3 patients and linear enhancement of the small bowel wall in 7 patients. Conclusion CT and contrast enhancement CT after direct lymphangiography are helpful for demonstrating the extent of disease, therefore can be used in observation of pleural and peritoneal effusions and organ, as well as in following up.