肠结核的多层螺旋CT肠道造影表现  

Manifestation of Intestinal Tuberculosis on Multi-slice Computed Tomography Enteroclysis

作　　者：梁伟强[1] 赵静[1] 贾应梅 蔡华崧[2] 宋晨宇[2] 罗宴吉[2] 

机构地区：[1]江门市新会区中医院,广东江门529100 [2]中山大学附属第一医院医学影像科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2017年第3期468-474,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(2014A030310484)

摘　　要：【目的】总结肠结核(ITB)在多层螺旋CT小肠造影(MSCTE)的表现,探讨MSCTE在ITB的诊断价值。【方法】收集15例经内镜检查或手术后病理确诊为ITB的临床与影像学资料,所有的患者均行MSCTE检查,回顾性分析其MSCTE表现,包括病灶的位置、数目、形状、边界和邻近组织的改变,以及腹部其它脏器、腹膜、大网膜和肠系膜的变化,并与内镜及手术结果相对照。【结果】15例ITB中,13例(86%)主要累及回盲部。4例(27%)表现为多节段肠壁均匀增厚,9例(60%)表现为局部肠壁实质性肿块形成,1例(6%)表现为多发节段性肠壁增厚并肿块形成,1例(6%)表现为不均匀强化的肿块并肠穿孔。12例ITB出现淋巴结肿大,均表现为环形强化。2例(13%)ITB的肠系膜血管出现"梳状征"。按其在MSCTE增强扫描上的强化模式,将该9例肿块型小肠结核分为3种类型:a.明显均匀强化型(n=5);b."靶征"征象型(n=2);c.干酪样坏死型(n=2)。【结论】ITB的影像学征象表现具有多样性。MSCTE能够清楚地显示肠粘膜轮廓、肠壁及其与周围组织的关系,为ITB的诊断提供丰富的信息。[ Objective ] To summarize image manifestations in intestinal tuberculosis （ITB） examined by muhi-slice computed tomography enteroclysis （MSCT） and evaluate the diagnostic value of MSCTE in ITB. [ Methods ] The imaging findings were retrospec- tively analyzed in 15 cases of ITB that were confirmed by endoscopy or postoperative pathologic examination, including the location, number, shape, edge, surrounding tissue alterations of ITB and other associated changes in the peritoneum, mesentery and solid abdominal organs, and compared with endoscopy and pathology. [Results] In 15 patients, ileocecum was involved in 13 cases （87%） , 4 cases （27%） showed multi-segmental symmetric intestinal mural thickening, 9 patients （60%） showed solid masses, 1 case （7%） showed multi-segmental symmetric intestinal mural thickening and solid masses, 1 case （7%） showed homogenous en- hanced masses and perforation, 12 cases （86%） showed enlarged lymph nodes （LNs） with rim enhancement, and 2 cases （13%） showed the comb sign of enhanced mesenteric vessels. Based on enhancement pattern of MSCTE, ITB was divided into three types ： homogenous enhancement type （n=5） ; target sign type （n=2） ; caseous necrosis type （n=2）. [ Conclusion ] The imaging features of ITB are diverse. MSCTE can clearly display the shape of intestinal mucosa, the alterations of intestinal wall and the relationship between lesion and adjacent tissues, which provides valuable information for the clinic diagnosis of ITB.

关 键 词：结核 消化道 X线断层摄影术 螺旋扫描 

分 类 号：R774.1[医药卫生—眼科]