乙状结肠-直肠弥漫性海绵状血管瘤影像学特征  

The imaging features of diffuse cavernous hemangioma of the rectosigmoid colon

作　　者：陈雀芦 马小龙[2] 胡文超 CHEN Quelu;MA Xiaolong;HU Wenchao(Department of Radiology,Wenzhou Central Hospital,Wenzhou 325000,China;Department of Rdiology,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]温州市中心医院放射科,浙江温州325000 [2]第二军医大学附属长海医院放射科,上海200433

出　　处：《实用放射学杂志》2018年第8期1210-1212,共3页Journal of Practical Radiology

摘　　要：目的探讨乙状结肠-直肠弥漫性海绵状血管瘤（DCHR）的影像学表现。方法回顾性分析15例经手术病理证实的DCHR患者临床、影像和病理资料。15例患者均于术前成功进行了CT、MR平扫加增强检查，13例行数字减影血管造影（DSA）肿瘤血管造影术。结果9例病变段占据乙状结肠及直肠，6例仅占据直肠，上游正常肠管均无明显梗阻、扩张表现。CT平扫显示病变段肠管弥漫性增厚且密度降低，增强扫描肠管周脂肪间隙内可见大量扩张的血管，且lOO％可见“静脉石”影；MR脂肪抑制T2WI序列显示增厚的肠壁及肠周扩张的血管为显著高信号，T2WI序列显示低信号夹杂小片高信号，增强后血管细线状强化；造影成功的8例DSA显示病灶均由直肠上动脉供血，其中3例伴有乙状结肠动脉供血，无髂动脉分支供血。5例有动一静脉瘘、血管湖，未见粗大的引流静脉。结论DCHR的CT检佥显示病变段肠管壁弥漫增厚、肠周大量扩张的血管、“静脉石”，MRT2WI抑脂序列显著高信号及病变段肠管无明显梗阻征象。Objective To explore the imaging features of diffuse cavernous hemangioma of the rectosigmoid colon （DCHR）. Methods Fifteen patients with DCHR confirmed by surgical pathology were included, and clinical,imaging and pathologic findings were retrospectively reviewed.All 15 patients underwent CT and MR scan,and 13 patients also underwent digital subtraction angiography （ DSA） before surgery. Results Sigmoid colons and rectums were involved in 9 cases,and only rectum was involved in 6 cases,without obvious bowel obstruction and dilatation in proximal intestinal canal. CT showed diffusethickening of bowel wall with decreasing density. A large number of dilated blood vessels were found in perirectal fat space on dynamic contrast enhancement CT,and the phleboliths were observed in all lesions （ 100% ）.Thickened intestinal wall and dilated perirectal vessels were hyperintensity on fat-suppression T2 WI（FS-T2WI） and hypointensity with punctuate hyperintensity on TlWI. Perirectal dilated vessels showed intense linear enhancement after injection. DSA was performed successfully in 8 cases,and showed that all the lesions were fed by superior rectal artery with 3 lesions also fed by sigmoid artery,not by iliac artery.Arteriovenous fistula and vascular pool were observed in 5 cases without large draining vein.Conclusion The imaging findings of DCHR are diffuse thickening of intestinal wall,dilated blood vessels in perirectal fat space, phleboliths in CT, hyperintensity on FS T2 WI without obvious bowel obstruction and dilatation in proximal intestinal canal.

关 键 词：直肠血管瘤 血管瘤 磁共振成像 计算机体层成像 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]