特发性乳糜尿患者直接淋巴管造影后CT表现  

Post-direct lymphangiography CT findings in patients with idiopathic chyluria

作　　者：关晓姣 沈文彬 信建峰 蒋丽华[1] 张春燕[1] 过丽芳 董健[1] 王仁贵[1] GUAN Xiaojiao;SHEN Wenbin;XIN Jianfeng;JIANG Lihua;ZHANG Chunyan;GUO Lifang;DONG Jian;WANG Rengui(Center of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Lymphatic Surgical,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射中心,北京100038 [2]首都医科大学附属北京世纪坛医院淋巴外科,北京100038

出　　处：《中国医学影像技术》2022年第3期388-391,共4页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金面上项目(61876216);北京市属医院科研培育计划(PX2019027)。

摘　　要：目的 采用直接淋巴管造影CT(PLCT)观察特发性乳糜尿患者泌尿系统及其他腹部区域淋巴管表现。方法 观察26例乳糜尿患者PLCT图像,分析泌尿系统及腹部其他区域对比剂异常分布部位及范围,进行影像学分型;并根据临床表现进行分型,以Kappa检验评估2种分型结果的一致性。结果 26例中,25例(25/26,96.15%)单侧或双侧肾区见对比剂异常分布,1例(1/26,3.85%)双侧肾区均未见对比剂分布;7例输尿管内(7/26,26.92%)、11例(11/26,42.31%)膀胱输尿管开口处、14例(14/26,53.85%)膀胱内对比剂异常分布;26例(26/26,100%)均见腹膜后及椎旁淋巴管异常扩张,并与肾包膜外、皮下等部位异常沟通;15例(15/26,57.69%)对侧髂血管旁及10例(10/26,38.46%)对侧腹股沟见对比剂异常分布;4例(4/26,15.38%)腹盆腔淋巴结见对比剂点状分布;左侧肋间隙及脾脏内对比剂异常分布各1例;1例左侧肾蒂淋巴管分支向左侧腰大肌后下方走行并汇入左侧肾门。26例中,影像学分型为轻型14例、重型12例,临床分型为轻型12例、重型14例,其一致性一般(Kappa=0.235,P<0.05)。结论 PLCT可显示特发性乳糜尿患者淋巴-泌尿系统异常沟通及扩张淋巴管的部位、分布及其范围。Objective To observe performances of lymphatic vessels of urinary system and other regions of the abdomen in patients with idiopathic chyluria using direct post-lymphangiography CT(PLCT). Methods Direct PLCT images of 26 patients with chyluria were reviewed, the site and extent of abnormal distribution of contrast in urinary system and other abdominal regions were analyzed, and imaging classifying of idiopathic chyluria was performed. In addition, clinical classifying was performed according to the clinical presentation, and the concordance between the two classifying methods was assessed using Kappa test. Results Among 26 cases, abnormal contrast material distribution in the unilateral or bilateral renal regions were observed in 25 cases(25/26, 96.15%), while no contrast material distribution in bilateral renal region was detected in 1 case(1/26, 3.85%). Abnormal contrast material distribution in the ureter was noticed in 7 cases(7/26, 26.92%), at the entrance of ureter in 11 cases(11/26, 42.31%), while in the bladder in 14 cases(14/26, 53.85%). Dilated retroperitoneal and paravertebral lymphatic vessels and abnormal communication with the outer of renal capsule and the subcutaneous region were found in all 26 cases(26/26, 100%).Contralateral side parietal iliac vessels and abnormal inguinal contrast distribution were observed in 15 cases(15/26, 57.69%) and 10 cases(10/26, 38.46%), respectively. Punctate distribution of contrast material in the abdominopelvic lymph nodes was found in 4 cases(4/26, 15.38%). Abnormal distribution of contrast medium in left costal space and spleen were observed each in 1 case, respectively. The lymphatic branch of the left renal pedicle ran and communicated to the hilus of left kidney in 1 case. Among 26 cases, 12 were clinically classified mild and 14 were classified severe, while 14 were PLCT classified mild and 12 were classified severe, the consistency of the two classifying methods was general(Kappa=0.235, P<0.05). Conclusion PLCT could be used to observe the site, distributio

关 键 词：乳糜尿 淋巴造影术 体层摄影术 X线计算机 

分 类 号：R691[医药卫生—泌尿科学] R814.42[医药卫生—外科学]