联合应用直接淋巴管造影后MSCT与^(99)Tc^(m)-DX淋巴显像诊断原发性小肠淋巴管扩张症的价值  

Value of CT Lymphangiography Combined with ^(99)Tc^(m)-DX Lymphoscintigraphy in Diagnosing Primary Intestinal Lymphangiectasia

作　　者：温静[1] 文哲 郝昆 颜煖 关晓姣 郭佳 孙小丽[1] 王仁贵[1] WEN Jing;WEN Zhe;HAO Kun(Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,P.R.China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射科,北京100038 [2]首都医科大学附属北京世纪坛医院核医学科,北京100038 [3]首都医科大学附属北京世纪坛医院淋巴外科,北京100038

出　　处：《临床放射学杂志》2022年第4期664-670,共7页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:61876216);北京世纪坛医院青年基金项目(编号:2015-q11)。

摘　　要：目的探讨联合直接淋巴管造影(DLG)后多层螺旋CT(MSCT)CT淋巴管成像(CTL)与^(99)Tc^(m)-DX淋巴显像两种检查方法在诊断原发性小肠淋巴管扩张症(PIL)中的应用价值。方法回顾性分析经手术病理和/或小肠内镜确诊为PIL的52例患者资料,所有患者均行^(99)Tc^(m)-DX淋巴显像及CTL两种检查。根据^(99)Tc^(m)-DX淋巴显像结果将PIL分为三型:1型:肠道动态显影型;2型:肠道延迟显影型;3型:肠道未显影型。并分别记录每组的CTL影像学表现,CTL评价指标包括肠系膜、肠壁、腹膜后、腹腔脏器对比剂异常分布、肠腔瘘、腹腔瘘、骶前反流、对侧腰干反流等。将各组的CTL评价指标进行统计学分析,P﹤0.05为差异有统计学意义。结果52例PIL患者^(99)Tc^(m)-DX淋巴显像表现为1型12例,2型17例,3型23例。CTL影像评价指标中,肠系膜、肠壁对比剂异常分布、腹膜后对比剂异常分布、腹腔脏器对比剂异常分布、肠腔瘘、腹腔瘘、骶前反流的发生率,^(99)Tc^(m)-DX淋巴显像1型均明显高于2、3型,差异均有统计学意义。结论PIL的^(99)Tc^(m)-DX淋巴显像分型从功能上反映了肠道淋巴液漏出的情况,而CTL从解剖上可清晰显示不同部位的淋巴管异常及乳糜反流,联合应用两种影像学方法对诊断PIL有重要价值。Objective To investigate the value of two examination methods,combined direct lymphangiography followed by MSCT(CTL)and ^(99)Tc^(m)-DX lymphoscintigraphy,in the diagnosis of primary intestinal lymphangiectasia(PIL).Methods Fifty-two patients diagnosed with PIL by surgical pathology and/or small bowel endoscopy were retrospectively analyzed,and all patients underwent both ^(99)Tc^(m)-DX lymphoscintigraphy and CTL.According to the ^(99)Tc^(m)-DX lymphoscintigraphy results,PIL was classified into three types:type one,consecutive visualization of intestine;type two,delayed visualization of intestine;and type three,novisualization of intestine.The CTL imaging performance of each group was also recorded separately.The CTL evaluation indexes included intestinal fistula,abdominal fistula,presacral reflux,contralateral lumbar stem reflux and abnormal distribution of contrast in mesentery,intestinal wall,retroperitoneum,abdominal organs.The CTL evaluation indexes of each group were statistically analyzed,and the difference was statistically significant at P﹤0.05.Results Fifty-two PIL patients with ^(99)Tc^(m)-DX lymphoscintigraphy showed 12 cases of type one,17 cases of type two,and 23 cases of type three.Among the CTL evaluation indexes,the incidence of intestinal fistula,abdominal fistula,presacral reflux and abnormal distribution of contrast in mesentery,intestinal wall,retroperitoneum,abdominal organs were significantly higher in ^(99)Tc^(m)-DX lymphoscintigraphy type one than in type two and three,and the differences were all statistically significant.Conclusion The ^(99)Tc^(m)-DX lymphoscintigraphy typing of PIL functionally reflects the leakage of intestinal lymphatic fluid,while CTL clearly shows the abnormal lymphatic vessels and celiac reflux at different sites anatomically,and the combined application of the two imaging methods is of great value for the diagnosis of PIL.

关 键 词：原发性小肠淋巴管扩张症 体层摄影术 X线计算机 直接淋巴管造影 ^(99)Tc^(m)-DX淋巴显像 

分 类 号：R574.5[医药卫生—消化系统] R816.5[医药卫生—内科学]