原发性下肢淋巴水肿的CT淋巴管成像表现  

CT Lymphangiography Features of Primary Lower Extremity Lymphedema

作　　者：刘梦珂 李兴鹏 张怡梦 张妍 郝琪 张晓杰 王仁贵 LIU Mengke;LI Xingpeng;ZHANG Yimeng(Department of Radiology,Affiliated 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,100038 [2]北京大学第九临床医学院放射科

出　　处：《临床放射学杂志》2024年第5期836-840,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金资助项目(编号:61876216)。

摘　　要：目的 探讨原发性下肢淋巴水肿(LEL)患者CT淋巴管成像(CTL)的影像表现。方法 回顾性搜集42例无明显诱因发生下肢肿胀且经淋巴核素显像诊断为LEL的患者,所有患者均于直接淋巴管造影术(DLG)后行常规胸腹盆部CT检查,同时重组CTL图像,分析CTL及常规胸腹盆部影像表现,并采用分类变量资料中的构成比进行统计描述。结果 42例患者CTL均显示不同部位的碘油异常沉积:胸导管末端39例,右淋巴导管7例,胸膜9例,纵隔12例,气管支气管周9例,心包1例,腋窝9例,横膈下28例,腹膜后间隙40例,肠系膜15例,肠周4例,胰周9例;注药对侧肾盂8例,腰干15例,髂干28例;注药侧肾盂5例,腰干12例,髂干42例,臀部12例,会阴18例,骨骼6例。42例患者常规胸腹盆部CT表现为肺内磨玻璃密度影21例,实变影4例,肺不张5例,网格影19例,胸膜下线征4例,树芽结节3例,支气管壁增厚19例,蛙卵征3例,胸腔积液7例,胸膜增厚14例,叶间裂增厚5例,心包积液4例,纵隔脂肪间隙混浊5例;腹盆壁皮下水肿5例,肠壁增厚6例,腹盆腔积液11例,肠系膜肿胀16例,腹盆腔/腹膜后淋巴结增多8例,腹股沟淋巴结增多4例。结论 原发性LEL是一种全身性淋巴管异常疾病。CTL检查能够明确淋巴管异常的范围、位置及程度,并清晰显示胸腹盆部的组织脏器情况,为原发性LEL的诊断和治疗提供有价值的影像信息。Objective To investigate the imaging performance of CT lymphangiography(CTL) in patients with primary lower extremity lymphedema(LEL). Methods 42 patients with lower extremity swelling and diagnosed with LEL by lymphangiography were retrospectively collected. All patients underwent conventional CT examination of the thoracoabdominopelvic region after direct lymphangiography(DLG) with simultaneous reconstruction of CTL images, and the CTL and conventional thoracoabdominopelvic imaging manifestations were analyzed and statistically described using the composition ratio in the categorical variable data. Results CTL of 42 patients showed abnormal iodine oil deposition in different areas: terminal thoracic duct in 39 cases, right lymphatic duct in 7 cases, pleura in 9 cases, mediastinum in 12 cases, peritracheal bronchus in 9 cases, pericardium in 1 case, axilla in 9 cases, subdiaphragm in 28 cases, retroperitoneal space in 40 cases, mesentery in 15 cases, peri-intestine in 4 cases, peripancreatic in 9 cases, contralateral renal pelvis in 8 cases, lumbar trunk in 15 cases, iliac trunk in 28 cases, lateral renal pelvis in 5 cases, ground-glass opacity in 12 cases, iliac trunk in 42 cases, buttocks in 12 cases, perineum in 18 cases, and bone in 6 cases. The routine CT of the chest, abdomen and pelvis in 42 patients showed ground-glass opacity(GGO) in 21 cases, solid shadow in 4 cases, pulmonary atelectasis in 5 cases, grid shadow in 19 cases, subpleural line sign in 4 cases, bud nodules in 3 cases, bronchial wall thickening in 19 cases, frog There were 3 cases of egg sign, 7 cases of pleural effusion, 14 cases of pleural thickening, 5 cases of interlobular fissure thickening, 4 cases of pericardial effusion, 5 cases of mediastinal fatty space clouding, 5 cases of subcutaneous edema of the abdominopelvic wall, 6 cases of intestinal wall thickening, 11 cases of abdominopelvic effusion, 16 cases of mesenteric swelling, 8 cases of increased abdominopelvic/retroperitoneal lymph nodes, and 4 cases of increased inguinal lymph

关 键 词：淋巴水肿 下肢 体层摄影术 直接淋巴管造影术 

分 类 号：R816.3[医药卫生—放射医学] R551.2[医药卫生—临床医学]