核磁共振淋巴造影在胸腹腔乳糜漏中的诊断价值研究  

Magnetic resonance lymphography in detecting chylous leakage of thoracic and abdominal cavities

作　　者：陈传智 龚秀茹 都业弘 王轶彬[1] 路青 CHEN Chuanzhi;GONG Xiuru;DU Yehong;WANG Yibin;LU Qing(Department of Radiology,Shanghai East Hospital,Shanghai 200120,China)

机构地区：[1]上海市东方医院医学影像科,上海200120

出　　处：《上海医学》2024年第11期692-700,共9页Shanghai Medical Journal

基　　金：上海市卫生健康委员会科研项目(202340212);上海市东方医院引进人才科研启动项目(DFRC2023015)。

摘　　要：目的探讨超声引导胸腹股沟淋巴结穿刺注射对比剂进行MRI淋巴造影(DCMRL)显示胸腹部淋巴管成像的可行性,并评估其对乳糜漏的诊断价值。方法纳入2020年10月—2024年10月间在东方医院经临床确诊,拟进一步治疗,行DCMRL检查的乳糜漏患者24例,其中男13例、女11例,年龄为(52±13)岁。所有患者均于MRI检查室外注射室内经超声引导下穿刺腹股沟淋巴结注射对比剂,进行胸腹部淋巴管动态对比增强MRI成像。记录所有患者双侧腹股沟淋巴结对比剂注射时长、注射对比剂结束至增强首期成像时间,对比剂至盆腔髂血管旁淋巴管、腰干、乳糜池、胸导管、胸导管出口的显影时间。由两位高年资影像科医师采用影像质量评估5分法对图像质量进行评价。结果24例患者中,胸腹腔乳糜性积液8例,腹腔乳糜性积液11例,胸腔乳糜性积液3例,胸腔积液合并心包乳糜性积液1例,心包乳糜性积液1例。双侧腹股沟淋巴结注射对比剂时长为(1.83±0.86)min,注射对比剂结束至增强首期成像时间为(3.39±1.09)min,对比剂至盆腔髂血管旁淋巴管显影时间为(9.05±1.55)min,对比剂至腰干显影时间为(9.05±1.55)min,对比剂至乳糜池显影时间为(10.83±2.23)min,对比剂至胸导管显影时间为(10.50±3.45)min,对比剂至胸导管出口显影时间为(10.50±3.45)min。图像质量评分5分6例(25%),4分12例(50%),3分6例(25%)。24例患者均显示盆腔髂血管旁淋巴管、双侧腰干、乳糜池淋巴管,23例患者显示胸导管淋巴管,22例患者显示胸导管出口淋巴管。显性乳糜漏患者18例,共发现24个乳糜漏点,其中7个位于盆腔,5个位于腹腔,10个位于胸腔,2个位于心包腔;隐性乳糜漏患者4例;可疑乳糜漏患者2例。5例显性乳糜漏患者接受腹股沟淋巴结内注射碘油治疗,1例显性腹盆腔乳糜漏患者接受腹腔镜下包裹、缝合手术,治疗后引流量逐渐减少;12例显性乳糜漏、4例隐性�Objective To explore the feasibility of ultrasound-guided inguinal lymph node puncture and contrast agent injection for dynamic contrast-enhanced MR lymphangiography(DCMRL)in visualizing thoracic and abdominal lymphatics,and to evaluate its value in detecting chylous leakage.Methods A total of 24 patients with chylous leakage who were clinically confirmed and scheduled for treatment at Shanghai East Hospital between October 2020 and October 2024 were included in this study.There were 13 males and 11 females with an average age of(52±13)years.All the patients underwent ultrasound-guided puncture and injection of contrast agent into the inguinal lymph nodes outside the magnet room,followed by thoracic and abdominal DCMRL.The duration of contrast agent injection into the bilateral inguinal lymph nodes,the time from the end of contrast agent injection to the first phase of enhanced imaging,and the developing time of contrast agent in the lymphatic vessels beside the pelvic iliac vessels,lumbar trunks,cisterna chyli,thoracic duct,and thoracic duct outlet were recorded.The image quality was evaluated by two senior radiologists using a 5-point scale.Results There were 8 patients with chylous effusion in the thoracic and abdominal cavities,11 with chylous effusion in the abdominal cavity,3 with chylous effusion in the thoracic cavity,1 with pleural effusion and pericardial chylous effusion,and 1 with pericardial chylous effusion.The duration of contrast agent injection into the bilateral inguinal lymph nodes was(1.83±0.86)min.The time from the end of contrast agent injection to the first phase of enhanced imaging was(3.39±1.09)min.The developing time of contrast agent in the lymphatic vessels beside the pelvic iliac vessels,lumbar trunks,cisterna chyli,thoracic duct,and thoracic duct outlet was(9.05±1.55)min,(9.05±1.55)min,(10.83±2.23)min,(10.50±3.45)min,and(10.50±3.45)min,respectively.The image quality score was 5 in 6 cases(25%),4 in 12 cases(50%),and 3 in 6 cases(25%).The lymphatic vessels beside the pelvic il

关 键 词：乳糜漏 磁共振成像 淋巴造影术 胸导管 乳糜池 

分 类 号：R445.2[医药卫生—影像医学与核医学]