非肿瘤性肠壁增厚的多层螺旋CT表现与病理基础

陈光文; 宋 彬; 吴 苾

中国临床医学影像杂志 ›› 2009, Vol. 20 ›› Issue (8) : 615-619.

论著

非肿瘤性肠壁增厚的多层螺旋CT表现与病理基础

陈光文，宋彬，吴苾

作者信息 +

MDCT findings and pathological basis for non-tumorous bowel wall thickening

CHEN Guang-wen, SONG Bin, WU Bi

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文章历史 +

摘要

目的：探讨由非肿瘤性疾病引起的肠壁增厚的多层螺旋CT（MDCT）表现及病理基础。方法：回顾分析284例经手术、内镜取活检或临床证实的非肿瘤性肠壁增厚患者的CT资料，记录肠壁增厚的分布、增厚方式、程度、密度、强化方式以及相关肠外异常，分析CT征象的病理基础。结果：284例患者引起肠壁增厚的病因包括肝硬化门静脉高压109例，急性胰腺炎54例，肠梗阻36例，炎症性肠病14例，缺血性肠病12例，放射性肠炎13例，结核12例，免疫系统疾病10例，感染性肠炎3例，急性阑尾炎3例，低蛋白血症5例，其它少见病8例，正常变异5例。所有非肿瘤性肠壁增厚在CT上的表现：1例高密度，144例等密度，127例低密度，5例脂肪沉积，7例肠壁积气；轻度强化249例，显著强化32例，不强化3例；271例均匀增厚，13例不均匀增厚；279例轻度增厚，5例显著增厚；单个解剖部位受累72例，多个解剖部位受累212例。相关肠外异常：肠系膜脂肪肿胀218例，腹水189例，淋巴结肿大5例，肠周脓肿2例，肠系膜血管病变25例，实质器官受累169例。结论：非肿瘤性疾病引起的肠壁增厚在MDCT上主要表现为轻度均匀性增厚，等、低密度，轻度强化，常累及多个解剖部位。熟悉各种引起肠壁增厚疾病的病理基础和CT表现特征，有助于疾病的诊断和鉴别诊断。

Abstract

Objective: To investigate the MDCT imaging manifestations and pathological basis of bowel wall thickening due to nontumorous causes. Methods: MDCT findings of 284 patients with bowel wall thickening due to nontumorous causes confirmed by surgery, biopsy or clinical follow-up were studied retrospectively, paying attention to location, range, symmetric or asymmetric, involvement degree of thickening, attenuation, presence or absence of enhancement and associated perienteric abnormalities of thickened bowel wall. MDCT findings were analyzed with correlation with pathological changes. Results: All the non-tumorous disease caused bowel wall thickening included liver cirrhosis(109 cases) , acute pancreatitis(54 cases), bowel obstruction(36 cases), inflammatory bowel disease(14 cases), ischemic bowel disease(12 cases), radiation enterocolitis(13 cases), tuberculosis (12 cases), immune reaction(10 cases), infective enteritis(3 cases), acute appendicitis(3 cases), hypoproteinemia(5 cases), rare diseases(8 cases) and normal variants(5 cases). The attenuation pattern of the thickened bowel wall included high attenuation(1 case), iso-attenuation(144 cases), low attenuation(127 cases), fat deposition(5 cases) and pneumatosis(7 cases). The enhancement pattern of the thickened bowel wall included mild enhancement(249 cases), marked enhancement(32 cases) and unenhancement(3 cases). Degree of bowel wall thickening included mild thickening(279 cases) and marked thickening(5 cases). Two hundred and twelve patients with bowel wall thickening showed multisegmental distribution while 72 patients had single segmental involvement. Associated perienteric abnormalities of thickened bowel wall included swelling of fat(218 cases), ascites(189 cases), lymphadenopathy(5 cases), perienteirc abscess(2 cases), mesenteric vascular lesion(25 cases) and involvement of solid abdominal organs(169 cases). Conclusion: Bowel wall thickening due to nontumorous causes showed mild and homogeneous thickening, iso-attenuation or low attenuation, mild enhancement and multisegmental distribution on MDCT. Paying attention to the characteristics and pathological basis of thickening of bowel wall benefits the diagnosis and differential diagnosis of various intestinal diseases.

导出引用

陈光文;宋彬;吴苾. 非肿瘤性肠壁增厚的多层螺旋CT表现与病理基础[J]. 中国临床医学影像杂志. 2009, 20(8): 615-619

CHEN Guang-wen;SONG Bin;WU Bi. MDCT findings and pathological basis for non-tumorous bowel wall thickening[J]. Journal of China Clinic Medical Imaging. 2009, 20(8): 615-619

中图分类号： Ｒ574 Ｒ814.42