摘要
目的回顾分析腹盆腔结核CT[或正电子发射计算机体层摄影（PET）-CT]表现特征，以提高本病的诊断水平。方法收集广州军区总医院2009年7月至2016年7月经病理或临床、实验室检查证实的腹盆腔结核患者35例。其中男18例，女17例，年龄13-74岁，平均年龄（41．8±17．6）岁。29例患者行CT平扫＋增强扫描；6例行PET-CT检查。结果单纯淋巴结结核1例；结核性腹膜炎16例，其中10例并发腹盆腔淋巴结结核；腹盆腔内脏结核12例，其中4例并发淋巴结结核；消化道结核（肠结核为主）3例，其中2例并发淋巴结结核；前列腺和精囊腺结核并发输尿管结核1例，结核性腹膜炎并发肠结核和淋巴结结核1例，结核性腹膜炎并发肾上腺结核1例。腹盆腔淋巴结结核表现为淋巴结数目增多、肿大、坏死及环形强化、钙化，且常并发其他部位结核。结核性腹膜炎表现为腹膜增厚（严重者呈“饼状改变”，PET-CT显示腹膜条状及片状代谢增高）、脂肪间隙浑浊、淋巴结改变、腹盆腔积液、肠梗阻。腹盆腔内脏结核中泌尿系结核（包括。肾结核、单纯输尿管结核、膀胱结核）表现为肾实质内“花瓣样强化”低密度灶，输尿管、膀胱壁增厚和（或）肿块形成、钙化或结石等；盆腔生殖系统结核表现为女性腹盆腔巨大的分隔囊性包块，邻近壁腹膜增厚，男性前列腺囊实性包块，精囊腺增大、边缘模糊并邻近输尿管管壁增厚；胰腺结核表现为胰腺肿胀，密度均匀，胰周包裹性积液及多发小淋巴结；肾上腺结核表现为双侧。肾上腺块状及结节状均匀软组织密度，PET-CT显示放射性摄取异常增高，同时并发结核性腹膜炎。消化道结核表现为受累肠管的不规则增厚，增强呈延迟及环形强化。结论腹盆腔结核涉及脏器广泛，CT与PET-CT的影像学表现多样，相对无特异性。
Objective To improve the level of radiological diagnosis of peritoneal and pelvic tuberculosis by retrospective analysis of CT or PET-CT features. Methods We collected thirty-five cases with peritoneal and pel- vic tuberculosis admitted and confirmed by pathology, clinical manifestation and laboratory test in the General Hos- pital of Guangzhou Military Command of PLA during July 2009 to July 2016. There were 18 males and 17 females with average age of 41.8＋17.6 （ranged from 13 to 74）. Plain and contrast enhanced CT （CECT） were performed in 29 cases and 6 cases were examined by PET-CT. Results There were 1 case with lymphoid tuberculosis and 16 cases with tuberculous peritonitis including 10 cases complicated with peritoneal and pelvic lymphoid tuberculosis, 12 cases with peritoneal and pelvic visceral tuberculosis including 4 cases complicated with lymphoid tuberculosis, 3 cases with gastrointestinal tuberculosis including 2 cases complicated with lymphoid tuberculosis, 1 case with prostate and seminal vesicle tuberculosis complicated with ureteral tuberculosis, 1 case with tuberculous peritonitis complicated with intestinal tuberculosis and lymphoid tuberculosis, and 1 case with lymphoid tuberculosis complicated with adrenal tuberculosis. Peritoneal and pelvic lymphoid tuberculosis showed increased number of lymph nodes, enlargement, necrosis and ring enhancement, calcification, and often complicated with other parts of tuberculosis. Tuberculous peritonitis showed peritoneum thickening looked like pie in some serious cases which showed peritoneal strips and patches with increased metabolism, fat space turbidity, lymph node changing, peritoneal and pelvic effu-sion and intestinal obstruction. Urinary tuberculosis including renal tuberculosis, ureteral tuberculosis and bladder tuberculosis showed low-density focus looked like petaling enhancement in renal parenchyma, the wall of ureter and bladder thickening or mass formation or calcification or calculus. Pelvic reproductive system tuberculosis showed a
出处
《结核病与肺部健康杂志》
2016年第3期180-185,共6页
Journal of Tuberculosis and Lung Health
基金
国家自然科学基金(61273249)
广州市重大协同创新专项基金(201604020107)
国家科学仪器重大专项基金(61527811)
关键词
结核
腹腔
体层摄影术
X线计算机
诊断显像
Tuberculosis
Peritoneal
Tomography, X-Ray computed
Diagnostic imaging
