直接淋巴管造影术后CT在原发性小肠淋巴管扩张症中的回顾性研究
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摘要
目的探讨直接淋巴管造影术后CT(PLCT)在原发性小肠淋巴管扩张症(PIL)中的诊断价值。方法回顾性分析2010年1月至2016年12月经内镜检查确诊为PIL的患者25例,所有患者均于内镜检查后2周内行PLCT检查。两名放射科医师采用盲法分析图像。PLCT评价内容包括(1)小肠肠壁增厚;(2)水肿样病变及其范围;(3)对比剂在小肠壁与肠系膜的异常分布;(4)返流;(5)腹部其他异常淋巴管的部位及范围;(6)颈部异常对比剂分布。按PLCT中小肠壁与肠系膜是否有异常分布的对比剂分为两组,进行比较及统计学分析,以P<0.05差异有统计学意义。结果肠壁增厚23例,水肿样改变15例,其中7例仅腹腔积液,8例胸、腹腔积液;肠壁与肠系膜异常对比剂分布13例,10例出现对比剂返流至盆腔。腹腔内其他异常扩张淋巴管包括:4例分布于腰大肌及椎旁区域,1例分布于双肾盂,2例分布于骶骨前缘及直肠周围;21例颈部胸导管出口旁大片对比剂分布,其中3例出现于左侧腋下,4例位于双侧颈部。按对比剂是否分布于小肠及肠系膜将PIL分两组,阴性组的平均年龄、返流及腹膜后其他部位异常淋巴管扩张比例均明显小于阳性组。结论小肠壁及肠系膜内对比剂的分布是PIL的特异征象,提示异常扩张淋巴管的分布和范围,对PIL治疗方式的选择和术前评价具有重要意义。
Objective To investigate the clinical value of post-lymphangiographic CT( PLCT) in primary Intestinal Lymphangiectasia( PIL). Methods Twenty-five patients diagnosed as PIL with endoscopy were recruited in this study from 2010 to 2016. All the patients were performed PLCT within 2 weeks after capsule endoscopy,and the imaging data were reviewed by two radiologists separately. Subjective assessment included( 1) intestinal wall thickening,( 2) edematous lesions,( 3) abnormal distribution of contrast media in intestinal wall or mesentery,( 4) lymphatics reflux,( 5) lymphangiectasia in other abdominal area,( 6) abnormal distribution of contrast media around thoracic outlet area. Results Twenty-three intestinal wall thickening and 15 edematous lesions( 7 ascites only,8 pleural and peritoneal fluids),13 intestinal and mesenteric lymphangiectasia and 10 lymphatics reflux to pelvis were found in PLCT,while for other abdominal lymphangiectasia,4 around psoas muscle and lumbar vertebra,1 in bilateral renal pelvis,2 in presacral area and around rectum. Besides,21 abnormal distributions of contrast media around thoracic outlet were found,including 3 in axilla and 4 in bilateral neck. Based on the distribution of contrast media in intestines and mesentery,PIL was divided into positive( 13 cases) and negative( 12 cases) group. For negative cases,the average age( 8. 7 Versus 23. 6 years),lymphatics reflux( 18. 2% Versus 61. 5%) and lymphangiectasia in other area( 18. 2% Versus 38. 5%) is lower than positive group.( all P < 0. 05).Conclusion Intestinal and mesenteric distribution of contrast media is the specific imaging feature in PIL,which is important for therapeutic management and preoperative assessment.
Objective To investigate the clinical value of post-lymphangiographic CT( PLCT) in primary Intestinal Lymphangiectasia( PIL). Methods Twenty-five patients diagnosed as PIL with endoscopy were recruited in this study from 2010 to 2016. All the patients were performed PLCT within 2 weeks after capsule endoscopy,and the imaging data were reviewed by two radiologists separately. Subjective assessment included( 1) intestinal wall thickening,( 2) edematous lesions,( 3) abnormal distribution of contrast media in intestinal wall or mesentery,( 4) lymphatics reflux,( 5) lymphangiectasia in other abdominal area,( 6) abnormal distribution of contrast media around thoracic outlet area. Results Twenty-three intestinal wall thickening and 15 edematous lesions( 7 ascites only,8 pleural and peritoneal fluids),13 intestinal and mesenteric lymphangiectasia and 10 lymphatics reflux to pelvis were found in PLCT,while for other abdominal lymphangiectasia,4 around psoas muscle and lumbar vertebra,1 in bilateral renal pelvis,2 in presacral area and around rectum. Besides,21 abnormal distributions of contrast media around thoracic outlet were found,including 3 in axilla and 4 in bilateral neck. Based on the distribution of contrast media in intestines and mesentery,PIL was divided into positive( 13 cases) and negative( 12 cases) group. For negative cases,the average age( 8. 7 Versus 23. 6 years),lymphatics reflux( 18. 2% Versus 61. 5%) and lymphangiectasia in other area( 18. 2% Versus 38. 5%) is lower than positive group.( all P < 0. 05).Conclusion Intestinal and mesenteric distribution of contrast media is the specific imaging feature in PIL,which is important for therapeutic management and preoperative assessment.
引文
1 Freeman HJ,Nimmo M.Intestinal lymphangiectasia in adults[J].World Journal of Gastrointestinal Oncology,2011,3:19-23.
2 Lakshminarayana G,Mathew A,Rajesh R,et al.Hennekam lymphangiectasia syndrome[J].Indian Journal of Nephrology,2011,21:273-275.
3 Oh TG,Chung JW,Kim HM,et al.Primary intestinal lymphangiectasia diagnosed by capsule endoscopy and double balloon enteroscopy[J].World Journal of Gastrointestinal Endoscopy,2011,3:235-240.
4 Ingle SB,Hinge Ingle CR.Primary intestinal lymphangiectasia:Minireview[J].World Journal of Clinical Cases,2014,2:528-533.
5 Mine K,Matsubayashi S,Nakai Y,et al.Intestinal lymphangiectasia markedly improved with antiplasmin therapy[J].Gastroenterology,1989,96:1596-1599.
6 Guermazi A,Brice P,Hennequin C,et al.Lymphography:An Old Technique Retains Its Usefulness[J].Radiographics,2003,23:1541-1558.
7 Suga K,Shimizu K,Kawakami Y,et al.Lymphatic drainage from esophagogastric tract:feasibility of endoscopic CT lymphography for direct visualization of pathways[J].Radiology,2005,237:952-960.
8 Xiong L,Engel H,Gazyakan E,et al.Current techniques for lymphatic imaging:State of the art and future perspectives[J].European Journal of Surgical Oncology,2014,40:270-276.
9 Lee EW,Shin JH,Ko HK,et al.Lymphangiography to Treat Postoperative Lymphatic Leakage:A Technical Review[J].Korean J Radi ol,2014,15,724-732.
10 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldmann's disease)[J].Orphanet J Rare Dis,2008,3:5.
11 Connell FC,Gordon K,Brice G,et al.The classification and diagnostic algorithm for primary lymphatic dysplasia:an update from2010 to include molecular findings[J].Clinical Genetics,2013,84:303-314.
12 Hokari R,Kitagawa N,Watanabe C,et al.Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss[J].J Gastroenterol Hepatol,2008,23:e88-e95.
13 Gruber-Rouh T,Naguib NNN,Lehnert T,et al.Direct lymphangiography as treatment option of lymphatic leakage:Indications,outcomes and role in patient's management[J].Eur J Radiol,2014:83,2167-2171.
14 Cammarota G,Cianci R,Gasbarrini G.High-resolution magnifying video endoscopy in primary intestinal lymphangiectasia:a new role for endoscopy?[J].Endoscopy,2005,37:607.
15 Fang YH,Zhang BL,Wu JG,et al.A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery:a case report[J].World J Gastroenterol,2007,13:2263-2265.
16 Imbesi V,Ciccocioppo R,Corazza GR.Long-Standing Intestinal Lymphangiectasia Detected by Double-Balloon Enteroscopy[J].Clinical Gastroenterology and Hepatology,2011,9:e88-e89.
17 陈孝柏,魏海亮,张建梅,等.直接淋巴管造影对胸导管出口梗阻的诊断价值[J].中华放射学杂志,2013,47:401-404.
18 刘勇,文哲,赵晓宁,等.超声检测颈段胸导管病变与小肠淋巴管扩张症的相关性[J].中国超声医学杂志,2015,31:8-11.
19 Wen Z,Tong G,Liu Y,et al.The lymphoscintigraphic manifestation of(99m)Tc-dextran lymphatic imaging in primary intestinal lymphangiectasia[J].Nuclear Medicine Communications,2014,35:493-500.
2 Lakshminarayana G,Mathew A,Rajesh R,et al.Hennekam lymphangiectasia syndrome[J].Indian Journal of Nephrology,2011,21:273-275.
3 Oh TG,Chung JW,Kim HM,et al.Primary intestinal lymphangiectasia diagnosed by capsule endoscopy and double balloon enteroscopy[J].World Journal of Gastrointestinal Endoscopy,2011,3:235-240.
4 Ingle SB,Hinge Ingle CR.Primary intestinal lymphangiectasia:Minireview[J].World Journal of Clinical Cases,2014,2:528-533.
5 Mine K,Matsubayashi S,Nakai Y,et al.Intestinal lymphangiectasia markedly improved with antiplasmin therapy[J].Gastroenterology,1989,96:1596-1599.
6 Guermazi A,Brice P,Hennequin C,et al.Lymphography:An Old Technique Retains Its Usefulness[J].Radiographics,2003,23:1541-1558.
7 Suga K,Shimizu K,Kawakami Y,et al.Lymphatic drainage from esophagogastric tract:feasibility of endoscopic CT lymphography for direct visualization of pathways[J].Radiology,2005,237:952-960.
8 Xiong L,Engel H,Gazyakan E,et al.Current techniques for lymphatic imaging:State of the art and future perspectives[J].European Journal of Surgical Oncology,2014,40:270-276.
9 Lee EW,Shin JH,Ko HK,et al.Lymphangiography to Treat Postoperative Lymphatic Leakage:A Technical Review[J].Korean J Radi ol,2014,15,724-732.
10 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldmann's disease)[J].Orphanet J Rare Dis,2008,3:5.
11 Connell FC,Gordon K,Brice G,et al.The classification and diagnostic algorithm for primary lymphatic dysplasia:an update from2010 to include molecular findings[J].Clinical Genetics,2013,84:303-314.
12 Hokari R,Kitagawa N,Watanabe C,et al.Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss[J].J Gastroenterol Hepatol,2008,23:e88-e95.
13 Gruber-Rouh T,Naguib NNN,Lehnert T,et al.Direct lymphangiography as treatment option of lymphatic leakage:Indications,outcomes and role in patient's management[J].Eur J Radiol,2014:83,2167-2171.
14 Cammarota G,Cianci R,Gasbarrini G.High-resolution magnifying video endoscopy in primary intestinal lymphangiectasia:a new role for endoscopy?[J].Endoscopy,2005,37:607.
15 Fang YH,Zhang BL,Wu JG,et al.A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery:a case report[J].World J Gastroenterol,2007,13:2263-2265.
16 Imbesi V,Ciccocioppo R,Corazza GR.Long-Standing Intestinal Lymphangiectasia Detected by Double-Balloon Enteroscopy[J].Clinical Gastroenterology and Hepatology,2011,9:e88-e89.
17 陈孝柏,魏海亮,张建梅,等.直接淋巴管造影对胸导管出口梗阻的诊断价值[J].中华放射学杂志,2013,47:401-404.
18 刘勇,文哲,赵晓宁,等.超声检测颈段胸导管病变与小肠淋巴管扩张症的相关性[J].中国超声医学杂志,2015,31:8-11.
19 Wen Z,Tong G,Liu Y,et al.The lymphoscintigraphic manifestation of(99m)Tc-dextran lymphatic imaging in primary intestinal lymphangiectasia[J].Nuclear Medicine Communications,2014,35:493-500.