十二指肠憩室的多层螺旋CT表现及其临床意义

摘要

Objective To explore the multislice spiral computed tomography ( MSCT) manifestations of duodenal diverticula and analyze their clinical significance. Methods The clinical, gastrointestinal ( Cl) series and MSCT imaging data of 36 patients with duodenal diverticula were analyzed retrospectively. The relationship between these MSCT findings and clinical symptoms were also evaluated.Results In 36 patients, 41 duodenal diverticula were detected,of which 18 divenicula were less than 10mm in diameter, 12 diverticula were 10 - 20mm and 11 diverticula were larger than 20 mm on MSCT images. In diverticula ＞ 20mm , a compressed common bile duct was showed in 2 cases. MSCT manifested as cystic fluid - air density in 21 ( 51. 2％ ) diverticula, of which 2 (4. 8％ ) cases showed wall thickerung with adjacent exfiltration;17 (41. 5％ ) shawed simple cystic air density, of which 15 ( 88. 2％ ) diverticula were leas than 20mm; 2 (4. 8％ ) were simple cystic fluid density and 1 (2. 4％ ) case was mass with adjacent fluidity exfiltration. Enhancement CT scanning was performed in 23 patients and 26 diverticula were detected. Twelve ( 46. 2％ ) diverticula had a ring - shaped enhancement capsule wall, but 14 (53. 8％ ) diverticula were not. One patient had a mass and 2 patients had capsule wall thickening. All of them had adjacent exfiltration. These CT signa were correlated with their clinical symptoms. Conclusion Cystic fluid - air and aimple air density imaging are typical CT signs of the duodenal diverticula. A duodenal diverticula with simple cystic fluid imaging is misdiagnosed easily as a pancreatic cyst or cystic tumor. Capsule wall thickening and mass formation with adjacent exfiltration or pneumatosis are CT signs of secondary infection or perforating.%目的 探讨十二指肠憩室的多层螺旋CT(multislice spiral CT, MSCT)表现,并分析其临床意义.方法 收集36例十二指肠憩室的临床、消化道钡餐及MSCT检查资料,回顾性分析其影像学表现及其临床联系.结果 36例患者中,MSCT共检出十二指肠憩室41个,直径小于10mm 者18个,10～20mm者12个,大于20mm者11个,其中2个伴有邻近胆总管轻度受压.MSCT表现为液气囊状影21个(51.2%),其中囊壁显著增厚伴周围渗出性改变2个(4.8%);单纯气性囊状影17个(41.5%),其中15个(88.2%)直径小于20mm;单纯液性囊状影2个(4.8%);肿块形成伴周围渗出性改变1个(2.4%).23例行增强扫描的26个憩室中,可见囊壁显示且呈环形强化者12个(46.2%),其余14个(53.8%)均未见明确囊壁显示.2例囊壁显著增厚及1例肿块形成伴周围渗出性改变的憩室与其临床症状相关.结论 液气囊状影和单纯气性囊状影是十二指肠憩室的典型CT表现,单纯液性囊状影容易误诊为胰腺囊肿或囊性肿瘤,囊壁增厚、肿块形成伴周围渗出性改变或积气是憩室继发感染或穿孔的CT表现.