摘要
目的探讨非增强MR淋巴成像(MRL)与直接淋巴管造影(DLG)术后CT对定位诊断乳糜尿患者淋巴管-泌尿系瘘道与胸导管异常的价值。方法回顾性分析24例乳糜尿患者MRL及DLG后CT资料,观察MRL所示肾淋巴管及其他腹膜后淋巴管扩张、胸导管扩张和胸导管周围纡曲淋巴管,DLG后CT所示肾淋巴管和泌尿系对比剂反流、髂干和胸导管出口区淋巴管对比剂反流,判断淋巴管-泌尿系瘘道位置和胸导管梗阻相关征象。结果MRL显示19例(19/24,79.17%)淋巴管-泌尿系瘘道,位于双肾2例,左肾6例,右肾10例,膀胱1例。DLG后CT显示24例淋巴管-泌尿系瘘道,位于双肾6例,左肾7例,右肾10例,膀胱1例。MRL与DLG术后CT的一致性中等(Kappa=0.601,P<0.001),判断单侧肾脏水平淋巴管-泌尿系瘘差异有统计学意义(χ^2=22.463,P<0.001),MRL敏感度68.97%,特异度100%。2例DLG及术后CT对比剂未达胸导管颈段,MRL显示其中1例颈段胸导管。MRL发现2例DLG术后CT漏诊的合并单侧双肾盂输尿管畸形。结论MRL可作为无创显示乳糜尿患者淋巴管-泌尿系瘘道的初步检查方法;联合DLG术后CT能为评估淋巴管-泌尿系瘘及胸导管梗阻提供更多信息。
Objective To explore the value of unenhanced MR lymphography(MRL)and CT after direct lymphangiography(DLG)in diagnosis of lympho-urinary fistula location and thoracic duct abnormalities in patients with chyluria.Methods Data of 24 patients with chyluria were reviewed.The position of lympho-urinary fistula and signs related to obstruction of thoracic duct(TD)were analyzed.Dilated renal lymphatics and other retroperitoneal lymphatics,dilatation of TD,multiple tortuous dilated lymphatics around TD were evaluated with MRL,while contrast media reflux of renal lymphatic and urinary system,lymphatics in the outlet area of iliac trunk and thoracic duct were observed with CT after DLG.Results MRL depicted lympho-urinary fistula in 19 cases(79.17%),including 2 cases in bilateral kidneys,6 in left and 10 in right kidney,and 1 case in bladder.CT after DLG showed the level of lympho-urinary fistula,including 6 cases in bilateral kidneys,7 in left and 10 in right kidney,also 1 case in bladder.The consistency between MRL and DLG plus CT was moderate(Kappa=0.601,P<0.001).There was significant difference of unilateral renal level lympho-urinary fistula between MRL and CT after DLG(χ^2=22.463,P<0.001),the sensitivity and specificity of MRL was 68.97%and 100%,respectively.No contrast medium distribution at cervical section of TD was found neither with DLG nor CT after DLG,but was observed in one of them with MRL.MRL detected unilateral double renal pelvis and ureter in 2 cases misdiagnosed with CT after DLG.Conclusion MRL can be used as a noninvasive preliminary examination for lympho-urinary fistula in patients with chyluria,combining with CT after DLG can provide comprehensive assessment of TD and lympho-urinary fistula.
作者
孔令
岳云龙
左利利
董健
陈孝柏
温廷国
金延方
王仁贵
KONG Ling;YUE Yunlong;ZUO Lili;DONG Jian;CHEN Xiaobai;WEN Tingguo;JIN Yanfang;WANG Rengui(Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of MR,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中国医学影像技术》
CSCD
北大核心
2020年第5期707-711,共5页
Chinese Journal of Medical Imaging Technology
基金
北京市属医院科研培育计划(PX2017049)。
