腹膜轉(zhuǎn)移瘤的CT診斷及鑒別-2課件

1、腹膜轉(zhuǎn)移瘤的CT診斷及鑒別壁層、臟層腹膜壁層-貼附于腹壁、橫膈臟面和盆壁的內(nèi)面；臟層-覆蓋于內(nèi)臟表面，成為它們的漿膜層臟層腹膜將內(nèi)臟器官懸垂或固定于膈肌、腹后壁或盆腔壁，形成網(wǎng)膜、腸系膜及幾個(gè)韌帶腹膜腔是壁層腹膜和臟層腹膜之間的潛在間隙，在正常情況下，腹腔內(nèi)有75100ml黃色澄清液體，起潤滑作用。腹膜腔分為大、小腹腔兩部分，即腹腔和網(wǎng)膜囊腹膜的解剖結(jié)構(gòu)大網(wǎng)膜是連接胃大彎至橫結(jié)腸的腹膜，呈圍裙?fàn)钫诒豢铡⒒啬c大網(wǎng)膜共四層：包括胃前、后壁的腹膜在胃大彎處愈合，形成大網(wǎng)膜的前兩層，向下延伸至臍平面稍下方，然后向后上折返，包被橫結(jié)腸，形成大網(wǎng)膜的后兩層腸系膜包括小腸系膜、橫結(jié)腸系膜、乙狀結(jié)腸系膜等網(wǎng)膜

2、囊（小腹膜腔） 小網(wǎng)膜和胃后壁與腹后壁的腹膜之間的一個(gè)扁窄間隙。腹膜轉(zhuǎn)移瘤是腹膜最常見的腫瘤腹膜轉(zhuǎn)移瘤是腹部惡性腫瘤沿系膜、韌帶直接蔓延、腹膜腔種植及淋巴轉(zhuǎn)移、血行轉(zhuǎn)移的結(jié)果原發(fā)腫瘤多起源于胃、結(jié)腸或卵巢，其次為胰腺、膽道或子宮血行播散，惡性程度高的原發(fā)腫瘤鄰近器官/組織直接蔓延淋巴道轉(zhuǎn)移：大網(wǎng)膜淋巴系統(tǒng)，右側(cè)膈下淋巴系統(tǒng)（引流至前縱膈淋巴鏈-右側(cè)淋巴管-鎖骨下靜脈）當(dāng)其梗阻出現(xiàn)腹水腹膜表面播散：重力作用（乙狀結(jié)腸上部，腸系膜下部，Douglas腔，右側(cè)結(jié)腸旁溝）；蠕動(dòng)運(yùn)動(dòng)腹膜轉(zhuǎn)移瘤播散途徑1、腹膜假性粘液瘤肝表面 “扇貝樣”壓跡腹腔積液形成囊腔鈣化，尤其呈弧形時(shí)懷疑多位于大網(wǎng)膜和橫膈膜，較少

3、累及胃腸表面腹膜闌尾可見液性或軟組織團(tuán)塊鑒別診斷2、惡性腹膜間皮瘤石棉暴露相關(guān)，4類，惡性，囊性/囊實(shí)性，腺瘤樣，分化良好的乳頭狀間皮瘤胸膜異常表現(xiàn)，鈣化斑無法探及原發(fā)腫瘤或繼發(fā)性肝臟病灶及淋巴結(jié)3、腹膜淋巴瘤常有淋巴結(jié)受累，主動(dòng)脈前和腹膜后淋巴結(jié)腫大，可融合，血管夾心征，軟，均質(zhì)無明顯壞死，非梗阻性，相對(duì)血供少脾腫大，不常見胃腸道侵犯，尤其胃和回腸末端4、腹膜結(jié)核出現(xiàn)腸系膜大結(jié)節(jié)可見側(cè)腹壁均勻增厚及強(qiáng)化（平滑均勻）脾腫大，脾臟鈣化灶回盲部腸壁受累后腹膜及胰腺周圍的淋巴結(jié)腫大，低密度中心及環(huán)形強(qiáng)化Figure 16. Peritoneal tuberculosis in a 45-year o

4、ld Senegalese male. A and B. Presence of left iliac and splenic hilar lymphadenopathies with necrotic centre (black arrow heads). C and D. Enhancement and regular thickening of the parietal peritoneum, iliac fossae, and pelvis (white arrow heads) with free ascites (asterisk).E. Invasion of the great

5、er omentum (black arrow) and lymph nodes of the mesenteric root.5、脾種植常有外傷脾臟破裂，脾切除史，無臨床癥狀脾臟碎片種植于腹膜腔，皮下，縱隔、胸膜腔（膈破裂）平掃等密度，增強(qiáng)強(qiáng)化方式同脾臟，無腹水Figure 17. Incidental sonographic discovery of soft-tissue lesions that are splenosis implants in a 45-year old female with a history of splenectomy following a road ac

6、cident. A. Note the history of splenectomy (asterisk). Presence of peritoneal tissue lesions (black arrow heads) in the splenectomy site (C) and in the right peri-renal space (B). An enhancement study (white arrow heads) found isodensity to the hepatic parenchyma before administration of intravenous

7、 contrast material(D), then a non-homogeneous appearance in the arterial phase(E), becoming homogeneous in the venous phase(F).6、彌漫性腹膜平滑肌瘤病罕見良性病變，腹膜肌瘤結(jié)節(jié)（病理似子宮平滑肌瘤）多見于黑人，育齡期婦女，與雌孕激素避孕藥攝入有關(guān)主要累及盆腹膜及大網(wǎng)膜，子宮，卵巢，臟層腹膜延遲強(qiáng)化，無淋巴結(jié)腫大及胃壁增厚，無腹水及肝轉(zhuǎn)移灶Figure 18. A 45-year old female was investigated for a feeling of

8、pressure in the pelvis leading to the incidental discovery of diffuse peritoneal leiomyomatosis(DPL) confirmed histologically by diagnostic peritoneoscopy. A and C. Large pelvic soft-tissue mass displacing the adjacent organs, enhancing progressively and non-homogeneously in the venous phase (black arrow heads).B and D. It becomes homogeneous and enhances more markedly in the delayed phase at 5 min(white arrow heads).壁腹膜呈寬帶狀