- 期刊
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The Differential Diagnosis of Ascites: CT Evaluation
電腦斷層攝影對良性或惡性腹水之鑑別診斷
摘要
本研究以5個徵象，回顧分析30份腹水病患的電腦斷層攝影圖，以鑑別良性或惡性腹水。這5個徵象為（1）腹水的分佈；（2）完整的腹膜內外界限；（3）腸道和腸系膜位置表徵；（4）是否合併肝內或肝外腹部腫塊；（5）是否合併後腹膜淋巴病變。我們的結果顯示，腹水合併腹內腫塊或後腹膜淋巴病變常為惡性腹水，準確度達100%。腹膜內外界限模糊或腸道和腸系膜向後汙黏成團（clouding or matting）則時常表示惡性疾病或發炎（敏感性各為60%和56.25%，特異性各為80%和71.42%）。在大量或少量腹水的病患，腹水的分佈對鑑別診斷幫助不大。（敏感度31.25%，特異性78.57%）。本文的病例中，除骨盆腔外，腹水最常積聚的位置在肝臟周圍和右側大腸旁溝（peri-hepatic or paracolic gutter），最不常出現的位置在小囊（lesser sac）。充份了解惡性腹水的表徵對鑑別診斷應有助益。
並列摘要
Five indices were used as rules of thumb to review abdominal computed tomograms (CT) of consecutive 30 ascitic patients in an attempt to differentiate benign from malignant ascites. These included: (1) distribution of ascites; (2) bowel-mesentery pattern (3) intact intra-/extraperitoneal interface; (4) associated hepatic or non-hepatic metastases; and (5) retro-peritoneal lymphadenopathy. Among these indices, the direct identification of abdominal mass or lymphadenopathy had highest accuracy (1 00%) in predicting malignant ascites. Obliteration of intra-/extraperitoneal interface and matted bowel-mesentery pattern reflected high possibility of malignancy (sensitivity 60%, 56.25%, respectively, specificity 80%, 71.42%, repectively), and the inflammatory process, was the next probability. The distribution of fluid in cases with large or small amount of ascites was not very helpful in differential diagnosis (sensitivity 31.25, specificity 78.50%). The most frequent sites of fluid accumulation in our cases were perihepatic and right paracolic gutter in contrast to the least site in the lesser sac. A full knowledge of these indices might further aid in differentiation of the nature of the ascites.