CT淋巴管成像对原发性乳糜尿患者诊断及分级的应用价值初探

目的：探讨CT淋巴管成像（CTL）对于原发性乳糜尿患者诊断及分级的应用价值。方法：回顾性收集确诊为原发性乳糜尿的79例患者的临床及CTL影像学资料，CTL指标主要包括：(1)肾脏受累侧别及肾内淋巴管分布范围：单肾、双肾、肾窦、肾实质及肾门上区、肾门下区；(2)腹膜后异常淋巴管分布情况：包括腹膜后、腰干区域、肾血管周、肾周脂肪囊、肾上腺区域等；(3)腹盆部及胸部扩张淋巴管分布及淋巴反流情况；(4)其他异常表现：包括腹盆部、胸部及骨骼等部位的淋巴管相关异常改变；(5)影像学分级：按照腹膜后累及区域范围进行影像学分级，将腹膜后区域分为左侧和右侧肾门上区、肾门下区、腰干区、肾血管旁区、肾周区等10个区域，累及5个及以内区域为轻度，累及6个及以上区域为重度。根据乳糜尿临床分级标准进行临床分级，对于原发性乳糜尿患者临床特点及CTL征象采用分类变量资料中的构成比进行统计描述，利用一致性Kappa检验评估原发性乳糜尿患者影像分级及临床分级的一致性。结果：79例CTL示肾内异常碘油沉积74例（93.7%），单肾55例（69.6%），双肾19例（24.1%），肾窦74例（93.7%），肾实质37例（46....

The Application Value of CT Lymphangiography in Diagnosis and Grading in Patients with Primary Chyluria

Objective: To investigate the application value of CT lymphangiography in diagnosis and grading in patients with primary chyluria. Methods: Clinical and CTL imaging data of 79 patients diagnosed with primary chyluria were collected retrospectively. For CTL, the indexs were (1) Involved kidney and distribution of abnormal lymphatic vessels in the kidney: unilateral or bilateral kidney,renal sinus, renal parenchymal, suprahilar area and subhilar area; (2) Distribution of perirenal and retroperitoneal abnormal lymphatic vessels: retroperitoneal area,lumbar trunk area, renal perivascular area, fatty capsule area, adrenal area, etc; (3) Distribution of dilated lymphatic vessels and lymphatic reflux in chest, abdomen and pelvis; (4) Other abnormal manifestations: lymphatic-related abnormal changes in the chest, abdomen, pelvic cavity and bone; (5) Imaging grading: the imaging grading was carried out according to the range of retroperitoneal involvement, and the retroperitoneal area was divided into 10 areas, including left and right suprahilar area, subhilar area, perirenal area, renal perivascular area and lumbar trunk area, involvement of five or fewer areas were graded as mild, while involvement of six or more were graded as severe. In addition, clinical grading was carried out according to clinical manifestations. The clinical characteristics and CTL signs of patients with primary chyluria were statistically described by the composition ratio of classification variables, and the consistency of imaging grade and clinical grade of patients with primary chyluria was evaluated by Kappa test. Results: CTL showed abnormal lipiodol deposition in kidney in 74 cases (93.7%), unilateral kidney in 55 cases (69.6%), bilateral kidneys in 19 cases (24.1%), renal sinus in 74 cases (93.7%), renal parenchyma in 37 cases (46.8%); suprahilar area in 61 cases (77.2%), 52 cases (65.8%) were unilateral and 9 cases (11.4%) were bilateral; subhilar area in 61 cases (77.2%), 47 cases (59.5%) were unilateral and 14 cases (17.7%) were bilateral; retroperitoneal area in 78 cases (98.7%); lumbar trunk area in 76 cases (96.2%), 20 cases (25.3%) were unilateral and 56 cases (70.9%) were bilateral; perivascular area in 72 cases (91.1%), 45 cases (57.0%) were unilateral and 27 cases (34.2%) were bilateral; fatty capsule in 14 cases (17.7%), 13 cases (16.5%) were unilateral and 1 case (1.3%) was bilateral; adrenal area in 12 cases (15.2%); bladder in 31 cases (39.2%), perivesical area in 12 cases (15.2%), iliac perivascular area in 73 cases (92.4%), abdominal and pelvic wall in 14 cases (17.7%), perineal area in 12 cases (15.2%), perirectal area in 14 cases (17.7%), mesentery in 26 cases (32.9%), intestinal wall in 11 cases (13.9%), intestinal canal in 5 cases (6.3%), peripancreatic area in 15 cases (18.9%), perisplenic area in 2 cases (2.5%), perihepatic area in 7 cases (8.8%), hilus of the lung in 1 case (1.3%), mediastinum in 14 cases (17.7%), pericardium in 1 case (1.3%), extrapleural area in 25 cases (31.6%), chest wall in 2 cases (2.5%), skeleton in 2 cases (2.5%), end of thoracic duct in 70 cases (88.6%). Among the 79 patients with primary chyluria, according to clinical classification, 27 cases were mild and 52 cases were severe; according to imaging classification, 40 cases were mild and 39 cases were severe. The consistency of the two grades was moderate. Conclusion: CTL can evaluate the distribution and range of intrarenal, perirenal and retroperitoneal dilated lymphatic vessels accurately, and evaluate the abnormal lymphatic vessels in the chest, abdomen and pelvis and thoracic duct in patients with primary chyluria.It can provide image basis for the diagnosis, grading and treatment of primary chyluria.