Coakley F V, Hricak H
Department of Radiology, University of California San Francisco, 94143-0628, USA.
Clin Radiol. 1999 Sep;54(9):563-74. doi: 10.1016/s0009-9260(99)90018-1.
The abdominal cavity extends from the diaphragm to the pelvic floor, and is lined by a serous membrane known as the peritoneum. The peritoneum is the largest serous membrane in the body, and its surface area is comparable to the surface area of the skin (approximately 2 m2, in adults). Infoldings of the peritoneum suspend the various organs contained in the abdominal cavity. The peritoneum is, therefore, comprised of two layers, a parietal layer lining the abdominal cavity, and a visceral layer enveloping the contained organs. The peritoneal cavity is enclosed between these two layers, and is normally empty, apart from a small amount of physiological fluid. As a result, the normal peritoneal cavity is only a potential space. In men, the space is closed. In women, the fimbriated ends of the Fallopian tubes open into the peritoneal cavity, and provide a potential route of communication with the outside. The peritoneal cavity and the specialized peritoneal infoldings, known as mesenteries, are important disease sites in the abdomen. However, plain radiographs, barium studies, and ultrasound are of limited utility in imaging peritoneal and mesenteric disease. Direct and consistent imaging of such diseases only became possible with the development of computed tomography (CT). Initially, magnetic resonance imaging (MRI) was of limited utility, because of image degradation by motion artifact. With modern fast MRI sequences, it is now possible to depict many of these peritoneal and mesenteric conditions with an accuracy similar to CT. This review will discuss the normal anatomy and physiology of the peritoneal space and mesenteries, and the related disease processes, with particular emphasis on CT and MRI findings. The review is structured along anatomical lines, because many disease processes in the abdomen are site specific, or spread along anatomical pathways. The radiology of peritoneal malignancy and peritoneal adhesions are discussed separately, because these two conditions are not site specific, and because they are conditions whose imaging features are not always well appreciated. Our aim is to present key anatomical and pathological concepts in the imaging of peritoneal and mesenteric disease. We hope this will facilitate a clearer understanding of the CT and MRI appearance of these diseases, and so enhance the ability of the clinical radiologist to formulate rational differential diagnoses, to understand pathways of disease spread, and to apply greater critical analysis in radiological interpretation. The review is not intended as an encyclopaedic description of peritoneal anatomy and pathology.
腹腔从膈肌延伸至盆底，其内壁衬有一层称为腹膜的浆膜。腹膜是人体最大的浆膜，其表面积与皮肤表面积相当（成人约为2平方米）。腹膜的褶皱悬吊着腹腔内的各种器官。因此，腹膜由两层组成，一层是衬于腹腔的壁层，另一层是包裹所含器官的脏层。腹膜腔被这两层所包围，除了少量生理液体外，通常是空的。因此，正常的腹膜腔只是一个潜在的空间。在男性中，这个空间是封闭的。在女性中，输卵管的伞端开口于腹膜腔，提供了与外界潜在的连通途径。腹膜腔和称为肠系膜的特殊腹膜褶皱是腹部重要的疾病部位。然而，普通X线片、钡剂造影和超声在腹膜和肠系膜疾病成像中的作用有限。随着计算机断层扫描（CT）的发展，才能够对这类疾病进行直接且一致的成像。最初，磁共振成像（MRI）的作用有限，因为运动伪影会导致图像质量下降。随着现代快速MRI序列的出现，现在能够以与CT相似的准确性描绘许多这些腹膜和肠系膜病变。本综述将讨论腹膜腔和肠系膜的正常解剖结构与生理功能以及相关疾病过程，特别强调CT和MRI表现。由于腹部的许多疾病过程具有部位特异性或沿解剖途径扩散，因此本综述按照解剖学线索进行组织。腹膜恶性肿瘤和腹膜粘连的放射学将分别进行讨论，因为这两种情况不具有部位特异性，而且其成像特征并不总是容易被理解。我们的目的是在腹膜和肠系膜疾病成像中呈现关键的解剖学和病理学概念。我们希望这将有助于更清楚地理解这些疾病的CT和MRI表现，从而提高临床放射科医生进行合理鉴别诊断、理解疾病传播途径以及在放射学解读中进行更严格分析的能力。本综述并非对腹膜解剖学和病理学的详尽描述。
