Ding Jian, Zhang Weiqiang, Wang Lizhang, Zhu Zefeng, Wang Jia, Ma Jianbing
Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Quant Imaging Med Surg. 2021 Feb;11(2):763-771. doi: 10.21037/qims-20-301.
The aim of our study was to evaluate the clinical characteristics and computed tomography (CT) imaging findings of idiopathic mesenteric phlebosclerosis (IMP).
From January 2013 to May 2019, the clinical data of 10 patients diagnosed with IMP were analyzed retrospectively. Computed tomography angiography (CTA) and colonoscopy were performed in all 10 patients. All CT imaging findings were evaluated by three radiologists, including the form and distribution of calcification, the bowel's thickness, and the surrounding fat gap. The calcification score was calculated according to the extent of the involved mesenteric veins. The colonic wall thickness was defined as the average value of the thickest and thinnest regions of the intestinal wall. The correlation between the calcification scores and the colonic wall thickness was analyzed using Spearman's correlation analysis.
All 10 patients were male with an average age of 59.6 years (range, 51-83 years). The average smoking index was 712 (range, 0-1,800). Among them, 7 patients had a history of long-term excessive daily intake of medicinal liquor or Chinese herbal medicine. Clinical symptoms of abdominal pain, diarrhea, bloating, and nausea were found. Colonoscopy showed dark purple discolorations of the edematous mucosa, engorged blood vessels, extensive erosion, ulceration, and multi-focal nodular surface in all patients. CT demonstrated colonic wall thickening, calcification along the mesenteric vein, and blurry surrounding fat gap in all 10 patients. Mesenteric venous calcification involved the terminal ileum, the ascending and transverse colon in all patients, and the descending colon and sigmoid colon's involvement in two patients. A total of 33 segments of the intestinal wall were involved. The median calcification score was 6 points, the mean thickness of the colonic wall was 10.73±3.22 mm, and there was no significant correlation (P=0.782) between calcification score and thickness of the colonic wall.
The main features of IMP are mesenteric venous calcification, colonic wall thickness, and pericolic fat stranding, and there is no correlation between calcification score and colonic wall thickness. Therefore, CT imaging combined with colonoscopy can improve the diagnostic accuracy of IMP.
我们研究的目的是评估特发性肠系膜静脉硬化（IMP）的临床特征和计算机断层扫描（CT）影像学表现。
回顾性分析2013年1月至2019年5月期间确诊为IMP的10例患者的临床资料。所有10例患者均进行了计算机断层血管造影（CTA）和结肠镜检查。3名放射科医生对所有CT影像学表现进行评估，包括钙化的形态和分布、肠壁厚度以及周围脂肪间隙。根据受累肠系膜静脉的范围计算钙化评分。结肠壁厚度定义为肠壁最厚和最薄区域的平均值。采用Spearman相关性分析钙化评分与结肠壁厚度之间的相关性。
10例患者均为男性，平均年龄59.6岁（范围51 - 83岁）。平均吸烟指数为712（范围0 - 1800）。其中7例患者有长期每日过量饮用药酒或服用中草药的病史。出现腹痛、腹泻、腹胀和恶心等临床症状。结肠镜检查显示所有患者的黏膜水肿呈暗紫色、血管充血、广泛糜烂、溃疡以及多灶性结节状表面。CT显示所有10例患者均有结肠壁增厚、沿肠系膜静脉的钙化以及周围脂肪间隙模糊。肠系膜静脉钙化累及所有患者的回肠末端、升结肠和横结肠，2例患者的降结肠和乙状结肠受累。肠壁共有33段受累。钙化评分中位数为6分，结肠壁平均厚度为10.73±3.22mm，钙化评分与结肠壁厚度之间无显著相关性（P = 0.782）。
IMP的主要特征是肠系膜静脉钙化、结肠壁增厚和结肠周围脂肪条索，钙化评分与结肠壁厚度之间无相关性。因此，CT成像结合结肠镜检查可提高IMP的诊断准确性。
