Greater and Lesser Omenta-大网膜和小网膜的正常解剖及异常影像表现.ppt

Greater and Lesser Omenta: Normal Anatomy and Pathologic Processes 大网膜和小网膜的正常解剖及异常影像表现Eunhye Yoo, MD, Joo Hee Kim, MD, Myeong-Jin Kim, MD 大网膜和小网膜是个非常复杂的解剖区域。正因为如此，网膜病变从积液到弥漫性网膜浸润，CT表现表现多种多样，同时又无特征性。网膜不仅是限制病变扩散的屏障，同时又是病变传播的途径。累及网膜的病变：感染、炎症、肿瘤、外伤和坏死。 高分辨率螺旋CT扫描同时行多平面重建能很好显示网膜的解剖结构和病变状况。充分认识网膜的影像解剖和病变的各种CT表现及一些特征性征象，对诊断和治疗具有非常必需的。 CT 扫描参数和重建技术 采用16-section CT scanner，平扫和增强: 0.5-second rotation time, 0.75-mm collimation, 3-mm section thickness, 35-cm field of view, 3-mm reconstruction thickness, 12-mm feed per rotation, 120 kV, and 140 mA。 常规采用3-mm section thickness 断面图像。后处理工作站进行sagittal、coronal, or oblique 多平面重建。 正常解剖 大网膜主要由脂肪组织和一些细小扭曲的胃网膜血管gastroepiploic vessels构成。 CT表现为位于前腹壁下，胃、横结肠和小肠前之间的一组不同宽度的脂肪组织, 。在大网膜和邻近的软组织结构间的腹水衬托下，大网膜显示为一单纯的脂肪层., 一旦网膜出现异常的软组织病变，则显示为模糊状、条索状、结节状影和肿块. 小网膜由肝胃韧带和肝十二指肠韧带组成，它将胃小弯、远侧十二指肠和肝脏连接起来，覆盖小网膜的前方。肝胃韧带内含胃左血管和胃左组淋巴结。肝十二指肠韧带，为小网膜侧方厚层，内含门静脉、肝动脉、肝外胆管和,肝门组淋巴结。 正常情况下小网膜囊是闭合的, 只有它的边如胃后壁、胰腺体部才可以在CT上显示。 Greater and Lesser Omenta: Normal Anatomy and Pathologic Processes1 Drawing of the anatomy of the greater and lesser omenta ：The greater omentum (GO) is composed of a double layer of peritoneum that extends from the greater curvature of the stomach (S) inferiorly. Its descending and ascending portions usually fuse to form a four-layer vascular fatty apron; the resulting space is contiguous with the lesser sac (LS). The lesser omentum (LO) connects the lesser curvature of the stomach and proximal duodenum with the liver (L) and contains blood vessels, nerves, and lymph nodes. The lesser sac is empty and collapsed so that only parts of its boundaries, such as the posterior gastric wall and pancreatic body, are observed on axial CT scans. Ao = aorta, C = colon, K = kidney, P = pancreas, Sp = spleen, 1 = falciform ligament, 2 = gastrohepatic ligament, 3 = gastrosplenic ligament. Greater and Lesser Omenta: Normal Anatomy and Pathologic Processes1 Ao = aor