肝结核的MSCT表现与影像分型

MSCT Manifestation and Image Classification of Hepatic Tuberculosis

目的探讨肝结核MSCT表现及其影像分型,以提高对该病的认识,降低漏诊率。方法回顾性分析本院确诊的28例肝结核患者MSCT影像学特点,并结合文献报道进行初步影像分型。结果包膜型肝结核15例,CT表现为肝包膜增厚,环状强化;结核性肝脓肿4例,CT表现为肝脏低密度区,环状强化或无强化;肝结核瘤5例,CT表现为30 mm以下低密度结节,环状强化或不强化;混合型肝结核2例,CT表现为肝包膜和肝实质同时受累;粟粒型肝结核2例,CT表现肝内多发低密度小结节,增强扫描动脉期轻度强化。合并肝外结核:肺结核14例,脊柱结核1例,脾结核1例,盆腔结核2例,胸膜结核2例。结论肝结核CT表现可以分为5型,包膜型肝结核具有特征影像,其余类型无特征性,容易误诊,结合肝外病史,有助于肝结核的诊断。

Objective To explore the manifestations and imaging classification of hepatic tuberculosis MSCT,and reduce the missed rate of hepatic tuberculosis CT.Methods The imaging characteristics of MSCT in 28 patients with hepatic tuberculosis diagnosed in our hospital from 2005 to 2019 were analyzed retrospectively.Results 15 cases of enveloped hepatic tuberculosis showed thickening and annular enhancement on CT.4 cases of tuberculous hepatic abscess presented as low-density liver area with annular enhancement on CT.The CT findings of 5 cases of hepatic tuberculoma were low density nodules below 30 mm with annular enhancement or no enhancement.In 2 cases of mixed hepatic tuberculosis,CT findings showed that both liver capsule and liver parenchyma were involved.In 2 cases with miliary hepatic tuberculosis,CT showed multiple low-density small nodules in the liver,and mild enhancement in the arterial phase.Among the 28 cases in this group,14 cases were complicated with pulmonary tuberculosis,1 case of spinal tuberclosi,2 cases of pelvic tuberculosis,and 2 cases of pleural tuberculosis.Conclusion The CT manifestation of hepatic tuberculosis can be divided into 5 types.The enveloped hepatic tuberculosis has imaging characteristics,while the other types have no characteristic,which can be easily misdiagnosed.An associated history of extrahepatic tuberculosis is helpful for the diagnosis of tuberculosis.