心脏、心包细粒、泡状棘球蚴病的影像学表现

Imaging manifestations of cardiac and pericardiac echinococcosis and alveolar hydatid disease

目的 总结心脏、心包包虫病的影像学表现。方法 1 例泡状棘球蚴病、8 例细粒棘球蚴病(单纯型1 例,复杂型7例)全部经X线检查;B超检查7例;MR检查2例;CT和ECT检查各1例。结果 细粒棘球蚴病X线检查可见心脏单发或多发突出心轮廓外肿块,呈密度不一,边缘光滑、锐利,圆形或分叶状,导致心影变形、搏动减弱消失或异常。B超示心脏或心包腔内边缘清楚、光滑锐利的囊性团块回声,破裂感染时回声增强。1 例泡状棘球蚴病B超示中强回声实性团块并有钙化,CT平扫及增强显示混杂密度占位,低密度小囊聚集和小圆形钙化,增强后病灶无强化。细粒棘球蚴病2 例MR表现囊状长T1长T2信号,T1WI、T2WI低信号囊壁,内囊及囊膜下T1WI低信号,T2WI高信号,质子密度75%为低信号,囊肿破裂感染时呈不均匀信号,壁不均匀,不连续。结论 X线检查先于超声发现本病。X线、B超同为本病首选检查,CT对泡状包虫病显示小囊样和小圈状钙化细微结构优于其他,MR当超声、CT不具特征时仍可显示囊壁与小囊。

Objective To summarize the imaging findings of cardiac and pericardiac echinococcosis. Methods Eight cases of echinococcosis, including 1 case with simple form and 7 cases with complexity, and one case of alevolar echinococcosis were reported. They were all examined by X-ray, and 7 of them by ultrasound, 2 cases by MRI, 1 case by CT and 1 case by ECT. Results X-ray films can reveal the single and multiple cystic outside the heart which has a sharply rounded, and well-defined border, irregular density, and the arc-like calcification and produces the deformation of the heart contour, the pulsation degenerates or die, or becomes abnomal. Sonography-B discloses a well defined and sharply roundly border in the cardia or pericardiac cavity where has an echo produced by cystic mass, which echoed stronger when rupture and infection. One case of alveolar echinococcosis tested on sonography-B revealed a calcified solitary mass, while on CT revealed a mixed density, low-density small-cysts gathering, all flake calcification, focus had no enhancement. Two cases of echinococcosis on MR had cystic signal. T1WI、T2WI showed low signal, ring-like cystic wall. T1WI low signal in internal capsule and cyst membrane and T2WI high signal, the proton density 75% was regarded low signal when cystic rapture and infection had unequal signal discontinuous wall. Conclusion X-ray is superior to sonography in finding the disease, and they can be the first selection of diagnosis. CT is superior to other examination aids in revealing the small cyst-like and small ring-like calcified organization. MR can show the cyst wall and small cyst when CT fails to do it.