CT对肝结核的诊断价值

Diagnostic value of CT on hepatic tuberculosis

目的探讨CT对肝结核病的诊断价值。方法回顾性分析经病理所证实的10例肝结核病的CT表现与诊断,并与病理所见对照。结果10例肝结核病包括粟粒型肝结核、结节型肝结核和结核瘤3种类型。(1)粟粒型肝结核5例,CT表现为肝脏弥漫性肿大,伴有多发性粟粒状低密度灶,增强扫描病灶无明显强化;(2)结节型肝结核3例,CT表现为肝内多发片状低密度或混杂密度结节灶,病灶中心密度高,伴有“粉末状钙化”,增强扫描动脉期病灶的范围缩小,静脉期出现典型环状强化;(3)结核瘤型2例,1例表现为肝内孤立性占位,伴有中央坏死,包膜菲薄且光滑,增强扫描可见包膜轻度强化;1例表现为结核瘤型肝脓肿,多个结节融合成簇,液化坏死,出现液液平面,周围伴有卫星灶。结论粟粒型肝结核CT征象缺乏特异性,很难做出定性诊断,需结合病史及实验室检查。结节型肝结核“中心粉末状”钙化及结核瘤型肝脓肿具有一定特异性,有助于鉴别诊断。

Objective To assess CT manifestations and diagnostic value in patients with hepatic tuberculosis. Methods Ten cases of hepatic tuberculosis proved by hepatic biopsy or surgical specimens were analyzed retrospectively. Results This group of hepatic tuberculosis included three types. （ 1 ） Five cases of miliary hepatic tuberculosis demonstrated that the liver swelled diffusely associated with multiple miliary low attenuations, and showed no enhancement after contrast agents administration. （2） Three cases of tubercle hepatic tuberculosis depicted multiple hypodensity areas or mixed density regions in the liver. The extension of lesions reduced in arterial phase, and a ring-like enhancement was displayed in the portal phase. （3） One case of hepatic tuberculoma illustrated solitary space occupying lesion accompanied with central necrosis. The envelope was thin and smooth which enhanced slightly after injecting Gd-DTPA. Another one was hepatic abscess and depicted fluid-fluid level inside the lesion. Conclusions The CT manifestations of miliary hepatic tuberculosis lack of characteristics, it is hard to make the diagnosis clear-cut unless integrating the medical history and lab test. The ‘ powder calcification＇ findings of tubercle hepatic tuberculosis is propitious to draw a qualitative diagnosis. And the feature of hepatic tuberculomas with fluidfluid level is in favor of making a differential diagnosis against parallel tumors.