肝脓肿增强动态CT扫描动脉期肝脏短暂强化的诊断价值

Significance of transient hepatic parenchymal enhancement in the hepatic arterial phase during dynamic contrast-enhanced CT of hepatic abscesses

目的探讨肝脓肿增强动态CT扫描时动脉期肝脏实质短暂强化(THPE)的病理基础及其临床意义。方法回顾性分析行增强动态CT扫描的肝脓肿病例43例,均常规先行平扫,分别于注射对比剂后30s、65s和3～5min行动脉期、门静脉期和延迟扫描,分析THPE发生率、部位、形态和各期强化表现。结果43例中,动脉期有28例出现THPE,发生率65%。28例共有脓肿36个,出现THPE36处,表现为动脉期出现肝叶/段形(占31%)、扇形(占50%)、不规则形(占14%)或弥漫形(占5%)强化,门静脉期/延迟扫描与正常肝实质呈等密度。肝脓肿THPE以叶/段形、扇形多见(81%)。结论肝脓肿THPE常以叶/段形、扇形多见,提高对THPE征象的认识,对了解病变的病理基础、病变定性,尤其是化脓性炎症期、脓肿形成初期的不典型肝脓肿的诊断和鉴别诊断具有重要作用。

Objective To assess the clinical significance of transient hepatic parenchymal enhancement（THPE） in the hepatic arterial phase during dynamic contrast-enhanced CT of hepatic abscesses, and investigate the pathogenesis of THPE. Methods Forty-three patients underwent dynamic contrast-enhanced CT were identified to have hepatic abscesses. Unenhanced spiral CT images were routinely obtained before injection of contrast material, then spiral CT scans were performed during the hepatic arterial phase（30 s） and the portal venous phase（65 s） and delayed phase（3 - 5 min）, respectively, after the initiation of injection. The incidence, location, shape of THPE and enhancement feature of different phases during dynamic contrast-enhanced CT were analyzed. Results Twenty-eight in forty-three patients were identified to have THPE（65%）. There were 36 hepatic abscesses and 36 THPEs in the 28 patients. All of 36 THPEs showed lobar multisegmental（31%）, sectorial（50%）, polymorphous （14%） and diffuse（5%） hyperattenuating in hepatic arterial phase imaging that returned to normal attenuation on the portal venous and delay phase/mage. The THPEs caused by hepatic abscesses were usually lobar multisegmental or sectorial （81%）. Conclusion Hepatic abscesses were often identified to have THPE in the hepatic arterial phase during dynamic contrast-enhanced CT. The THPE caused by hepatic abscesses is usually lobar multisegmental or sectorial,which is important in understanding the pathogenesis of THPE and characterics of hepatic abscesses, especially atypical hepatic abscesses （inflammation phase or early abscesses ）.