肝脏周围炎的CT和MRI诊断

CT and MRI Diagnosis of Fitz-Hugh-Curtis Syndrome

目的探讨FHCS临床、CT和MRI表现,提高本病的诊断水平。方法收集近7年间资料完整的FHCS21例,男7例,女14例;平均年龄34.5岁。主要以胰腺炎、盆腔炎、胆囊炎胆石症、阑尾炎和腹痛查因就诊。采用16层螺旋CT机先作全肝连续平描,再经肘静脉以4～5ml/s速率注入100ml碘海醇,行动脉期、门脉期、平衡期增强扫描。MRI扫描仪为西门子1.5T超导型,行SE序列常规T1WI和T2WI成像,再经肘静脉注入总量0.1mmol/KgGd-DTPA,行动脉期、门脉期、平衡期增强扫描。结果CT平扫6例显示肝包膜增厚和包膜下积液,增强CT动脉期16例(100%)显示肝包膜均匀性强化和增厚,其中线型3例(18.8%),宽带型5例(31.3%),混合型8例(50%),局限型11例(68.8%),广泛型5例(31.3%)。4例累及到局部肝实质,动脉期呈斑片状或楔状强化。T1WI3例显示稍高信号的肝包膜增厚,T2WI可见1例稍高信号肝包膜增厚和3例局部肝实质斑片状稍高信号。增强动脉期5例均可见轻度强化,其中局限型3例,广泛型2例;线型3例,宽带型2例。静脉期5例较动脉期强化明显;平衡期5例强化基本消退。结论FHCS有广义和狭义之分,男女均可发病,可继发于腹部和盆腔各种炎症。CT和MRI可清楚显示肝包膜增厚、肝包膜和局部肝实质强化等特征,结合临床比较容易诊断。

Objective To evaluate the clinical manifestations, CT and MRI findings of Fitz-Hugh-Curtis Syndrome （FHCS）. Methods The medical records and images of 21 patients with FHCS were retrospectively reviewed. There were 7 males and 14 females. The mean age was 34.5 years. The major causes of admitting to hospital were acute pancreatitis, pelvic inflammatory disease, cholecystitis, cholelithiasis, appendicitis and abdominalgia. All CT examinations were performed with 16-slice helical CT scanner. After plain scan the patients underwent intravenous administration of 100 ml iohexol solution at a rate of 4-5ml/s, arterial phase, portal phase and balanced phase were acquired. MRI was performed with a 1.5T scanner. T1WI and T2WI sequences were routinely acquired. Then patients underwent intravenous administration of Gd-DTPA with 0.1mmol/kg. Arterial phase, portal phase and balanced phase were obtained. Results The thickening hepatic capsule and subcapsular fluid were seen in 6 cases on plain CT scan. On the arterial phase, there were 16 patients whose hepatic capsule was uniformly enhanced and thickened, including string type in 3 cases （18.8%）, broadband type in 5 cases （31.3%）,nfixed type in 8 cases （50%）. Diffuse enhancement was seen in 5 cases （31.2%）, local enhancement in 11cases （58.8%）. The local liver parenchyma （4 cases） was involved which showed the patching or wedging enhancement on the arterial phase. T1WI images showed slightly high signal representing the thickening hepatic capsule in 3 cases. T2WI images showed slightly high signal （1 case） and patching pattern of slightly increased signal （3cases） respectively, representing the thickening hepatic capsule and the liver parenchyma involved. The thickening hepatic capsule had slight enhancement in all 5 cases on the arterial phase, including the local type in 3 cases, diffuse type in 2 cases, string type in 3 cases and broadband type in 2 cases. The enhancement was more apparent on the venous phase than arterial phase, while on the balanced phase tiffs enhancement almost disappeared. Conclusion CT and MRI can show the features of hepatic capsule thickening and the enhancement of local liver parenchyma and hepatic capsule, by which and referring to clinical symptom FHCS could be easily diagnosed.