肝结核的螺旋CT动态增强扫描表现及诊断价值

The Analysis of Image of Hepatic Tuberculosis with Dynamic Enhanced Spiral CT Scanning

目的探讨各型肝结核的螺旋CT动态增强扫描表现及其诊断价值。资料与方法18例肝结核患者行螺旋CT平扫和动态增强扫描,均经手术病理或穿刺活检证实。结果(1)浆膜型1例:肝包膜呈梭形增厚低密度影,增强扫描病灶内有分隔样强化,邻近肝实质动脉期明显强化。(2)粟粒型8例(病灶最大径<2.0cm):表现为肝内散在多发(6例)或单发(2例)粟粒小结节状低密度灶,增强扫描动脉期和静脉期病灶边缘轻度强化。(3)结核瘤型7例(病灶最大径≥2.0cm):表现为单发或多发较大结节或肿块,4例病灶内有斑点状钙化,1例结核性肝脓肿有环形钙化,增强扫描动脉期病灶边缘轻度强化,周围肝组织明显强化,静脉期病灶边缘明显环形强化或病灶内蜂窝状强化。(4)胆管炎型1例:表现为肝门部肝内胆管扩张,增强扫描胆管壁强化,合并有腹膜后和肠系膜根部肿大淋巴结环形强化。(5)混合型1例:表现为肝包膜及邻近肝组织内低密度灶,同时具有浆膜型和结核瘤型的CT表现。结论将肝结核分为浆膜型、粟粒型、结核瘤型、胆管炎型和混合型5种类型较合理。螺旋CT动态增强扫描能显示肝结核的一些特征性表现,如病灶"边缘强化征"、"蜂窝征"等,有助于该病的定性诊断。

Objective To assess the dynamic enhanced spiral CT findings and diagnostic value in various types of hepatic tuberculosis. Materials and Methods 18 cases with hepatic tuberculosis underwent plain and dynamic enhanced spiral CT scanning of which 8 cases were male and 10 were female, aged from 15 to 72 years（ mean, 46.3 years） ,proved by hepatic biopsy or surgical specimens. Results （ 1 ） Serohepatic type （ n = 1 ） , which showed focal spindle-shaped incrassation of liver capsule. Dynamic contrast enhanced CT showed internal septal enhancement, and marked enhancement was seen in the adjacent liver parenchyma . （2） Miliary type （n = 8; diameter 〈 2.0cm in size） ： CT showed multiple or single, miliary low attenuation loci within the liver. With dynamic scanning, slight peripheral enhancement were seen during arterial phase and portal venous phase. （3） Tuberculoma type （n = 7; diameter ≥2.0 cm in size） ： showing single or multiple low density lesions with flecked calcifications in 4 cases, ring-shaped calcifications in 1 case of tuberculous hepatic abscess. After contrast administration, slight peripheral enhancement were seen during arterial phase, and marked ring-like or internal multi-locular enhancement were displayed in the portal phase. （4） Cholangitis type （ n = 1 ）, dilatation of biliary duct were presented in the porta part of hepatic, and showed enhancement along the wall of biliary duct. Accompanied ringlike enhancement were revealed in retroperitoneal adenopathy. （5） Mixed type（ n = 1 ）, which showed the CT manifestation combining with the above-mentioned serohepatic type and tuberculoma type. Conclusion Hepatic tuberculosis could be classified into five types ： serohepatic type, miliary type, tuberculoma type, cholangitis type and mixed type, which is more reasonable. Dynamic enhanced spiral CT scanning demonstrate some characteristic manifestations valuable for the qualitative diagnosis of hepatic tuberculosis.