重度酒精性肝病CT征象治疗前后动态变化对比分析(附6例报告)

A comparative analysis of the dynamic changes of CT signs in severe alcoholic liver disease patients before and after the treatment

目的对比分析重度酒精性肝病CT征象在禁酒及支持治疗前后不同时期的动态变化,以期提高对本病诊断准确性。方法对比分析我院临床及随访证实的6例重度酒精性肝病患者治疗前后CT征象的动态变化,总结其CT特点。结果 CT平扫在普遍密度降低的肝实质内见接近液体密度的更低密度区,部分病灶呈局限性膨隆,有轻度占位效应,酷似占位性病变,增强扫描肝实质呈斑片状不均匀强化,更低密度区周边部分血管及脏器有轻度受压移位现象。禁酒、支持治疗6～9个月等不同时期后复查,病变明显好转,更低密度区及其轻度占位效应减轻或消失,增强扫描趋于均匀强化,血管形态及走行正常。结论酒精性肝病除脂肪肝及肝硬化的表现外,尚有某些酷似占位性病变的CT征象,熟悉这些征象,结合病史及临床随访,对其正确诊断与及时治疗具有重要意义。

Objective To compare the dynamic changes of CT signs in severe alcoholic liver disease（SALD） patients before and after inhibiting alcohol and supporting treatment and to elevate the diagnostic accuracy.Methods The dynamic changes of CT signs in 6 patients with clinical follow-up proved SALD were comparatively analyzed before and after the treatment.Results Precontrast CT scans showed lower density areas approaching to liquid density in general hypodense liver parenchyma,while partial foci appeared as local expansion and slight space-occupying effect mimicking space-occupying lesions.Postcontrast CT scans showed patchy nonhomogeneous enhancement around the hypodense areas and slight compression and shift of the partial vessels and organs.Following inhibiting alcohol and supporting treatment for 6-9 menths the reexaminations found that the lesions were significantly improved,while the lower density areas and slight space-occupying effect were relieved or disappeared,simultaneously,the lesions were approached homogeneous enhancement on postcontrast CT images and the vascular shape and path became to normalization.Conclusion Alcoholic liver disease except the manifestations fatty liver and cirrhosis,remains some CT signs mimicking space-occupying lesions so that understanding these signs and combineting with clinical history and follow-up have great significance for the definite diagnosis and timely treatment of SALD.