肝结核的CT诊断

CT diagnosis of hepatic tuberculosis

目的:探讨肝结核的CT特征。方法:回顾性分析54例经手术及经皮肝穿刺病理证实的肝结核患者的CT表现。结果:肝结核的CT表现分为3种类型:①肝浆膜型31例,平扫肝包膜及包膜下多发结节状低密度灶,增强扫描病灶无强化或边缘轻度至中度强化;②肝实质型21例,分为粟粒型12例和结节型9例。前者CT平扫显示,肝内散在多发粟粒小结节状低密度灶,直径<2cm,增强扫描病灶无强化或周边环形强化,中央无强化,后者CT平扫显示肝内单发或多发低密度灶,直径>2cm,增强扫描病灶无强化或周边环形强化或成簇样强化;③结核性胆管炎2例,CT表现胆管狭窄及远端胆管扩张。结论:CT分型在一定程度上反映了肝结核的感染途径。而病灶的增强方式又反映了肝结核的不同病理改变。熟悉这些特点有助于对肝结核的诊断。

Objective： To evaluate the CT features of hepatic tuberculosis. Methods： CT findings in 54 patients with hepatic tuberculosis confirmed by surgery and percutaneous transhepatic biopsy were retrospectively analyzed. Results： CT findings of hepatic tuberculosis could be divided into three types： ①Hepatic serous type（n=31）, unenhanced liver capsule and multiple nodules under the capsule low density lesions enhanced scan lesions without enhancement or mild to moderate ring- shaped enhancement. ②liver parenchyma（n=21） is further divided into miliary type in 12 cases and nodular in 9 cases. The former CT scan shows multiple intrahepatic scattered miliary hypodenselesions,diameter 〈2cm. Enhanced scan manifest lesions without enhancement or ring-shaped enhancement around the central non-enhanced region; the latter CT scan shows single or multiple intrahepatic hypodense lesions, diameter〉2cm.Enhanced scan manifest no enhancement or ring-shaped or clustered enhancement around the central non-enhanced region. ③tuberculous cholangifis 2 cases, CT showed a bile duct stricture and distal bile duct dilatation. Conclusion： CT classification to some extent reflects path of tuberculosis infection. The lesion enhanced in a manner reflecting the different pathological changes of hepatic tuberculosis. Being familiar with these features contributes to the diagnosis of hepatic tuberculosis.