急性肝炎致肝内淋巴淤滞及胆囊壁增厚的磁共振成像表现

MRI Displaying of Acute Hepatitis Causing Intrahepatic Lymphatic Stasis and Gallbladder Wall Thickening

目的探讨急性肝炎致肝内淋巴淤滞(ILS)及胆囊壁增厚的磁共振成像(MRI)表现及其临床意义。方法选取南昌大学附属新余医院2006—2012年MRI诊断为急性肝炎致ILS及胆囊壁增厚的患者15例,其中戊型肝炎10例、甲型肝炎3例、乙型肝炎2例,8例行MRI平扫加增强,7例行MRI平扫。回顾性分析MRI平扫及增强表现。结果 15例患者MRI平扫于T1WI、T2WI示肝内门静脉周围长T1、长T2信号的双轨道征或靶征,肝内下腔静脉周围呈环行或前方弧形长T1、长T2信号。胆囊壁环形增厚,呈稍长T1、稍长T2信号,边界清楚,胆囊周围少量积液。8例MRI增强扫描示肝内门静脉、下腔静脉周围未见强化,肝内门静脉周围呈双轨征或靶征,下腔静脉周围呈环征或前弧形征。胆囊壁中度均匀环形强化,胆囊周围积液未见强化。结论急性肝炎致ILS及胆囊壁增厚MRI表现具有特征性和较高敏感性,因而对本病有重要诊断价值,可为临床评价急性肝炎致肝脏损害程度提供影像学依据。

Objective To investigate the displaying of magnetic resonance imaging （MRI） and its significance in the diagnosis of intrahepatic lympllatic stasis （ILS） caused by acute hepatitis and gallbladder wall thickening. Methods 15 cases di- agnosed with ILS and gallbladder wall thickening caused by acute hepatitis by MRI admitted to the Xinyu Hospital Affiliated to Nanchang University from 2006 to 2012 were selected. Among the patients, 10 cases were hepatitis E, 3 were hepatitis A and 2 were hepatitis B. 8 cases were given enhanced plain MRI scan and 7 cases were given MR/plain scan. The scan and displaying of the MRI were retrospectively analyzed. Results Long T1 long q＇2 signal was found with double track sign or target sign surround- ing the hepat - portal vein in T1WI and T2WI series, while Long T1 long T2 signal was found with circle or vaulted shape sur- rounding the inferior vena cava. The gallbladder wall was thickening cireumferentially, displaying slightly long T1 slightly long T2 signal with clear boundary and small amount of fluid around the gallbladder. The 8 cases of enhanced scan showed no enhancement in hepat - portal vein and inferior vena cava, with hepat - portal vein displaying double track sign or target sign and inferior vena cava displaying circle or vaulted shape. The gallbladder wall showed circumferentially moderate and balanced enhancement, and no enhancement was found in the fluid around the gallbladder. Conclusion The MRI displaying of ILS and gallbladder wall thick- ening caused by acute hepatitis is specific and sensitive, and therefore it is of great clinical significance in terms of providing ima- ging evidences for evaluating the level of damage of acute hepatitis.