人体肝脏巨片形吸虫感染影像学表现

Imaging findings of hepatic fasciola gigantica

目的探讨人体肝巨片形吸虫病的影像学表现特点及其诊断价值。方法回顾分析经临床确诊26例肝巨片形吸虫病患者的临床、病理及影像学表现。26例行CT平扫检查,其中24例行CT增强。9例行MRI平扫检查,其中7例行MRI增强。2例行肝穿刺病理学检查。结果 26例CT平扫示肝肿大并实质内弥漫斑片状密度减低影,边界欠清,15例病灶相互融合呈簇状或隧道样病灶,以包膜下肝实质内为主,其中24例CT增强病灶不均匀轻度强化;19例脾轻度增大。9例MRI平扫示为肝肿大并实质弥漫性病变,病变呈稍长T1、稍长T2,DWI上呈稍高或高信号改变;7例增强扫描呈蜂窝状稍强化;5例MRCP示肝内胆管及胆总管未见扩张或梗阻。2例穿刺病理活检表现为寄生虫性肉芽肿与坏死,周围大量单核细胞和嗜酸性粒细胞浸润。结论人体肝巨片形吸虫感染的CT、MRI表现为肝包膜下多发微小脓肿,部分呈簇状或隧道样特点,结合血清学检查,有助于早期诊断。

Objective To investigate the imaging features of hepatic fasciola gigantica.Methods CT with（24）and without （2）intravenous contrast,unenhanced MRI（9）and contrast-enhanced MRI（7）of 26 patients with hepatic fasciola gigantica were retrospectively analyzed.Liver biopsy was performed on 2 patients.Results Unenhanced CT demonstrated hepatomegaly with diffuse patchy liver parenchymal density,ill-defined lesion borders in all 26 patients and splenomegaly in 19 patients.All 24 lesions enhanced heterogeneously and slightly on CT.MRI also showed hepatomegaly in all 9 patients with diffuse slightly low T1,high T2 signal intensities and hyperintensities on diffusion-weighted imaging.On all 7 contrast-enhanced MRI,honeycomb enhancement pattern was observed.MRCP performed on 5 patients did not show any intra-or extrahepatic bile duct dilatation.Core biopsy on 2 patients showed necrotic parasitic granulomas surrounded by heavy mononuclear and eosinophilic infiltration.Conclusion The shape of the trematode with multiple subcapsular microabscesses that coalesce to form tunnel-shaped abscesses are key features on CT and MRI.Multi-modality imaging combined with enzyme-linked immunoassay can aid early diagnosis of fascioliasis.