CT动态增强与MRI在肝脓肿病理分期中的诊断及临床价值

The Clinical Value of CT Dynamic Enhancement and MRI in the Diagnosis of Liver Abscess

目的探讨CT动态增强与MRI在肝脓肿病理分期诊断中的临床价值。方法回顾性分析我院2013年8月-2015年12月期间收治并经手术病理证实的81例肝脓肿患者的一般临床资料及影像学资料,观察比较肝脓肿CT动态增强扫描和MRI扫描的影像表现特征,对其病变分期、病因、范围、形态以及强化方式进行总结分析。结果本组81例患者中单发67例、多发14例;肝脏脓肿位于肝肝右叶49例、肝左叶25例、同时侵犯左右肝脏7例;病灶的直径在1cm^13cm之间;CT动脉期表现为脓肿壁强化程度高于正常肝实质,炎性反应带无强化;门静脉期脓肿壁强化程度降低,其密度略高于正常肝实质密度,炎性反应带强化,呈等密度改变;延迟期脓肿壁仍有强化,其密度稍高于正常肝实质密度,炎性反应带呈低密度,3期扫描中脓腔中心液化坏死区均未见明显强化;MRI平扫病灶主要表现为T1呈均匀或不均匀的低信号,T2表现极高信号,增强扫描后,脓肿壁呈环形或蜂窝状强化,分房的脓肿间隔也出现强化,液化区无明显强化。结论联合应用螺旋CT动态增强扫描和MRI扫描,在对肝脓肿病理分期临床诊断中达到优势互补的目的,能够提高诊断准确率,降低误诊率,值得临床诊断中进一步推广与应用。

Objective To investigate the clinical value of CT dynamic enhancement and MRI in the diagnosis of liver abscess.Methods Retrospective analysis of the general clinical data and imaging data of 81 patients with liver abscess confirmed by surgery and pathology in our hospital from August 2013 to December 2015. Observation and comparison of CT dynamic enhanced scan and MRI scan imaging features of liver abscess. Summary and analysis of the pathological stage, etiology, scope, form and strengthening methods are summarized and analyzed.Results In this group, 81 cases were solitary in 67 cases and multiple in 14 cases. The abscess was located in the right lobe of the liver in 49 cases, the left lobe of the liver in 25 cases, and the left and right liver in 7 cases. The diameter of the abscess was between 1cm^13cm. CT features of arterial phase into the abscess wall strengthening degree higher than that of normal liver parenchyma and inflammatory reaction with no enhancement; portal venous phase abscess wall enhancement degree decreased, the density slightly higher than normal liver parenchyma and inflammatory reaction with enhanced were density changes; delay abscess wall is enhanced and the density is slightly higher than that of normal liver parenchyma, inflammatory reaction with a low density, the liquefactive necrosis of pus cavity center showed no obvious enhancement in all the 3 phases scanning. MRI plain scan lesions mainly showed T1 is homogeneous or inhomogeneous low signal, T2 is very high signal, the abscess wall was ring or honeycomb enhancement, distribution of abscess interval to strengthen, liquefied area without obvious enhancement.Conclusion Combined with the application of spiral CT dynamic enhancement scan and MRI scan and in the pathology of liver abscess stage clinical diagnosis achieve complementary advantages, can improve the diagnostic accuracy rate, reduce the misdiagnosis rate. It is worthy of clinical diagnosis in the further promotion and application.