浆膜型肝结核的CT表现特征

CT characteristics of the sero-hepatic type of hepatic tuberculosis

目的探讨浆膜型肝结核的CT特征。方法采用回顾性横断面研究，收集2001年1月至2015年12月浙江省乐清市人民医院（5例）、温州医科大学附属二院（5例）和温州市人民医院（7例）收治的17例肝浆膜型结核患者的CT资料。17例患者均于MSCT检查前禁食8h，不行腹部加压，用屏气扫描。17例均行CT平扫及增强检查。结果17例患者共发现41个结节，其中多发结节13例，单发结节4例，结节最大直径0．8～4．7cm，平均（2．38±4．82）cm。CT表现为肝包膜区局限性梭形低密度结节灶和邻近肝组织受压内凹22个，其中1个结节灶中心见斑点状钙化；聚集的多发结节样低密度灶19个。35个结节灶邻近的肝包膜有不同程度增厚。结节灶周围可见少量液性密度15个，结节灶周围肝组织浸润22个。伴发少量腹水8例，腹膜后淋巴结增大2例。结节于动脉期中度强化5个，轻度强化36个；门静脉期中度强化32个，轻度强化9个；实质期中度强化32个，轻度强化9个。结节灶呈环形强化26个，蜂窝状或多环状强化15个。强化环壁厚度为0．2～0．9cm，其中薄壁30个，厚壁11个。结节灶中央均为囊样低密度区，增强后强化不明显，CT值21～39Hu。结节灶周围浸润的肝组织增强后动脉期呈明显片状强化，门静脉期及平衡期呈等密度。结论浆膜型肝结核的CT表现具有一定特征，结合临床表现及实验室检查可作出提示性诊断。

Objective To study the CT features of the sero-hepatic type of hepatic tuberculosis. Methods This is a retrospective, multi-center and cross-sectional study. 17 patients with the sero-hepatic type of hepatic tuberculosis from the Yueqing People＇ s Hospital （ n = 5 ） , Second Mfiliated Hospital of Wenzhou Medical College （ n = 5 ） , and Wenzhou People＇ s Hospital （ n = 7 ） were studied. All these patients were fasted for 8 h prior to CT scanning. They underwent enhanced after conventional CT breathless scanning with no abdominal pressure. Results The CT scans displayed 41 lesions in these 17 patients with the sero-hepatic type of hepatic tuberculosis, including a solitary lesion in 13 patients and multiple lesions in 4 patients. The diameter of the lesions varied from 0. 8 to 4.7 cm, with a mean ± S.D. of 2. 38 ±4.82 cm. The CT features showed a localized spindle-shaped focal lesion just underneath the liver capsule with resultant concave compression of the adjacent liver tissue （ n = 22） , spotted calcifications in the center of the focal nodules （n = 1 ） ; and aggregation of multiple low density nodular foci （n = 19 ）. Additional CT features included focal nodules surrounded by a small amount of liquid （ n = 15 ） , compression of adjacent liver tissue （ n = 22）, a small amount of ascites （ n = 8 ）, and retroperitoneal lymph nodes enlargement （ n = 2 ）. These nodules showed moderate （n = 5 ） and slight enhancement in the arterial phase （n = 36） ; moderate （ n = 32） and mild enhancement in the portal venous phase （ n = 9 ） ; and moderate （ n = 32 ） and mild enhancement in the parenchymal phase （ n = 9 ） , respectively. The nodules showed ring-shaped （ n = 26 ） , honeycomb or multiple ring-shaped enhancement （n = 15 ）. The enhanced ring-shaped wall thickness varied from 0.2 to 0.9 em, with a thin wall （ n = 30 ） and a thick wall （ n = 11 ）. The center of the focal nodule was a low density sac-shaped area, with no obvious contrast enhancement. The CT value was 21 to 39 hu. The infiltrative liver tissues which surrounded the focal nodules were shown as lamellar areas of obvious arterial enhancement, with equidensity in the portal vein phase and equilibrium phase. Conclusions CT showed characteristic features of the sero-hepatic type of hepatic tuberculosis. Clinical and laboratory findings could provide important supplementary information to make the diagnosis.