肝窦阻塞综合征的临床及影像学特点分析

Analyses of clinical and imaging features of hepatic sinusoidal obstruction syndrome

目的探讨肝窦阻塞综合征(hepatic sinusoidal obstructive syndrome,HSOS)的临床特点及CT、MRI征象,提高对本病的认识。方法回顾性分析8例经临床或病理学证实的肝窦阻塞综合征的临床特点,并对其CT或MRI征象归纳、总结。结果本组8例患者起病前均曾有不同程度服用土三七或含有土三七成分的药酒史,影像征象表现为肝肿胀者6例,肝实质密度/信号不均匀减低及增强后"地图样"强化8例均有不同程度表现,增强后静脉期以第二肝门为中心沿三支肝静脉呈"火焰状"强化者7例,下腔静脉肝段狭窄者5例,门静脉增宽3例,本组4例表现为"格林森鞘积液、门脉管壁水肿",另有胆囊壁水肿3例。结论肝窦阻塞综合征临床上与服用中药土三七密切相关,临床表现主要为药物性肝损伤,影像学表现为肝肿胀、增强后肝实质"地图样"强化、下腔静脉肝段狭窄等具有一定的诊断价值,以第二肝门为中心沿三支肝静脉呈"火焰状"强化为本病的特异表现。

Objective To investigate the clinical,CT,and MRI features of hepatic sinusoidal obstruction syndrome（ HSOS）,so as to improve the understanding of this disease. Methods The clinical features of 8 cases of HSOS confirmed by clinic or pathology were retrospectively analyzed and,meanwhile,their CT or MRI findings were summarized. Results All of those 8 patients had the medical history of taking gynura segetum or medicinal liquor containing components of gynura segetum at different degree before the onset. The imaging signs were that liver edema appeared in cases of,liver parenchyma density/signal heterogeneity reduction and the ＂ map-like＂ enhancement in 8 cases at different degrees. In the venous phase,at second hepatic portal as the center along the three hepatic veins,7 cases exhibited the flame like enhancement,5 cases exhibited the stenosis of hepatic segment of inferior vena cava,and 3 cases exhibited the wideness of portal vein. In this group,4 cases showed ＂ Gleason sheath effusion,door vascular wall edema＂and 3 patients presented with gallbladder wall edema. Conclusion HSOS was closely related to taking gynura segetum. The main clinical manifestations were the drug-induced liver damage. Liver imagings showed swelling,the ＂ map-like＂ enhancement of liver parenchyma,and the stenosis of hepatic segment of inferior vena cava,which had certain diagnostic value. Importantly,the flame like enhancement at second hepatic portal as the center along the three hepatic veins in the venous phase was the specific manifestation of this disorder.