肝脏结核的CT诊断及其鉴别诊断

Imaging diagnosis and differential diagnosis of the hepatic tuberculosis

目的探讨CT平扫+动态增强对肝脏结核的诊断价值。方法回顾性分析15例经手术或穿刺病理证实的肝脏结核的影像表现。其中男10例,女5例,行上腹部CT平扫及动态增强扫描。结果4例表现为肝实质内单发结节,9例表现为肝脏内多发结节,2例病灶位于肝脏包膜下。增强扫描2例病灶动脉期呈轻度不均匀强化,门脉期及延迟期强化程度减低,强化类型呈“快进快出型”;2例病灶动脉期轻度强化,门脉及延迟期同肝实质基本相似,强化类型呈“慢进慢出型”;4例病灶呈环形强化;5例病灶动脉期可见“晕佂”;1例动脉期未见明显强化,门脉期及延迟期示病灶呈轻度强化;3例病灶未见明显强化;4例病灶内出现钙化。结论CT平扫及增强检查对肝脏结核具有较高诊断价值,根据病灶不同的强化特点,可以判断病变的病理学特征。

Objective To investigate the diagnostic value of CT plain scan + dynamic enhancement for hepatic tuberculosis. Methods The imaging findings of 15 cases of hepatic tuberculosis confirmed by surgery or puncture pathology were retrospectively analyzed. There were 10 males and 5 females with CT scan and dynamic enhanced scan of the upper abdomen. Results In 4 cases, there were single nodules in the liver parenchyma;9 cases showed multiple nodules in the liver;2 cases were located under the liver capsule. The enhanced scan showed mild inhomogeneous enhancement of the arterial phase in 2 cases, and the degree of enhancement in the portal vein and lag phase was reduced. The type of enhancement was “fast-forward and rapid-out”;2 cases were mildly intensified in the arterial phase, and the portal vein and delayed phase were associated with the liver. The essence was basically similar, the type of enhancement was “slow-in and slow-out”;4 cases showed ring-shaped enhancement;5 cases showed “syncope” in the arterial phase;1 case showed no obvious enhancement in arterial phase, and the portal vein and delayed phase showed lesions. There are mild enhancement and no obvious enhancement in 3 lesions. Calcification in 4 lesions. Conclusion CT plain scan and enhanced examination have high diagnostic value for hepatic tuberculosis. According to the different enhancement features of lesions, the pathological features of lesions can be judged.