肝结核的CT与MRI影像诊断价值

Values of CT and MRI imaging in the diagnosis of hepatic tuberculosis

目的探讨各型肝结核的CT与MRI的影像表现.方法回顾性分析经临床或穿刺病理证实19例肝结核患者,其中14例行肝脏CT平扫加增强扫描,3例只行CT平扫,1例行CT及MRI平扫加增强检查,1例只行MR平扫检查.结果19例肝结核患者中浆膜型肝结核12例、实质型肝结核7例(其中实质结节型5例、实质粟粒型1例和实质脓肿型1例),大多数浆膜型肝结核患者合并结核性腹膜炎,有约78.95%的患者同时合并肺结核,36.84%的患者首发症状为发热;浆膜型、实质型肝结核CT增强扫描示病灶呈渐进性强化,动脉期病灶周边可见异常血流灌注,门脉期显示结核病灶最为清晰,MR表现为病灶在DW序列呈高信号,但是其ADC值为高信号,其中实质脓肿型肝结核增强扫描病灶中央无强化,周边呈环形强化.结论浆膜型肝结核是目前肝结核较为常见的类型,CT与MR增强扫描对肝结核的准确分型与鉴别具有重要意义.

Objective To explore the clinical and imaging features of CT and MRI of hepatic tuberculosis.Methods Retrospective analysis was performed on 19 cases of liver tuberculosis confirmed by clinical or puncture pathology.Of 19 cases,14 cases were received CT scanning of the liver with enhancement,3 cases received no-costrst CT scanning of the liver only,1 case received CT and MRI scanning of the liver with enhancement,and 1 case received MRI scanning of the liver with no-costrst scan.Results There were 12 cases of serosal hepatic tuberculosis and 7 cases of parenchymal hepatic tuberculosis including 5 cases of parenchymal nodular type,1 case of parenchymal miliary type and 1 case of parenchymal abscess type.Most of the patients with serosal type hepatic tuberculosis were combined with tuberculous peritonitis,about 78.95%patients were combined with pulmonary tuberculosis,36.84%patients had fever as the first symptom.On contrast-enhanced CT scanning,serosa and parenchyma type of liver tuberculosis showed progressive enhancement,abnormal blood perfusion around the lesion in the arterial phase,and the tuberculosis lesion was most clearly seen in the portal vein phase.The MR image of liver tuberculosis showed hyperintensity in the DWI sequence,and the ADC value was also demonstrate high signal.On contrast-enhanced MRI scan,the focus had no enhancement in the center,and the surrounding area showed ring enhancement.Conclusion Serosa type of hepatic tuberculosis is the most common type of liver tuberculosis,CT and MR enhanced scanning have great clinic significance for the accurate classification and differentiation of liver tuberculosis.