肝脾手术及上消化道出血后肝脏缺血/坏死灶CT和MR特征

CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage

目的探讨肝脾术后及上消化道出血后患者肝脏缺血/坏死灶的CT与MR表现特点。方法搜集解放军总医院第五医学中心肝脾术后及上消化道出血后短期内经影像及临床诊断为肝脏缺血/坏死病变36例患者临床资料,其中肝癌切除术9例,肝癌消融手术(微波/射频、氩氦刀、酒精注射)5例,脾脏切除术11例,上消化道出血11例。常规肝脏CT和/或MR平扫及动态增强,综合分析病灶的形态及密度/信号表现。结果(1)病灶数量:全部患者均为多发病灶。(2)病变分布:散在各叶、簇状聚集或区域分布,以周边部为主。(3)病灶大小:结节病灶边界清楚,单个最大直径1.0~1.5 cm,可融合呈楔形片状或段/亚段性大片状,有轻微占位效应。(4)CT密度值或MR信号特征:CT平扫病灶呈稍低密度;MR平扫呈T1WI稍低信号、T2WI较高信号、DWI呈稍高信号、双回波未见脂质/脂肪;增强扫描多不强化(24/36例,66.7%),部分病灶边缘薄环状强化;门静脉主干及/或分支多可见栓子(21/36例,58.3%)。(5)短期复查(最短5 d)病灶变小或消失,局部肝体积变小或表面凹陷。结论发生于患者肝脾手术及上消化道大出血后的肝脏缺血/坏死灶,影像表现为多发结节状或片状乏血供灶,短期复查可见明显好转,并需要与感染、恶性肿瘤术后转移相鉴别。

Objective To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.Methods A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected,including 9 patients with liver cancer resection,5 patients with liver cancer ablation(microwave ablation/radiofrequency ablation,argon-helium knife,alcohol injection),11 patients with spleen resection,and 11 patients with upper gastrointestinal bleeding.Conventional liver CT and/or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesions:All cases had multiple lesions.(2)Distribution of lesions:scattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesions:the boundary of the nodular lesion was clear,and the single maximum diameter was 1.0-1.5 cm.It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect.(4)CT density or MR signal characteristics:CT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1WI,high signal on T2WI,slightly high signal on DWI and no lipid/fat on dual phase imaging;24 out of 36 cases(66.7%)showed no enhancement,while some lesions showed thin ring enhancement on the edge;emboli were found in the main and/or branches of portal vein(21/36 cases,58.3%).(5)In the short-term review(minimum 5 days),the lesions became smaller or disappeared,and the local liver volume became smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage.The imaging manifestations are multiple nodular or flaky hypovascular foci,and the short-term review shows a markedly improvement.It needs to be differentiated from infection and metastasis of malignant tumors after operation.