土三七致肝窦阻塞综合征19例的影像及病理特征分析

CT,MRI findings and pathological analysis of hepatic sinusoidal obstruction syndrome caused by gynura segetum

目的:探讨土三七致肝窦阻塞综合征(HSOS)的CT、MRI表现及病理特征,旨在提高临床对该病的认识。方法:回顾性分析19例经病理证实的HSOS患者的影像资料及病理结果。结果:14例行CT平扫及增强扫描,示肝脏体积增大,密度不均匀,腹腔中重度积液;动脉期肝动脉增粗、扭曲,门静脉期及实质期肝实质呈斑片状不均匀强化,肝静脉三大分支走行处的肝实质强化程度较其余部分肝实质高且均匀。5例行MRI平扫及增强扫描,示肝实质不均匀,冠状位示肝段下腔静脉纤细或扁平,但血流通畅。病理检查见肝细胞水肿、变性,部分坏死,肝窦明显淤血、扩张,汇管区扩大,纤维结缔组织轻度增生。结论:土三七致HSOS的影像学表现有一定特征性,反映了其病理特征,对该病诊断有重要价值。

Objective:To investigate the CT and MRI manifestations and pathological basis of hepatic sinusoidal obstruction syndrome(HSOS)induced by gynura segetum,aiming to improve the understanding of this disease.Methods:The imaging and pathological results of 19 patients with pathologically proved HSOS were analyzed retrospectively.Results:CT examination of 14 cases showed that the volume of liver was enlarged,the density was uneven,and the peritoneal fluid was moderate to severe,the hepatic artery was thickened and twisted in arterial phase,the hepatic parenchyma was patchy and uneven in portal and parenchymal phase,and the enhancement of hepatic parenchyma near the three branches of hepatic vein was higher and more uniform than the rest of the hepatic parenchyma.Compared with CT,MRI of 5 cases showed that the liver parenchyma was heterogeneity,coronal view showed that the inferior vena cava was thin or flat,but smooth.Pathology showed hepatocyte edema,degeneration,partial necrosis,obvious congestion and expansion of hepatic sinus,enlargement of portal area,slight proliferation of fibrous connective tissue.Conclusion:The imaging of the HSOS induced by gynura segetum have certain characteristics,reflecting its pathological features,and are of great value in the diagnosis of this disease.