肝脏炎性病变与肝脏乏血供肿瘤的CT和磁共振成像诊断及鉴别诊断

CT and MRI diagnosis and differential diagnosis of hepatic inflammatory lesions and hypovascular tumors

目的探讨肝脏炎性病变与乏血供肿瘤的CT和磁共振成像(MRI)诊断及鉴别诊断,为临床诊断及治疗提供影像参考。方法回顾性分析2016年1月至2020年4月的20例肝脏炎性病变及20例乏血供肿瘤患者的CT和MRI的平扫及增强后动脉期、静脉期及延迟扫描的影像表现。结果肝脓肿10例,呈双环征;不典型肝脓肿5例,多发单环强化;胰腺炎累及肝尾状叶1例,边缘轻度强化;肝脏逆行胆道感染1例,边缘轻度强化,以胆管周围分布;肺炎克雷伯杆菌累及肝脏1例,边缘轻度强化;肝脏放线菌感染1例,肝脏肿大,边缘轻度强化;右侧乳腺癌术后放疗致肝脏放射性炎症1例,边缘轻度强化;肝脏炎性假瘤3例,轻度持续向心性强化;退变结节并发早期小肝癌3例,胰腺癌肝转移6例、胆囊癌累及肝脏或肝内转移4例、结肠癌肝转移6例,呈牛眼状强化;肝内胆管细胞癌4例,边缘持续强化。病灶大小2~110 mm,单发15例,多发25例。CT或MRI检查均能给予较为明确诊断及提示。结论肝脏的炎性病变和乏血供肿瘤的影像表现各有其特殊的影像征象,对临床上肝脏炎性病变及乏血供肿瘤诊断和鉴别诊断及治疗有一定的参考价值及指导意义。

Objective To explore the CT and MRI diagnosis and differential diagnosis of hepatic inflammatory lesions and hypovascular tumors,and to provide imaging reference for clinical diagnosis and treatment.Method Retrospectively analyze CT and MRI plain scan and delayed scan imaging of 20 patients from January 2016 to April2020 with inflammatory liver lesions and 20 patients with lack of blood supply tumor.Result Ten cases with hepatic abscess with double ring sign,5 cases with atypical liver abscess with multiple single ring enhancement,1 case with pancreatitis involving caudate lobe of the liver with mild enhancement,1 case retrograde infection of the biliary tract of the liver,1 case with retrograde biliary tract infection with marginal enhancement around bile duct klebsiella pneumonia involved the liver,1 case of hepatic actinomycosis,1 case with hepatic enlargement,1 case with hepatic radiation,1 case with right breast cancer,1 case with hepatic radiation,there were 3 cases with inflammatory pseudotumor with the liver mild and persistent centripetal enhancement,degenerative nodules complicated with early small liver cancer in 3 cases,there were 6 cases with liver metastasis from pancreatic,4 cases with liver or intrahepatic metastasis from gallbladder carcinoma,6 cases with liver metastasis from colon carcinoma,it showed the bull-eye enhancement,and 4 cases with intrhepatic cholangiocarcinoma.The lesion size was 2-110 mm,single lesion in 15 cases,multiple lesion in 25 cases.CT and MRI examination can provide a more clear diagnosis.Conclusion The imaging features of inflammatory lesion and hypovascular tumor of the liver have their own special imaging features,which is of certain reference value and guiding significance for the diagnosis and treatment of inflammatory lesion and hypovascular tumor of the liver.