肝结核超声动态造影表现及其病理基础  

Characteristics of Hepatic Tuberculosis on Enhanced-ultrasonography and Their Histopathological Basis

作　　者：曹兵生[1] 张蕊[1] 黎晓林[1] 王仲元[2] 宋晶莹[3] 

机构地区：[1]解放军总医院第二附属医院超声科,北京市100091 [2]解放军总医院第二附属医院结核病研究所,北京市100091 [3]解放军总医院第二附属医院病理科,北京市100091

出　　处：《中国超声医学杂志》2008年第7期657-660,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的研究肝结核超声动态造影表现特征及其病理基础。方法对8例肝结核15个肝内病灶进行常规超声检查和超声造影检查,分析灰阶超声和超声造影图像特征。对不同的造影特征区进行超声引导下穿刺活检,分析其病理组织特征。结果15个肝结核病灶中,10(66.7%)个病灶位于肝被膜下,14个病灶呈低回声或不均匀等回声,1个病灶呈混合回声。超声造影动脉期13个病灶中,11个病灶呈环状或整体高增强,门静脉期15个病灶均呈低增强或无增强。穿刺病理显示造影无增强区与组织完全坏死对应,动脉期高增强区对应的组织病理改变是小血管扩张,明显的炎细胞浸润;门脉期低增强区对应的组织病理改变是肝板结构破坏,组织灶状坏死。结论肝结核超声造影表现与其病理变化有密切的关系;肝板结构破坏、干酪样坏死、灶状坏死及血管扩张是肝结核病灶超声造影不同表现的病理基础。Objective To study the kinetic enhancement manifestations of hepatic tuberculosis lesions on contrast-enhanced ultrasound （CEUS） and their pathologic basis. Methods Eight patients with 15 hepatic tuberculotic lesions were studied with conventional ultrasound and CEUS. Ultrasound guided biopsy was done for each different enhanced regions of tuberculotic lesions and their pathologic statuses were studied. Results Of the 15 hepatic tuberculotic lesions, 10 （66.7%） were located under the hepatic capsule, and 14 lesions were hypoechoic or iso-heterogeneous echoes but the largest lesion demonstrated heterogeneous echoes with central free echo area. After administration of SonoVue, 11 out of 13 lesions demonstrated hyperenhancement on aterial phase, and 15 lesions appeared hypo-enhaneement or non-enhancement at portal venous phase. Pathologic results showed hyper-enhanced region at arterial phase was characterized with blood capillary dialation and moderate severe inflammation, while hypo-enhanced region was related to distruction of hepatic cell plates and focal necrosis, and non-enhancement region was related to caseous necrosis and abscesses. Conclusions Kinetic enhanced manifestations of hepatic tuberculosis are related to pathologic status and destruction of hepatic cell plates, forcal caseous necrosis as well as inflammation. These are the basis of enhanced manifestations.

关 键 词：肝结核 超声造影 病理学 

分 类 号：R525[医药卫生—内科学] R445.1[医药卫生—临床医学]