自身免疫性肝炎致肝硬化的MRI表现及其临床价值  

MRI Features and Clinical Value of Liver Cirrhosis Caused by Autoimmune Hepatitis

作　　者：吴春[1] 王劲[1] 廖碧红[1] 姜在波[1] 朱康顺[1] 关守海[1] 钱结胜[1] 李征然[1] 庞鹏飞[1] 何炳均[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广州510630

出　　处：《临床放射学杂志》2010年第8期1065-1068,共4页Journal of Clinical Radiology

基　　金：广东省自然科学基金研究团队项目(编号:05200177);广东省科技计划项目(编号:2008B060600034)

摘　　要：目的探讨自身免疫性肝炎(autoimmune hepatitis,AIH)致肝硬化的MRI诊断特点,以提高其诊断准确性。资料与方法回顾分析经临床确诊为AIH所致肝硬化患者7例,所有患者均按肝功能Child-Pugh分级(A级2例,B级2例,C级3例)并行MR T1WI、T2WI、扩散加权成像(DWI)及动态增强扫描。2例行肝穿刺活检,2例经1～2年随访,分析其MRI表现并与病理、肝功能分级对照。结果 (1)肝脏形态学改变:5例(ChildB、C级)全肝萎缩。3例(Child C级)肝脏内可见多个大小不等结节形成,可见结节融合,横径最大约为53mm,结节信号表现多样,但在DWI上均呈低信号,部分结节增强后可见强化,随访后强化信号消失。(2)继发门静脉高压改变:除1例(Child A级)无明显继发门静脉高压表现,余6例门静脉主干增粗、胃底及脾静脉延长迂曲。7例脾均增大,2例(Child C级)脾内可见含铁血黄素沉积,其中1例伴有脾梗死。3例(Child C级)腹腔积液形成。(3)其他:1例(Child A级)肝内胆管轻度扩张。所有患者均无淋巴结改变。肝穿刺病理结果符合AIH致肝硬化表现。结论 AIH致肝硬化的MRI表现特点为:随着肝功能Child-Pugh分级的加重,肝脏形态学及继发门静脉高压改变随之加重;全肝萎缩,肝左外叶及尾状叶的代偿性增大少见;肝硬化结节形态、信号改变多样,癌变罕见;可伴有肝内胆管扩张;较少伴有淋巴结肿大。MRI可作为AIH致肝硬化的有效检查手段。Objective To analyze the imaging characteristics of MRI in liver cirrhosis caused by autoimmune hepatitis and to evaluate its clinical value. Materials and Methods All 7 cases patients with liver cirrhosis caused by autoimmune hepatitis were clinically confirmed. All of patients,including 2 cases of Child-Pugh A,2 cases of Child-Pugh B and 3 cases of Child-Pugh C,underwent conventional MRI、DWI and four phases dynamic enhancement scanning. 2 cases underwent liver biopsy. 2 cases were followed up for 1-2 years. The MRI images were reviewed and analysed retrospectively in comparison with pathological results and liver function grade. Results （1）Morphologic changes of liver：Global atrophy of the liver occured in 5 cases （Child B、C grade）,3 cases（Child C grade）had many surface nodularities in the liver,including regenerative nodules and dysplastic nodules,the nodules had many kinds of magnetic resonance signal and could be fused,the diameter of the biggest fused nodule was 53 mm,but all the nodules were low signals on DWI. The follow-up results showed some noduls,which could be enhanced early after being injected the contrast materials,could not be enhanced any more. （2）The findings secondary to portal hypertension：1 case（Child A grade）had no significant findings,the other patients gained main portal vein enlargment,gastric fundus vein and splenic vein varices. All the patients gained Splenomegaly,the hemosiderin deposited in the spleens of 2 cases（Child C grade）,one of them gained infarction of spleen. 3 cases（Child C grade）gained ascites. （3）The others：The biliary duct dilatation occurred in 1 case（Child A grade）. Lymphadenopathy was not observed in all the patients. The results of the liver biopsy were accord with liver cirrhosis caused by autoimmune hepatitis. Conclusion With the aggravation of liver function grade,the variation of liver′morphology and portal hypertension became more and more serious;Global atrophy of the liver without enlargement of the caudate lobe

关 键 词：自身免疫性肝炎 肝硬化 磁共振成像 

分 类 号：R575.1[医药卫生—消化系统]