肝衰竭的CT影像表现及病理对照  

CT findings of liver failure with pathologic correlation

作　　者：陈枫[1] 赵大伟[1] 卢实春[2] 陈煜[3] 宋文艳[1] 何宁[1] 文硕[1] 

机构地区：[1]首都医科大学附属北京佑安医院放射科,100069 [2]首都医科大学附属北京佑安医院外科,100069 [3]首都医科大学附属北京佑安医院肝病内科,100069

出　　处：《中华放射学杂志》2011年第5期454-458,共5页Chinese Journal of Radiology

基　　金：国家重点基础研究发展计划（973）资助项目（2007CB512801）

摘　　要：目的探讨肝衰竭肝坏死和再生的CT影像表现。方法回顾性分析5例肝衰竭患者原位肝移植术前的CT表现，并与术后的大体标本和病理结果相对照，分析其影像特征。结果肝衰竭的CT影像表现有3种：（1）大块状融合病灶2例：病理结果分别为肝细胞的大块状坏死和聚合的结节样再生。CT平扫相应表现为地图样分布的低密度和高密度区；增强扫描肝内坏死区强化出现在静脉期，聚合的肝细胞结节样再生以动脉期强化明显。（2）弥漫的结节状病灶2例：病理结果分别为肝内弥漫的结节状坏死和结节状冉生。CT平扫均表现为弥漫的稍高密度结节灶；增强扫描动脉期均出现强化，前者静脉期及延迟期表现为结节状低密度灶，后者静脉期及延迟期表现为等密度改变。（3）多发小片状病灶1例：病理为肝内分散的肝细胞小片状坏死。平扫肝脏密度弥漫性减低；增强扫描静脉期表现为肝周的小片状强化，动脉期及延迟期为等密度改变。结论肝衰竭的CT影像表现具有特征性。Objective To investigate CT tindings of hepatic＇, necrosis and regeneration after liver failure. Methods Five patients with liver tailure underwent CT scan before orthotopic liver transplantation. These findings were retrospectively reviewed and correlated with gross specimen and pathologic findings obtained after transplantation. Results Among 5 cases, the CT appearances of liver tailure can be divided into 3 types. （ 1 ） Massive confluent aggregate loci in 2 patients demonstrated low attenuation and high attenuation as geographical patterns on CT scans betore contrast enhancement, respectively. The histopathological liver changes showed massive necrosis and regeneration. Regions of necrosis enhanced to attenuation greater than that of normal liver parenchyma in portal-venous phase, the regions of regeneration enhanced to attenuation greater than that of normal liver parenchyma in arterial phase on postcontrast CT images. （2）In 2 patients, diffuse nodules of liver demonstrated high attenuation on plain CT scans, which was nodular necrosis and nodular regeneration pathologically. All enhanced to attenuation greater than that of normal liver parenchyma in arterial phase. The former showed hypointensity in portal-venous phase and equilibrium phase. The latter enhanced to attenuation equal to that of normal liver parenchyma in portal- venous phase and equilibrium phase on posteontrast CT images. （3）Multiple small tocl in 1 case demonstrated low attenuation on precontrast CT images and enhanced to hyperintensity in portal-venous phase and isointensity in arterial phase and equilibrium phase on postcontrast CT images. The histopathological liver changes showed multiple necrosis. Conclusion Liver failure may reveal characteristic imaging patterns at CT.

关 键 词：肝功能衰竭 肝再生 体层摄影术 X线计算机 

分 类 号：R575.3[医药卫生—消化系统]