儿童肝泡球蚴病影像学分型、PNM分期及其生长特性的研究  

Analysis of imaging classification, PNM staging and growth characteristics of hepatic alveolar echinococcosis in children

作　　者：黄瑞[1] 鲍海华[1] 李伟霞[1] 高飞[1] 孟莉[1] 樊海宁[2] 

机构地区：[1]青海大学附属医院影像中心,青海西宁810001 [2]青海大学附属医院肝胆胰外科、青海省重点包虫病研究所

出　　处：《实用放射学杂志》2016年第6期926-929,共4页Journal of Practical Radiology

基　　金：青海省科技厅基金项目（2009-Z-714）.

摘　　要：目的 探讨儿童肝泡球蚴病（HAE）的影像学分型、PNM分期及边缘带表观扩散系数（ADC）值与正常肝组织的差异性，研究其生长特性。方法 分析31例儿童HAE的CT及MRI资料，了解患病时间，临床表现及相关实验室检查，根据HAE影像学特点对其进行分型，同时记录病灶的位置、数目、范围，根据侵犯和转移情况明确PNM分期；测量正常肝组织与病灶边缘带的ADC值。结果 31例患者发病时间为（2.45±1.44）年；23例出现腹痛、黄疸和不同程度肝功能损害。31例患者肝内病灶共43个，其中2例侵及全肝无法计数。分型：巨块型20例，液化坏死型9例，多发结节型2例。PNM分期：P4期15例（48.39%）；N1 8例（25.8%）；M1 13例（41.94%）。侵犯情况：侵犯胆管23例（74.19%）、门静脉及肝静脉受侵均25例（80.65%），侵及下腔静脉8例，周围侵犯8例；正常肝组织、边缘带ADC值分别为（1.12±0.104）×10-3mm2/s、（0.877±0.137）×10-3mm2/s，ADC值存在统计学差异（t=5.612，P=0.001）。结论 儿童HAE具有独特影像学特点，CT及MRI能直观地对儿童HAE进行评价；fMRI能从功能上反映出病灶的生长特性。Objective To explore the imaging classification and PNM （parasite lesion, neighboring organ invasion and metastases） staging of hepatic alveolar echinoeoccosis （HAE） in children according to the imaging features and to compare the difference in ADC values between peripheral zone and normal live parenchyma. To study the growth characteristics of HAE in children. Methods 31 pediatric patients with HAE were scanned using CT and MRI. Course of the disease, clinical manifestations, laboratory tests＇ results were recorded. CT and MR imaging features ofHAE including the location, number and size were also recorded, and the PNM staging was clarified based on the invasion and metastases. The ADC values in normal live parenchyma and the peripheral zone of lesion were measured. Results The course of the disease in 31 patients was mean （2.45±1.44） years. Abdominal pain, jaundice and varying degrees of liver function damage were found in 23 patients. There were 43 hepatic lesions in 31 patients, 2 of whom invaded the whole liver and could not be counted. Three types of the classification included massive type in 20, liquefaction necrosis type in 9 and multiple nodules type in 2. The PNM staging included P4 stage in 15 （48.39%）, N1 stage in 8 （25.8%）, and M1 stage in 13 （41.94%）. The invasion of bile duct in 23 （74.19%） , of portal or hepatic vein in 25 （80.65%） of inferior vena cava or neighboring area in 8 were found. The ADC values of the peripheral zone of lesion and normal live parenchyma were （1.12 ±0. 104）× 10.3 mm2/s and （0. 877 ± 0. 137）× 10.3 mm2/s, respectively, exhibiting a statistical difference （t=5. 612, P=0. 001）. Conclusion The children HAE has some imaging characteristics. CT and MRI can evaluate the children HAE directly,and the functional MRI can reflect the growth characteristics of the lesions.

关 键 词：儿童 肝泡球蚴 影像学分型 PNM分期 

分 类 号：R532.32[医药卫生—内科学] R575[医药卫生—临床医学]