肝包虫合并肝癌CT与MRI诊断  

CT and MRI diagnosis of hepatic echinococcosis combined with liver cancer

作　　者：田登锋 孙艳秋[1] TIAN Dengfeng;SUN Yanqiu(Department of Imaging,Qinghai People's Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院影像科,青海西宁810000

出　　处：《实用放射学杂志》2019年第12期1958-1961,共4页Journal of Practical Radiology

基　　金：青海省科学技术厅资助项目(2015-ZJ-749);青海省卫生和计划生育委员会指导性计划项目(2016-wjzdx-04)。

摘　　要：目的总结肝包虫合并肝癌的CT及MRI表现并复习文献,提高对该病的影像学认识。方法回顾性分析经手术及病理证实5例肝包虫合并肝癌患者临床及影像学资料,影像学观察内容包括病灶的部位、大小、密度或信号特点、强化特征、肝内外胆管及血管侵犯情况,并与手术结果做对比。结果①CT及MRI共检出肝细粒棘球蚴病灶9个,肝内及腹腔多发合并感染1例,泡球蚴病1例;②CT及MRI共检出肝癌灶8个,肝内多发转移2例;CT平扫6个肝癌灶未见明确显示,DWI序列肝癌灶信号低于包虫病灶而明显高于正常肝组织,增强扫描呈“快进快出”强化;③CT及MRI显示病灶累及第2肝门3例,受累肝动脉3支,肝静脉6支,门静脉8支,2例累及下腔静脉,磁共振胰胆管成像(MRCP)显示胆管受累2例,CT显示肝左叶胆管扩张1例,CT漏诊包虫囊肿胆管内瘘并感染1例,与手术所见基本一致。结论CT及MRI能够准确显示肝包虫及肝癌的分布、累及的范围及肝内脉管系统受侵情况。Objective To improve the imaging understanding of the disease by summarizing the CT and MRI manifestations of hepatic echinococcosis combined with liver cancer and reviewing the literature.Methods The clinical and imaging data of 5 patients with liver echinococcosis combined with liver cancer confirmed by surgery and pathology were analyzed retrospectively.Imaging findings included location,size,density or signal characteristics,enhancement features,intrahepatic and extrahepatic bile duct and vascular invasion,and were compared with surgical results.Results①9 lesions of hepatic cystic echinococcosis were found by CT and MRI.Intrahepatic and intraperitoneal were multiple cystic echinococcosis combined with infection in 1 case,and 1 case was alveolar echinococcosis.②8 liver cancer lesions were detected by CT and MRI.Liver cancer with multiple intrahepatic metastases occurred in 2 cases.There was no clear display of 6 liver cancer lesions on CT plain scans.In DWI sequence,the signal intensity of liver cancer was lower than that of hydatid lesions,but significantly higher than that of normal liver tissue.The enhanced scan showed"fast in and fast outM.③CT and MRI showed lesions involving the second porta hepatis in 3 cases,3 hepatic arteries,6 hepatic veins and 8 portal veins were involved,2 cases involving the inferior vena cava,MR cholangiopancreatography(MRCP)showed bile duct involvement in 2 cases,CT showed dilatation of left hepatic bile duct in 1 case,CT missed diagnosis of hydatid cyst and intraductal fistula combined with infection in 1 case,which was basically consistent with the operation findings.Conclusion CT and MRI could accurately show the distribution,extent of involvement of hepatic echinococcosis and liver cancer and the invasion of intrahepatic vasculature.

关 键 词：肝包虫病 肝癌 计算机体层成像 磁共振成像 

分 类 号：R532.32[医药卫生—内科学] R735.7[医药卫生—临床医学]