肝脏局灶性慢性炎性病变的影像及病理对照分析  

Imaging manifestations and pathological features of focal liver chronic inflammatory lesions

作　　者：覃夏丽 赵凡玉[1] 杨朋 蒋子健 罗城[1] 唐玲 QIN Xiali;ZHAO Fanyu;YANG Peng;JIANG Zijian;LUO Cheng;TANG Ling(Departmentof Radiology,Guangxi Zhuang Autonomous Region National Hospital,Nanning 530001,China;Departmentof Radiology,the First Affiliated Hospitalof Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西壮族自治区民族医院放射科,广西南宁530001 [2]广西医科大学第一附属医院放射科,广西南宁530021

出　　处：《实用放射学杂志》2022年第5期755-758,772,共5页Journal of Practical Radiology

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210679).

摘　　要：目的探讨肝脏局灶性慢性炎性病变CT/MRI与病理特点,提高影像诊断水平。方法回顾性收集12例经病理证实的肝脏局灶性慢性炎性病变患者的资料,所有患者均行CT平扫及增强检查,其中1例行MRI平扫检查,5例行MRI平扫及钆塞酸二钠(Gd-EOB-DTPA)增强检查;分析其影像及临床资料,测量病灶及正常肝实质在平扫及增强各期的CT值,绘制时间-密度曲线。结果12例(14个病灶)患者中3例为嗜酸性脓肿,1例为异物巨细胞性肉芽肿,8例为慢性肝脓肿;CT/MRI平扫呈软组织密度/信号,CT动脉期轻度强化或强化不明显,92.86%(13/14)的病灶门脉期、延迟期呈渐进性延迟强化;分别有50.00%(7/14)、14.29%(2/14)的病灶出现分隔状、蜂窝状强化;21.43%(3/14)的病灶呈均匀强化,在延迟期呈等密度;28.57%(4/14)的病灶周围肝实质出现厚环形动脉期稍高灌注;21.43%(3/14)的病灶于动脉期或门脉期出现周围较细的水肿带。85.71%(6/7)的病灶呈T_(1)WI稍低信号T_(2)WI稍高信号,14.29%(1/7)呈T_(1)WI、T_(2)WI低信号,扩散加权成像(DWI)轻度扩散受限;MRI增强扫描强化方式与CT相似,100.00%(6/6)的病灶呈肝胆期低至稍低信号,其中66.67%(4/6)的病灶周围肝实质出现斑片状肝胆期稍低信号。结论肝脏局灶性慢性炎性病变CT/MRI平扫呈软组织密度/信号,增强扫描动脉期强化不明显,门脉期、延迟期呈渐进性延迟强化、分隔状强化等特点可为临床诊断提供有价值的影像学信息。Objective To investigate the CT/MRI manifestations and pathological features of focal liver chronic inflammatory lesions,to improve the imaging diagnosis.Methods 12 patients with focal liver chronic inflammatory lesions confirmed by pathology were retrospectively enrolled.All patients underwent plain and contrast enhancement CT,1 case underwent plain MRI and 5 cases underwent plain MRI and Gd-EOB-DTPA enhanced MRI.Imaging and clinical data were analyzed,the CT values of all lesions and normal liver parenchyma were measured on plain,arterial phase,portal venous phase and delay phase images,and the time-density curves were also drawn.Results Among 12 cases(a total of 14 lesions),3 were eosinophilic granuloma,1 was foreign body giant cell granuloma,and other 8 were chronic liver abscess.All lesions showed generally homogeneous soft-tissue density/signal.92.86%(13/14)lesion^s showed progressive and delayed enhancement in CT portal venous phase and delayed phase,and mild or insignificant enhancement in arterial phase.There were 50.00%(7/14)and 14.29%(2/14)lesions with septal or honeycombed enhancement,respectively.21.43%(3/14)lesions had homogeneous enhancement and isodensity in delayed phase.28.57%(4/14)lesions appeared thick hyper-perfusion ring around the lesion in arterial phase.21.43%(3/14)lesions were surrounded by a slight edema zone in arterial or portal venous phase.85.71%(6/7)lesions showed mild hypointensity on T_(1)WI and mild hyperintensity on T_(2)WI,14.29%(1/7)lesions showed hypointensity on T_(1)WI and T_(2)WI,slight restricted diffusion ondiffusion weighted imaging(DWI).Theenhanced patterns on MRI of the lesions were similar to thoseon CT.100.00%(6/6)lesions had mild-hypointensity in hepatobiliary phase,of which 66.67%(4/6)lesions showed patchy hypointensity in the peripheral liver parenchyma.Conclusion Plain CT/MRI shows focal liver chronic inflammatory lesions with soft-tissue density/signal,while the contrast enhancement images show less obvious enhancement in arterial phase,progressive delay and s

关 键 词：肝脏局灶性慢性炎性病变 计算机体层成像 磁共振成像 病理学 

分 类 号：R575[医药卫生—消化系统] R814.42[医药卫生—内科学] R445.2[医药卫生—临床医学] R446.8