不典型肝脓肿动态增强CT表现与病理基础.docVIP

不典型肝脓肿动态增强CT表现与病理基础 　　[摘要] 目的 分析不典型肝脓肿的动态增强CT表现及病理基础。方法 24例经手术或临床证实的不典型肝脓肿患者纳入研究,回顾性分析其动态增强CT表现及相关病理学基础。结果 不典型肝脓肿主要表现为增强动脉期病灶周围一过性肝段性强化,病灶分隔轻度强化;门脉期持续性强化,病灶范围缩小或不变。结论 动态增强CT检查有助于不典型肝脓肿的诊断,熟悉CT征象及病理基础有利于提高疾病的诊断和鉴别诊断。 　　[关键词] 肝脓肿; 断层摄影术/ X线计算机; 病理学 　　[中图分类号] R575.4 [文献标识码] A [文章编号] 1673-9701(2010)13-79-02 　　 　　Dynamic Enhanced CT Manifestations and Pathologic Basis in Atypical Liver Abscess 　　ZHANG Xueqin1 CHEN Guangwen2 WANG Yinglin1 　　1.Department of Radiology,Chongqing Municipal Beibei Hospital Traditional Chinese Medicine,Chongqing 400700,China;2.Department of Radiology,West China Hospital of Sichuan University,Chengdu 610041,China 　　 　　[Abstract] ObjectiveTo analyze the dynamic enhanced CT manifestations and pathologic basis in atypical hepatic abscess. Methods Dynamic enhanced CT findings and correlated pathologic basis in 24 cases of atypical hepatic abscess which were proven by operation or clinical data were retrospectively analyzed. ResultsIn the arterial phase of enhanced CT,the slightly separating enhancement of the focus and temporal hepatic segments enhancement around the focus were found. In the portal vein phase,the persistent enhancement was found and the focus diminished or unchanged. ConclusionDynamic enhanced CT examination is helpful in the diagnosis of atypical hepatic abscess. To be familiar with CT manifestations and pathologic basis is favorable to improve the diagnosis and differential diagnosis of the diseases. 　　[Key words]Liver abscess; Computed tomography/X-ray; Pathology 　　 　　不典型肝脓肿是脓肿早期或蜂窝组织炎阶段,脓肿未液化或小部分液化[1],其CT征象不典型,诊断与鉴别诊断有一定的困难。笔者分析不典型肝脓肿的动态增强CT征象及病理基础,加深对CT征象的理解和认识,以提高诊断水平。 　　1 资料与方法 　　1.1 临床资料 　　选择经手术或临床证实的不典型肝脓肿24例,其中6例为多病灶,共计33个病灶。男18例,女6例。年龄20～71岁,平均51.2岁。临床表现有??热、腹痛,实验室检查白细胞及中性粒细胞升高。其中1例为肝移植术后,3例胆囊切除术后,1例为拔牙后败血症。 　　1.2 扫描方法 　　采用西门子Sensation 16层螺旋CT进行上腹部平扫及增强扫描,扫描参数为:管电压120KV,管电流200～220mA,扫描准直器0.75mm,螺距0.75,层厚5mm,层间距5mm,矩阵512×512。采用非粒子型造影剂碘海醇75～100mL(1.5mL/kg体重),高压注射器团注,速率为2～3mL/s,延迟时间25s(动脉期)、60s(门脉期)。扫描范围从肝顶