肝脓肿炎症期CT和MR诊断分析.docVIP

肝脓肿炎症期CT和MR诊断分析 　　[摘要] 目的 通过双排螺旋CT三期增强扫描与低场强MR平扫影像对照，探讨肝脓肿炎症期的影像特征，为该病的早期治疗提供影像学依据，降低其并发症与病死率。方法 回顾分析经病理或临床证实的炎症期或含有炎症期肝脓肿的患者19例，并行CT、 MR同层对照分析。结果 肝脓肿炎症期病变感染途径分四种，影像表现既相似，也有差异。不同点为：①胆道源性，共7例，平扫胆管壁为环形T2WI稍高信号；增强扫描为高密度“环征”。CT增强与MRI平扫对胆管炎的显示能力无明显差异（t=1.43，P=0.227）。 ②门静脉源性，共8例。门静脉炎MR平扫表现为“晕征”，CT增强扫描显示外周为低密度环，内部为高密度环。MRI平扫显示门静脉炎及周围组织水肿的能力优于CT增强 （t=3.23，P=0.014）。 ③肝动脉源性，共2例，表现为肝内片状稍长T1稍长T2信号。④临近组织器官蔓延，共2例，病灶范围较局限，影像表现与前者相似。四者相似点为范围不等的炎性水肿区，平扫表现为片状稍长T2信号，增强扫描动脉期可出可出现一过性强化。结论 采用螺旋CT三期增强扫描与MR平扫相结合，发挥各自优势，从影像学的角度揭示肝脓肿炎症期病变，为早期诊断提供依据。 　　[关键词] 肝脓肿；炎症期；胆管炎；门静脉炎；CT增强；MR平扫 　　The Diagnosis of The Stage of Inflammation of Pyogenic Liver Abscess Formation Between CT and MR Scan 　　KANG Su-hai1， ZHANG Hui﹡2， LIU Qi-wang2， XIE Wei， LIANG Hong-qin1 　　（1 Department of Radiology， The 264 Hospital of PLA，Taiyuan，China，030001；2 Department of Imaging of the First Affiliated Hospital of Shan Xi Medical University） 　　Objective： The characteristic findings of pyogenic liver abscess（PLA） were studied through the correlation between three phase enhanced CT scan and MRI plain scan in order to offer the imaging basement for early diagnosis and treatment ，so as to reduce the complication and mortality of this disease. Methods： The study were retrospectively reviewed twenty-one patients with PLA belonged to the stage of inflammation of abscess ， which were confirmed by pathology or clinical treatment. Nineteen patients of them were underwent CT and MRI plain scan ， and then analysis the image of CT/MRI in the same situation. Results： PLA was caused by infection originating in four tracts. Although causes were different， imaging of the stage of inflammation were either similar or different. Their similar imaging showed slight low attenuation or mildly hypointense on T1-weighted and mildly hyperintense on T2–weighted， which their area ranged from less than one segment to more than one liver lobe. In hepatic artery phase（PAH）， transient hepatic attenuation difference （THAD） could be seen . It became is