5例肝结核的影像学分析并文献复习

摘要/Abstract

摘要： 目的利用CT和MRI分析肝结核患者的临床及影像表现的多样性,回顾该病目前常用的检查手段以及主要的影像学表现。方法回顾性分析本院2011–2015年经病理证实的5例肝结核患者的CT及MRI表现,并结合国内外文献报道,进一步认识和学习该病多种影像表现。结果结合文献分析,本研究中肝结核主要分为以下三种亚型：①肝浆膜型1例,表现为肝脏包膜下多发低密度小结节影,增强后无明显强化;②肝实质型3例,其中粟粒型1例,CT表现为肝脏弥漫性肿大、密度减低,增强扫描肝实质强化不均匀,可见多发低密度区。结节型1例,CT表现为结节状钙化。肝囊肿型1例,CT表现为囊性灶,周围见环状钙化;③结核性胆管炎1例,表现为局限性肝内胆管扩张,增强扫描肝内胆管管壁有强化。结论肝结核患者的临床及影像表现具有多样性,容易误诊。肝浆膜型结核、结节型肝结核及结核性胆管炎的CT及MRI表现有一定的特征性,尤其是伴有钙化时,可提示肝结核的诊断。

关键词: 肝结核, 计算机体层摄影, 磁共振成像

Abstract: Objective To analyze the clinical and imaging features of hepatic tuberculosis, and to review the common modalities and the main imaging findings of the disease. Methods To further understand the diversity of the image performance, CT and MRI findings of five patients with pathological confirmed hepatic tuberculosis were retrospectively analyzed combined with the literature reviews. Results There were 3 types of hepatic tuberculosis: ① Hepatic serous type(n=1), which showed multiple nodular lesions with low density and no enhancement;② Liver parenchymal type(n=3): including miliary subtype (n=1), which showed diffuse liver enlargement, low density and heterogeneous enhancement of liver parenchyma. Nodular subtype(n=1), one with nodular calcification on CT scan. Cystic subtype(n=1) showed cyst-like low density with ring-shaped calcifications;③ Tuberculous cholangitis(n=1), presented with biliary ducts dilatation and enhanced. Conclusions The clinical and imaging manifestations of liver tuberculosis are diverse and can be easily misdiagnosed. The remaining 3 types of hepatic tuberculosis of CT and MRI features showed some characteristics, especially with calcifications, which could help us make the diagnosis of hepatic tuberculosis.

Key words: Hepatic tuberculosis, Computed tomography, Magnetic resonance imaging

王欣, 蒋诚诚, 李勇刚. 5例肝结核的影像学分析并文献复习[J]. 新发传染病电子杂志, 2017, 2(2): 100-103.

WANG Xin, JIANG Cheng-cheng, LI Yong-gang. Imaging analysis of five patients with hepatic tuberculosis with literature review[J]. Electronic Journal of Emerging Infectious Diseases, 2017, 2(2): 100-103.

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