肝脏结核的CT诊断及其鉴别诊断

摘要/Abstract

摘要： 目的探讨CT平扫+动态增强对肝脏结核的诊断价值。方法回顾性分析15例经手术或穿刺病理证实的肝脏结核的影像表现。其中男10例, 女5例, 行上腹部CT平扫及动态增强扫描。结果4例表现为肝实质内单发结节, 9例表现为肝脏内多发结节, 2例病灶位于肝脏包膜下。增强扫描2例病灶动脉期呈轻度不均匀强化, 门脉期及延迟期强化程度减低, 强化类型呈“快进快出型”;2例病灶动脉期轻度强化, 门脉及延迟期同肝实质基本相似, 强化类型呈“慢进慢出型”;4例病灶呈环形强化;5例病灶动脉期可见“晕佂”;1例动脉期未见明显强化, 门脉期及延迟期示病灶呈轻度强化;3例病灶未见明显强化;4例病灶内出现钙化。结论 CT平扫及增强检查对肝脏结核具有较高诊断价值, 根据病灶不同的强化特点, 可以判断病变的病理学特征。

关键词: 肝脏结核, CT, 鉴别诊断

Abstract: Objective To investigate the diagnostic value of CT plain scan + dynamic enhancement for hepatic tuberculosis. Methods The imaging findings of 15 cases of hepatic tuberculosis confirmed by surgery or puncture pathology were retrospectively analyzed. There were 10 males and 5 females with CT scan and dynamic enhanced scan of the upper abdomen. Results In 4 cases, there were single nodules in the liver parenchyma; 9 cases showed multiple nodules in the liver; 2 cases were located under the liver capsule. The enhanced scan showed mild inhomogeneous enhancement of the arterial phase in 2 cases, and the degree of enhancement in the portal vein and lag phase was reduced. The type of enhancement was “fast-forward and rapid-out”; 2 cases were mildly intensified in the arterial phase, and the portal vein and delayed phase were associated with the liver. The essence was basically similar, the type of enhancement was “slow-in and slow-out”; 4 cases showed ring-shaped enhancement; 5 cases showed “syncope” in the arterial phase; 1 case showed no obvious enhancement in arterial phase, and the portal vein and delayed phase showed lesions. There are mild enhancement and no obvious enhancement in 3 lesions. Calcification in 4 lesions. Conclusion CT plain scan and enhanced examination have high diagnostic value for hepatic tuberculosis. According to the different enhancement features of lesions, the pathological features of lesions can be judged.

Key words: Hepatic tuberculosis, CT, Differential diagnosis

何占平, 陈晶, 徐海霞, 鲁宏. 肝脏结核的CT诊断及其鉴别诊断[J]. 新发传染病电子杂志, 2019, 4(4): 212-216.

HE Zhan-ping, CHEN Jing, XU Hai-xia, LU Hong. Imaging diagnosis and differential diagnosis of the hepatic tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(4): 212-216.

参考文献

[1] World Health Organization.Global tuberculosis report 2018[EB/OL][2018-09-18]. http://www.who.int/tb/publications/global_report/en/.
[2] Tritou I, Prassopoulos P, Daskalogiannaki M, et al.Miliary hepatic tuberculosis not associated with splenic or lung involvement. A case report[J]. Acta Radiol, 2000, 41(5):479-481.
[3] Kok KY, Yapp SK.Isolated hepatic tuberculosis: report of five cases and review of the literature[J]. J Hepatobiliary Pancreat Surg, 1999, 6(2): 195-198.
[4] Wu Z, Wang WL, Zhu Y, et al.Diagnosis and treatment of hepatic tuberculosis: report of five cases and review of literature[J]. Int J Clin Exp Med, 2013, 6(9):845-850.
[5] Park JI.Primary hepatic tuberculosis mimicking intrahepatic cholangiocarcinoma: report of two cases[J]. Ann Surg Treat Res, 2015, 89(2): 98-101.
[6] Yu HY, Sheng JF.Liver tuberculosis presenting as an uncommon cause of pyrexia of unknown origin: positron emission tomography/computed tomography identifies the correct site for biopsy[J]. Med Princ Pract, 2014, 23(6): 577-579.
[7] Levine C.Primary macronodular hepatic tuberculosis: US and CT appearances[J]. Gastrointest Radiol, 1990, 15(4): 307-309.
[8] Yu RS, Zhang SZ, Wu JJ, et al.Imaging diagnosis of 12 patients with hepatic tuberculosis[J]. World J Gastroenterol, 2004, 10(11):1639-1642.
[9] 周梅玲, 严福华. CT在肝结核瘤诊断中的价值[J]. 中国医学计算机成像杂志, 2005, 11(2): 115-118.
[10] 吴刚, 陈旭春. 肝脏炎性肌纤维母细胞瘤诊断和治疗[J]. 中国实用外科杂志, 2013, 33(9): 749-751.
[11] 王志军, 丛英珍, 许祖闪. 多层螺旋CT及MRI对肝脏结核性肉芽肿的诊断价值[J]. 放射学实践, 2011, 26(3): 329-332.
[12] Malde HM, Chadha D.The "cluster" sign in macronodular hepatic tuberculosis: CT features[J]. J Comput Assist Tomogr, 1993, 17(1): 159-161.
[13] Jain A, Chaturvedi R, Kantharia C, et al.Secondary sclerosing cholangitis in localized hepatobiliary tuberculosis simulating cholangiocarcinoma: a rare case report[J]. BMC Gastroenterol, 2017, 17(1): 126.
[14] 刘衡, 柏永华, 鲁宏. 胆囊结核CT、MRI表现[J]. 新发传染病电子杂志, 2017, 2(1):43-45.
[15] Kakkar C, Polnaya AM, Koteshwara P, et al.Hepatic tuberculosis: a multimodality imaging review[J]. Insights Imaging, 2015, 6(6): 647-658.
[16] 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.
[17] Park JI.Primary hepatic tuberculosis mimicking intrahepatic cholangiocarcinoma: report of two cases[J]. Ann Surg Treat Res, 2015, 89(2): 98-101.