肝脏炎性假瘤增强CT扫描表现*

doi:10.3969/j.issn.1672-5069.2024.04.033

摘要/Abstract

摘要： 目的分析肝脏炎性假瘤(IPL)病灶CT扫描的表现特征,尽可能帮助作出术前诊断。方法 2018年3月～2023年3月我院诊治的32例肝内占位性病变患者,均接受64层螺旋CT平扫和增强扫描检查,经手术或穿刺活检病理学检查确诊为IPL。结果在32例IPL患者中,经CT平扫发现肝内病灶位于肝右叶19例,肝左叶8例,尾状叶5例;直径为2.5~5.0 cm;单发低密度病灶20例,多发病灶12例;形态多样;在平扫时,IPL呈低密度或等密度病灶,边缘不清晰;增强扫描动脉期见病灶无明显强化;门脉期见13例病灶明显强化,7例病灶周边轻、中度环形强化,6例病灶中央呈核心样强化,边缘可见“钟乳石”样或结节样强化,6例病灶呈不均匀强化;延迟期见部分病灶仍呈不同程度的轻度强化;CT扫描还可见肝内病灶旁间接征象,如胆管局限性狭窄或扩张、肝实质萎缩、门静脉管壁不均匀增厚、管腔狭窄或闭塞、门静脉分支穿过或包绕病灶等。结论使用螺旋CT多期增强扫描诊断IPL有很大的临床价值,值得进一步分析总结,以指导临床决策。

关键词: 肝脏炎性假瘤, CT平扫和增强扫描, 特征, 诊断

Abstract: Objective The aim of this study was to summarize the feature of spiral CT multi-phase enhancement of inflammatory pseudotumor of the liver (IPL). Methods 32 patients with IPL were encountered in our hospital between March 2018 and March 2023, and all underwent 64-slice spiral CT multi-phase enhancement scan. The diagnosis was confirmed pathologically from tissues by surgery or fine needle aspiration biopsy. Results The plain CT scan showed intrahepatic lesions in the right lobe in 19 cases, in the left in 8 cases and in caudate lobe in 5 cases; the single lesions was found in 20 cases and multiple lesions in 12 cases, with the diameter of 2.5-5.0 cm; the appearances of the lesions was multiple, roundness, ellipse or ellipse-like; in plain CT scan, the IPL was low-density or equal-density with a vague edges; the enhancement scan showed the lesions were not obviously intensified at arterial phase; in the portal phase, the lesions was totally intensified in 13 cases, the edges mildly to moderately intensified in 7 cases, the central intensified with the stalactite-like edges in 6 cases, and the inhomogeneous lesions intensified in 6 cases; in the delayed phase, most lesions was still mildly intensified; the CT scan also revealed some indirect signs, such as local stricture or dilatation of the bile ducts, lobe atrophy, inhomogeneous wall incrassation, stricture or even obstruction of portal vain. Conclusion The IPLs really have some special CT manifestation feature, which might help differentiate the diagnosis.

Key words: Inflammatory pseudotumor of the liver, CT multi-phase enhancement scan, Feature, Diagnosis

吴鹤林, 吴卉卉, 沈春林. 肝脏炎性假瘤增强CT扫描表现^*[J]. 实用肝脏病杂志, 2024, 27(4): 623-626.

Wu Helin, Wu Huihui, Shen Chunlin. Feature of spiral CT multi-phase enhancement of inflammatory pseudotumor of the liver: An analysis of 32 cases[J]. Journal of Practical Hepatology, 2024, 27(4): 623-626.

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肝脏炎性假瘤增强CT扫描表现^*

Feature of spiral CT multi-phase enhancement of inflammatory pseudotumor of the liver: An analysis of 32 cases

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