脂肪肝对超声造影诊断肝内炎性假瘤的影响*

doi:10.3969/j.issn.1672-5069.2022.06.035

摘要/Abstract

摘要： 目的研究脂肪肝对超声造影诊断肝脏炎性假瘤(IPL)的影响。方法 2016年1月～2021年1月华北理工大学附属开滦总医院诊治的IPL患者28例,其中伴有脂肪肝者12例,正常肝内IPL患者16例。所有患者均接受超声造影检查,比较两组血供状态、超声造影增强模式和超声造影定量参数的异同。结果伴脂肪肝的IPL病灶动脉供血1例(8.3%)、静脉供血11例(91.7%)、富血供3例(25.0%)、乏血供9例(75.0%),IPL病灶动脉供血7例(43.8%)、静脉供血9例(56.3%)、富血供5例(31.3%)、乏血供11例(68.8%),两组供血类型存在显著性差异(P<0.05),而血供丰富程度无显著性差异(P＞0.05);伴脂肪肝病灶呈无明显增强型1例、快速廓清型5例、等增强型3例和低增强型3例,IPL病灶呈无明显增强型2例、快速廓清型5例、等增强型7例和低增强型2例,两组超声造影增强模式无显著差异(P=0.661);伴脂肪肝病灶造影剂到达时间为(8.9±1.3)s,显著慢于IPL病灶【((8.0±0.9)s,P<0.05】,峰值强度为(53.2±7.8)dB,显著弱于IPL病灶【((61.1±9.7)dB,P<0.05】,而两组达峰时间、曲线尖度和曲线下面积无显著性差异(P＞0.05)。结论与正常肝背景下的IPL病灶比,合并脂肪肝的IPL病灶以静脉供血为主,其造影剂的到达时间较长,而峰值强度降低,在临床诊断时需要认真地甄别。

关键词: 肝脏炎性假瘤, 脂肪肝, 超声造影, 血供, 诊断

Abstract: Objective The purpose of this study was to investigate the impact of fatty liver on the diagnosis of contrast-enhanced ultrasound (CEUS) in patients with inflammatory pseudotumor of liver (IPL). Methods 28 patients with IPL were encountered in Kailuan General Hospital, North China University of Science and Technology between January 2016 and January 2021, and out of them, 12 patients with underlying fatty liver. The diagnosis was made by fine needle aspiration biopsies or post-operational histopathologic examination. All patients underwent CEUS, and the blood supply status, contrast-enhanced modes and quantitative parameters were compared between the two groups. Results In patients with IPL and underlying fatty liver, there were 1 cases (8.3%) with arterial blood supply, 11 cases (91.7%) with venous blood supply, 3 cases (25.0%) presenting with rich blood supply, and 9 cases (75.0%) with poor blood supply, while in patients with IPL and normal liver, there were 7 cases (43.8%) with arterial blood supply, 9 cases (56.3%, P<0.05) with venous blood supply, 5 cases (31.3%) presenting with rich blood supply and 11 cases(68.8)with poor blood supply (P>0.05); there were no significant differences in blood supply type and blood supply richness between the two groups (P>0.05); In patients with fatty liver, there were no significant enhancement of foci under CEUS in 1 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 3 cases, and low enhancement in 3 cases, while in patients with IPL, there were no significant enhancement in 2 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 7 cases, and low enhancement in 2 cases, not significantly different between the two groups in contrast enhancement mode ( P=0.661); in patients with IPL and fatty liver, the contrast agent arrival time was (8.9±1.3) s, significantly slower than [((8.0±0.9)s, P<0.05], and the peak intensity was (53.2±7.8)dB, significantly weaker than [((61.1±9.7)dB, P<0.05] in patients with IPL, while there were no significant differences as respect to the peak time, the curve sharpness and the area under curve between the two groups (P> 0.05). Conclusion The IPL foci in patients with fatty liver are mainly having venous blood supply, and the underlying fatty liver might interfere with the imaging diagnosis, which should be carefully identified.

Key words: Inflammatory pseudotumor of liver, Fatty liver, Contrast-enhanced ultrasound, Blood supply, Diagnosis

黄玮, 范智慧, 陈磊, 王丹. 脂肪肝对超声造影诊断肝内炎性假瘤的影响^*[J]. 实用肝脏病杂志, 2022, 25(6): 897-900.

Huang Wei, Fan Zhihui, Chen Lei, et al.. Impact of fatty liver on the diagnosis of contrast-enhanced ultrasound in patients with inflammatory pseudotumor of liver[J]. Journal of Practical Hepatology, 2022, 25(6): 897-900.

参考文献

[1] Oh K, Hwang S, Ahn CS, et al.Clinicopathological features and post-resection outcomes of inflammatory pseudotumor of the liver.Ann Hepatobiliary Pancreat Surg,2021,25(1):34-38.
[2] 窦卫超,寸冬云,王秋虹,等. 肝脏炎性假瘤样滤泡树突状细胞肿瘤术前误诊为肝癌一例. 中华肝胆外科杂志,2018,24(3):172,178.
[3] Delgado SC, Santiago MJC, Cuevas LA.Inflammatory pseudotumor of the liver.Med Clin (Barc), 2021,157(6):303-304.
[4] Kimura Y , Ohno K , Hinata M , et al. Inflammatory pseudotumor of the liver in a patient with several risk factors for hepatocellular carcinoma. Kanzo, 2017, 58(11):611-618.
[5] Li HL, Liu HP, Guo GW, et al.Imaging findings of inflammatory pseudotumor-like follicular dendritic cell tumors of the liver: two case reports and literature review.World J Gastroenterol, 2019,25(45):6693-6703.
[6] Serrano AA, Rodríguez JC, Jiménez EG, et al.Inflammatory pseudotumor-like follicular dendritic cell sarcoma of the liver.Rev Esp Enferm Dig, 2021,113(5):378-379.
[7] Adachi K , Hashimoto K , Nonaka R , et al. A case of an IgG4-related inflammatory pseudotumor of the liver showing enlargement that was difficult to differentiate from hepatic cancer. Gan to Kagaku Ryoho, 2017, 44(12):1922-1924.
[8] Adachi Y , Iwata N, Adachi Y , et al. Coexistence of IgG4-related autoimmune hepatitis and inflammatory pseudotumors of the liver:a case report. Nihon Shokakibyo Gakkai Zasshi, 2020, 117(6):532-541.
[9] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病防治指南 (2018年版).实用肝脏病杂志,2018,21(2):177-186.
[10] Wang M, Zhang S, Yang Q.IgG4-related hepatic inflammatory pseudotumor misdiagnosed as cholangiocellular carcinoma of the liver.J Gastrointest Surg, 2021,25(4):1065-1066.
[11] Hayashi M, Fujita M, Abe K, et al.Intratumor abscess in a posttraumatic hepatic inflammatory pseudotumor spreading out of the liver.Intern Med, 2021,60(2):235-240.
[12] Kong WT, Wang WP, Shen HY, et al.Hepatic inflammatory pseudotumor mimicking malignancy: the value of differential diagnosis on contrast enhanced ultrasound.Med Ultrason, 2021,23(1):15-21.
[13] Matsumoto Y, Ogawa K, Shimizu A, et al.Inflammatory pseudo-tumor of the liver accompanied by eosinophilia.Intern Med, 2021,60(13):2075-2079.
[14] Shi Y, Wang X, Qiao Y, et al.The dynamic enhanced characterization with low mechanical index gray-scale harmonic imaging inflammatory pseudotumor of liver compared with hepatic VX2 tumor and normal liver.Adv Clin Exp Med, 2020,29(9):1073-1081.
[15] 张炎晶,刘利平,鲁琴,等. 超声造影评价兔脂肪肝及正常肝背景炎性假瘤血流灌注的研究. 中华超声影像学杂志,2013,22(6):525-529.
[16] 刘利平,李耀平,鲁琴,等. 兔脂肪肝内VX2移植瘤及炎性假瘤超声造影血流灌注及血管生成的对比研究. 中华肝胆外科杂志,2016,22(11):766-770.
[17] Nigam N, Rajani SS, Rastogi A, et al.Inflammatory pseudotumors of the liver: Importance of a multimodal approach with the insistance of needle biopsy.J Lab Physicians, 2019,11(4):361-368.
[18] Gomes CL, Silva N, Ramos JP.Inflammatory pseudotumor of the liver: clinical case.GE Port J Gastroenterol, 2019,26(4):305-307.
[19] Sheng RF, Zhai CW, Ji Y, et al.Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor.Hepatobiliary Pancreat Dis Int, 2017,16(6):631-637.
[20] Ichikawa S, Motosugi U, Suzuki T, et al.Imaging features of hepatic inflammatory pseudotumor: distinction from colorectal liver metastasis using gadoxetate disodium-enhanced magnetic resonance imaging.Abdom Radiol (NY), 2020 ,45(8):2400-2408.

脂肪肝对超声造影诊断肝内炎性假瘤的影响^*

Impact of fatty liver on the diagnosis of contrast-enhanced ultrasound in patients with inflammatory pseudotumor of liver

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[2]	蔡勇, 李璟, 欧琴. 2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 800-803.
[3]	王玉梅, 袁向东, 刘玉玲, 赵子瑜. 提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 808-811.
[4]	李响, 张铁英, 张旭辉, 孟繁坤. 基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 857-860.
[5]	张耀辉, 郑章增, 高星, 张亚利. 超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 861-864.
[6]	邬政宏, 吴冬秋, 刘四斌. DCE-MRI诊断原发性肝癌效能和TACE术后评估肿瘤活性应用价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 881-884.
[7]	蓝思荣, 徐继威, 张耀明, 李雄, 沈登文, 苏鸿辉. 实时超声造影与3D超声融合成像导航评估微波消融治疗原发性肝癌患者价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 889-892.
[8]	沈一芃, 祝峻峰. 肝硬化并发自发性细菌性腹膜炎临床研究进展^*[J]. 实用肝脏病杂志, 2022, 25(6): 909-912.
[9]	罗楠, 李荣宽. 肝硬化并发自发性细菌性腹膜炎诊治现状[J]. 实用肝脏病杂志, 2022, 25(5): 616-619.
[10]	米朦, 卢秉久, 王学良, 王晓彤, 郑佳连. 代谢相关性脂肪性肝病患者血脂分析^*[J]. 实用肝脏病杂志, 2022, 25(5): 653-656.
[11]	骆苏彦, 李婷婷, 王亚奇, 齐林. 原发性胆汁性胆管炎患者外周血Treg/Th17细胞相关细胞因子水平变化^*[J]. 实用肝脏病杂志, 2022, 25(5): 673-676.
[12]	龚豪, 黄丽, 张庆红, 李涛, 史秀岩. 应用尿微量白蛋白、β2-微球蛋白和N-乙酰-β-D氨基葡萄糖苷酶评估失代偿期肝硬化患者肾损伤效能研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 681-684.
[13]	黄娟, 张吉琛. MRI LAVA扫描技术评估布-加综合征患者侧支循环研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 689-692.
[14]	施莹, 柏根基, 孙阳. 多模态MRI对肝硬化增生性结节与小肝癌的鉴别诊断价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(5): 722-725.
[15]	杨静, 程艳丽. 特发性非肝硬化性门脉高压1例并文献复习[J]. 实用肝脏病杂志, 2022, 25(5): 750-752.