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肝脏灌注异常的CT表现及意义

作者:常燕翔1 张 雯2 颜志平2 武汉忠1

所属单位:1.江苏省东台市人民医院影像科(江苏 东台 224200) 2.复旦大学附属中山医院介入科(上海 200032)

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摘要

目的分析肝脏灌注异常的CT表 现,认识其发病机制及意义,提高肝脏疾 病诊断水平。方法 回顾性分析2012.6- 2014.6肝脏动态增强CT表现为灌注异常的 病例。分析其不同表现与相关疾病关系。 结果 38例肝脏灌注异常,6例为单发,2 例为多发;与肿瘤相关29例,与炎症相关 4例,门静脉血栓3例,肝硬化1例,原因 不明1例;CT表现为动脉期、门脉期的异 常强化,呈高密度或低密度,平衡期多呈 等密度。异常灌注的形态肝叶、肝段型3 例,楔形或扇形18例,片状16例,条带状 1例。HPD没有占位效应,内可见正常血管 穿行。结论 正确认识肝脏灌注异常对肝 脏疾病的诊断和鉴别诊断具有重要意义。

Objective To analyze the CT manifestation of abnormal hepatic perfusion, understanding its pathogenesis to improve the diagnosis of liver disease. Methods To analyze the cases show liver perfusion abnormalities with dynamic contrast-enhanced CT between June 2012 to June 2014, retrospectively. To analyze the relationship between the CT performance and primary disease. Results 38 cases of hepatic perfusion disorders, six cases for single, two cases for multiple; 29 cases associated with tumor, four cases with inflammation, three cases with portal vein thrombosis, one case with cirrhosis, and one case with unknown cause. CT findings showed high or low density abnormal enhancement in arterial phase and portal phase. mostly, isodense in the equilibrium phase. The case numbers of perfusion abnormalities shape shows like lobe or liver segment type, wedge or fan, sheet and banded were 3,18,16 and 1, respectively . Hepatic perfusion disorders has no mass effect, but has normal blood vessels crossed. Conclusion correct understanding of liver perfusion abnormalities is important in the diagnosis and differential diagnosis of liver disease.

【关键词】肝脏; 灌注异常; 体层摄影术; X线计算机

【中图分类号】R333.4

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.12.021

前言

肝脏灌注异常(hepatic perfusion disorders,HPD)是各种原因导 致肝脏局部血流动力学的改变,CT表现为动态增强动脉期或(及)门脉期 与正常肝实质强化程度不一致的区域。随着多排螺旋CT的广泛应用,肝 脏灌注异常的检出逐渐增多。