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CT三期增强扫描与 MRI在诊断肝脓肿中 的应用价值对比

作者:张文革

所属单位:河南省商丘市第三人民医院放射科 (河南 商丘 476000)

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摘要

目的 探讨MRI与CT诊断肝脓肿的 影像学特征,比较二者在肝脓肿中的诊断 价值。方法 选取我院2015年12月-2016 年9月收治肝脓肿患者82例,收集患者一 般资料、影像学资料等,分析CT增强扫 描、MRI扫描对肝脓肿的影像表现特征, 比较两种检查方式对肝脓肿的检出率。 结果 82例患者中单发者66例(80.48%)、 多发患者16例(19.51%),病灶平均直径 (5.02±1.79)cm;82例患者在CT平扫中病 灶均呈均匀低密度或不均匀的等低混杂 密度影,外观形态呈现圆形或类圆形, 14.63%(12/82)病灶部分与毗邻组织边界 不清,其中部分脓肿周围有低密度水肿 带,中央为脓腔,密度不均匀,CT值高于 水而低于肝实质;CT增强扫描中,动脉期 脓肿壁呈轻度环形强化,脓肿壁周围的 水肿带则无强化,63.41%(52/82)环形强 化的脓肿壁和周围的无强化的低密度水 肿带构成了的“环征”;82例患者MRI扫 描T1序列中建均呈均匀或不均匀的低信 号,周围信号强度介于脓腔和肝实质间, 73.17%(60/82)MRI平扫T2WI脂肪抑制序 列可见肝脏左外叶分叶状不均匀高信号 灶;MRI增强扫描后,脓肿壁呈环形或蜂 窝状强化,并可见内有分隔,脓腔中心液 化坏死区无强化;MRI扫描对肝脓肿总检 出率为96.34%(79/82),明显高于CT三期 增强扫描81.70%(67/82)(P<0.05);其中 MRI对门静脉源性的肝脓肿检出率显著高 于CT三期增强扫描(24.39% vs 12.19%) (P<0.05)。结论 CT三期增强扫描与MRI 扫描对肝脓肿对肝脓肿的检出率均较高, 联合两种检查方式可有助提高诊断准确 率。

Objective To evaluate the imaging features of MRI and CT in the diagnosis of hepatic abscess, and to compare the diagnostic value of both in liver abscess. Methods A total of 82 patients with liver abscess were enrolled in our hospital from December 2015 to September 2016, and the general data and imaging data were collected. The imaging features of CT scan and MRI scan were analyzed. The detection rate of liver abscess. Results Of the 82 patients, 66 (80.48%) were single, 16 (19.51%) had multiple patients, and the mean diameter of the lesion was (5.02±1.79)cm. The 82 patients had CT Uniform density of low density or uneven, such as low density density, the appearance of the shape of circular or round, 14.63% (12/82) lesions and adjacent tissue boundary is unclear, some of the abscess around the low density of edema, the central For the abscess, the density is not uniform, CT value is higher than the water and lower than the liver parenchyma. CT enhanced scan, the arterial abscess wall was mild ring enhancement, abscess wall edema around the no enhancement, 63.41% (52/82 ) Circular enhancement of the abscess wall and the surrounding non-enhanced low-density edema band formed a "ring sign". 82 patients with MRI scan T1 sequence were homogeneous or uneven low signal, the surrounding signal intensity between the abscess And liver parenchyma, 73.17% (60/82) MRI scan T2WI fat suppression sequence can be seen in the left lobe of the liver lobulated uneven high signal foci. MRI enhanced scan, the abscess wall was ring or honeycomb enhanced, and visible There is separation, abscess center of liquefaction necrotic area without strengthening The total detection rate of liver abscess was 96.34% (79/82), which was significantly higher than that of CT three-phase enhanced scan (67.70%) (P<0.05). The MRI (24.39% vs 12.19%) (P<0.05). Conclusion CT three-phase enhanced scan and MRI scan have high detection rate of liver abscess in liver abscess, and the combination of two methods can improve the diagnostic accuracy.

【关键词】CT;MRI;肝脓肿;应用价值

【中图分类号】R575.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.12.023

前言

肝脓肿是临床中少见的一类肝脏炎症性疾病,其形成的主要原因 是由细菌、真菌等多种微生物作用下引发的肝脏化脓性病变[1]。肝脓 肿患者病死率较高,故早期发现、早期诊断对保障肝脓肿患者的生 命安全健康具有重要意义[2]。目前临床对肝脓肿的主要首选诊断方式 为影像学检查,其中检查方法包括MRI、CT、B超等,CT扫描成像速度 快,但对炎性水肿的分辨率较低,MRI对心脏、软组织、大血管成像 优势明显,两种检查方式被广泛应用于肝脓肿的诊断中[3]。为进一步 探讨MRI与CT诊断肝脓肿的影像学特征并对比二者在肝脓肿中的诊断 价值,本研究收集了82例肝脓肿患者的临床资料进行分析,现报告如 下。