CAJ | 학술논문

目的：探讨急性病毒性肝炎的影像表现，分析其影像特征及病理机制。方法：回顾性分析34例急性病毒性肝炎患者的 CT 及 MRI 表现。根据临床实验室检查将患者分为急性普通型肝炎与急性或亚急性重型肝炎两组，比较两组间影像表现的差异并进行统计学分析。结果：急性病毒性肝炎的 CT 及 MRI 表现主要包括4种：①肝实质异常强化，表现为动脉期门静脉周围和肝脏边缘小斑片状强化，静脉期及延迟期肝脏外周对比剂廓清延迟以及“反转”强化；②肝内门静脉周围间隙增宽，即门静脉周围“晕环征”或“轨道征”；③胆囊壁增厚水肿；④腹腔积液。肝内门静脉周围间隙增宽为急性病毒性肝炎的必然出现的异常影像表现，与病情严重程度无关。急性普通型肝炎与急性或亚急性重型肝炎两组患者在胆囊壁增厚水肿出现几率上组间比较差异无统计学意义（P ＞0．05），而胆囊受累程度组间比较差异有统计学意义（P ＜0．05）；两组患者在腹腔积液出现几率上比较差异有统计学意义（P ＜0．05）。结论：急性病毒性肝炎具有特定的异常影像表现，部分影像表现可在一定程度上反应病情严重程度。CT 及 MRI 检查对诊断、鉴别诊断具有参考价值。
목적：탐토급성병독성간염적영상표현，분석기영상특정급병리궤제。방법：회고성분석34례급성병독성간염환자적 CT 급 MRI 표현。근거림상실험실검사장환자분위급성보통형간염여급성혹아급성중형간염량조，비교량조간영상표현적차이병진행통계학분석。결과：급성병독성간염적 CT 급 MRI 표현주요포괄4충：①간실질이상강화，표현위동맥기문정맥주위화간장변연소반편상강화，정맥기급연지기간장외주대비제곽청연지이급“반전”강화；②간내문정맥주위간극증관，즉문정맥주위“훈배정”혹“궤도정”；③담낭벽증후수종；④복강적액。간내문정맥주위간극증관위급성병독성간염적필연출현적이상영상표현，여병정엄중정도무관。급성보통형간염여급성혹아급성중형간염량조환자재담낭벽증후수종출현궤솔상조간비교차이무통계학의의（P ＞0．05），이담낭수루정도조간비교차이유통계학의의（P ＜0．05）；량조환자재복강적액출현궤솔상비교차이유통계학의의（P ＜0．05）。결론：급성병독성간염구유특정적이상영상표현，부분영상표현가재일정정도상반응병정엄중정도。CT 급 MRI 검사대진단、감별진단구유삼고개치。
Objective:To investigate the imaging features,imaging characteristics and pathological mechanism of a-cute viral hepatitis.Methods:Thirty-four patients with acute viral hepatitis underwent MDCT and MR scan.According to the laboratory examination,the patients were divided into two groups:acute common hepatitis group and acute or subacute severe hepatitis group.In the study,the imaging differences between two groups were statistically analyzed.Results:The CT and MRI appearances of acute viral hepatitis included four parts:①Small patchy enhancement in periportal and peripheral hepatic parenchyma at arterial phase,delayed washout of contrast agent at the periphery of liver ,and characteristic"inver-sion"enhancement during portal venous and equilibrium phases;②Intrahepatic periportal space widening,namely,periportal halo or tracking sign;③Varying degrees of edema in gallbladder wall;④Ascites.Intrahepatic periportal space widening was the ubiquitous abnormal imaging feature in acute viral hepatitis,which had no correlation with the severity of the disease. There was no statistical significance between the incidence of gallbladder wall thickening in two groups (P >0.05).However the results showed that the degree of gallbladder wall edema and ascites between two groups had statistical significance (P <0.05).Conclusion:In this study the specific abnormal imaging feature of acute viral hepatitis were presented.Some of image findings reflected the severity of diseases in some degree.Thus CT and MRI are of definite value in diagnosis and dif-ferential diagnosis of acute viral hepatitis.