肝囊型包虫病的影像学特征与诊断
간낭형포충병적영상학특정여진단
Imaging features and diagnosis of hepatic cystic echinococcosis
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 11期 963-967 ,共5页

    王泽锋%张俊晶%耿亚军%牛剑祥%任建军

    왕택봉%장준정%경아군%우검상%임건군

    棘球蚴病,肝%X线计算机断层成像%磁共振成像%诊断 棘毬蚴病,肝%X線計算機斷層成像%磁共振成像%診斷
    극구유병,간%X선계산궤단층성상%자공진성상%진단
    Echinococcosis,hepatic%Tomography,X-ray computed%Magnetic resonance imaging%Diagnosis
    目的 总结肝囊型包虫病CT及MRI影像学检查特征,探讨其诊断及鉴别诊断要点.方法 回顾性分析2011年8月至2014年8月内蒙古医科大学附属医院收治的58例肝囊型包虫病患者的临床资料.患者行CT平扫及增强扫描、MRI平扫及增强扫描.结合文献将肝囊型包虫病分为5型:Ⅰ型:单纯囊肿型,Ⅱ型:多子囊型,Ⅲ型:内囊分离型,Ⅳ型:实变钙化型,Ⅴ型:混合型.对于明确诊断或疑似诊断肝囊型包虫病患者,予手术治疗.采用门诊和电话方式进行随访.术后3个月、6个月、1年各随访1次,以后每年门诊随访1次,5年以上无复发可停止随访.随访内容主要观察肝囊型包虫病复发情况.随访时间截至2015年8月.结果 (1)影像学检查情况:58例患者中,54例行CT扫描,21例行MRI扫描.58例患者中,Ⅰ型肝囊型包虫病17例,CT检查结果示边界清晰的低密度囊性病变;MRI检查结果示单个或多个圆形、椭圆形异常信号,T1WI呈低信号,T2WI呈高信号,囊壁T1WI和T2WI均呈低信号,以T2WI显示更清晰.Ⅱ型肝囊型包虫病13例,CT检查结果示母囊内见多个大小不等的子囊,排列呈"蜂窝状""车轮状";MRI检查结果示T1WI子囊信号低于母囊,T2WI子囊信号高于母囊;母囊及子囊囊壁均呈低信号.Ⅲ型肝囊型包虫病6例,CT检查结果示病变呈"套囊征""水蛇征"等,MRI检查结果示病变呈"飘带征".Ⅳ型肝囊型包虫病13例,CT检查结果示不规则高密度钙化影,密度不均匀,病变呈"脑回样"或"卷洋葱皮样"改变.Ⅴ型肝囊型包虫病9例,同时存在上述各型中2种或2种以上类型病变.(2)诊断情况:CT检查误诊4例,其中3例术前诊断为肝囊肿,1例术前诊断为肝转移癌,诊断准确率为92.6％(50/54).MRI检查误诊2例,术前均诊断为肝囊腺瘤,诊断准确率为90.5％(19/21).(3)治疗及随访情况:58例患者均行手术治疗,其中40例行肝囊型包虫病内囊摘除术(31例行开腹手术,9例行腹腔镜手术),10例行肝部分切除术,8例行肝囊型包虫病外囊完整剥除术.58例患者中,术后发生残腔积液3例,外囊不闭合2例,胆汁漏1例,引流4～8周后痊愈.50例患者获得术后随访,随访率为86.2％ (50/58),随访时间为12.0 ～48.0个月,中位随访时间为27.1个月.随访期间,1例肝门部囊型包虫病行内囊摘除术患者术后8个月复发,采用CT引导下无水酒精介入治疗后痊愈.其余患者未见复发.结论 CT和MRI影像学检查对肝囊型包虫病具有较高的诊断准确率."蜂窝状""车轮状"是多子囊型肝囊型包虫病的特征性表现.内囊分离型肝囊型包虫病CT检查特征表现为"套囊征""水蛇征",MRI检查表现为"飘带征".MRI检查增强的边缘环形强化是肝囊型包虫病与肝囊肿的鉴别要点.不规则钙化是肝包虫病与肝肿瘤的鉴别要点.
    목적 총결간낭형포충병CT급MRI영상학검사특정,탐토기진단급감별진단요점.방법 회고성분석2011년8월지2014년8월내몽고의과대학부속의원수치적58례간낭형포충병환자적림상자료.환자행CT평소급증강소묘、MRI평소급증강소묘.결합문헌장간낭형포충병분위5형:Ⅰ형:단순낭종형,Ⅱ형:다자낭형,Ⅲ형:내낭분리형,Ⅳ형:실변개화형,Ⅴ형:혼합형.대우명학진단혹의사진단간낭형포충병환자,여수술치료.채용문진화전화방식진행수방.술후3개월、6개월、1년각수방1차,이후매년문진수방1차,5년이상무복발가정지수방.수방내용주요관찰간낭형포충병복발정황.수방시간절지2015년8월.결과 (1)영상학검사정황:58례환자중,54례행CT소묘,21례행MRI소묘.58례환자중,Ⅰ형간낭형포충병17례,CT검사결과시변계청석적저밀도낭성병변;MRI검사결과시단개혹다개원형、타원형이상신호,T1WI정저신호,T2WI정고신호,낭벽T1WI화T2WI균정저신호,이T2WI현시경청석.Ⅱ형간낭형포충병13례,CT검사결과시모낭내견다개대소불등적자낭,배렬정"봉와상""차륜상";MRI검사결과시T1WI자낭신호저우모낭,T2WI자낭신호고우모낭;모낭급자낭낭벽균정저신호.Ⅲ형간낭형포충병6례,CT검사결과시병변정"투낭정""수사정"등,MRI검사결과시병변정"표대정".Ⅳ형간낭형포충병13례,CT검사결과시불규칙고밀도개화영,밀도불균균,병변정"뇌회양"혹"권양총피양"개변.Ⅴ형간낭형포충병9례,동시존재상술각형중2충혹2충이상류형병변.(2)진단정황:CT검사오진4례,기중3례술전진단위간낭종,1례술전진단위간전이암,진단준학솔위92.6％(50/54).MRI검사오진2례,술전균진단위간낭선류,진단준학솔위90.5％(19/21).(3)치료급수방정황:58례환자균행수술치료,기중40례행간낭형포충병내낭적제술(31례행개복수술,9례행복강경수술),10례행간부분절제술,8례행간낭형포충병외낭완정박제술.58례환자중,술후발생잔강적액3례,외낭불폐합2례,담즙루1례,인류4～8주후전유.50례환자획득술후수방,수방솔위86.2％ (50/58),수방시간위12.0 ～48.0개월,중위수방시간위27.1개월.수방기간,1례간문부낭형포충병행내낭적제술환자술후8개월복발,채용CT인도하무수주정개입치료후전유.기여환자미견복발.결론 CT화MRI영상학검사대간낭형포충병구유교고적진단준학솔."봉와상""차륜상"시다자낭형간낭형포충병적특정성표현.내낭분리형간낭형포충병CT검사특정표현위"투낭정""수사정",MRI검사표현위"표대정".MRI검사증강적변연배형강화시간낭형포충병여간낭종적감별요점.불규칙개화시간포충병여간종류적감별요점.
    Objective To summarize the features of computed tomography (CT) and magnetic resonance imaging (MRi) of hepatic cystic echinococcosis, and investigate the key points of identification and diagnosis.Methods The clinical data of 58 patients with hepatic cystic echinococcosis who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from August 2011 to August 2014 were retrospectively analyzed.Patients received plain and enhanced scan of CT and MRI.Hepatic cystic echinococcosis was divided into the 5 types according to the literatures, including unilocular echinococcasis in type Ⅰ, multivesicular hydatid cysts in type Ⅱ, anechoic content with detachment of laminated membrane from the cyst wall in type Ⅲ, calcification of lesions in type Ⅳ and mixed echinococcosis in type Ⅴ.Patients who were diagnosed as with definite or suspected hepatic cystic echinococcosis underwent surgery.The follow-up including observing the recurrence of hepatic cystic echinococcosis was performed by outpatient examination and telephone interview at postoperative month 3, 6, 12 for 1 year and then once every year up to August 2015, and was ended if there was no recurrence for more than 5 years.Results (1) The results of CT and MRI examinations: of the 58 patients, 54 received scan of CT and 21 received scan of MRI.Seventeen patients were detected in type Ⅰ with clear-boundary and low-density cystic lesions by CT examination;MRI examinations showed there were single or multiple, round or oval abnormal signal including low T1WI signal, high T2 WI signal and low T1 WI and T2WI signal of cyst wall.Thirteen patients were detected in type Ⅱ, CT examination showed the "daughter" cysts of multiple sizes were found in the "mother" cyst, arranged in "honeycomb" or "wheel" shape;MRI examination showed there were lower T1 WI signal in the "daughter" cyst and higher T2 WI signal in the "daughter" cyst compared with signal in the "mother" cyst, and low signal in the cyst wall of the "daughter" cyst and "mother" cyst.Six patients were detected in type Ⅲ with "capsule in capsule" sign and "water snake" sign by CT examination and "ribbon" sign by MRI examination.Thirteen patients were detected in type Ⅳ, CT examination showed there were irregular high-density calcified shadow with the performances for "return sample" or "sample volume skins" changes.Nine patients in type Ⅴ had more than 2 kinds of lesions.(2) Diagnosis: 4 patients were misdiagnosed by CT examination including 3 with preoperative diagnosis of hepatic cyst and 1 with preoperative diagnosis of metastatic carcinoma of liver, with an accurate rate of diagnosis of 92.6％ (50/54).Two patients with preoperative diagnosis of hepatic cystic adenocarcinoma were misdiagnosed by MRI examination, with an accurate rate of diagnosis of 90.5％ (19/21).(3) Treatment and follow-up: 58 patients underwent surgery, including 40 undergoing internal capsule removal with external capsule suturing (31 with open operation and 9 with laparoscopic operation), 10 undergoing partial hepatectomy and 8 undergoing external capsule enucleation.Of 58 patients, 3 were complicated with effusion of residual cavity, 2 with unclosed external capsule, 1 with bile leakage and then was cured after 4-8 week drainage.Fifty patients were followed up for 12.0-48.0 months with a median time of 27.1 months and a follow-up rate of 86.2％ (50/58).During the follow-up, 1 patient undergoing internal capsule removal had recurrence at postoperative month 8 and was cured by CT-guided interventional therapy using absolute alcohol, and other patients had no recurrence.Conclusions There was a higher accuracy in CT and MRI examinations for hepatic cystic echinococcosis."Honeycomb" and "wheel" shapes are characteristic findings of hepatic cystic echinococcosis in type Ⅱ.The characteristic performances of CT examination for hepatic cystic echinococcosis in type Ⅲ are "capsule in capsule " and "water snake" signs, and characteristic performances of MRI examination is "ribbon" sign.The ring-like enhancement of edge by MRI examination is an essential of identification and diagnosis between hepatic cystic echinococcosis and hepatic cyst, and irregular calcification is a differential point between hepatic echinococcosis and hepatic tumor.
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