原位肝移植术后肝脓肿的原因和处理

目的：探讨原位肝移植术(OLT)后肝脓肿的病因及治疗选择。 方法：分析4年间行OLT 558 例术后1~18 个月发生肝脓肿10 例(1.8％)的原因。结果：7 例为术后胆道并发症,2 例为肝癌复发灶射频消融术（RFA）后,1 例为不明原因感染。主要临床表现有发热、肝功能损害、低蛋白血症和贫血等。诊断主要根据临床表现及超声或CT 检查。治疗方法主要包括脓肿抽吸引流、PTCD胆道内外引流、抗感染和支持治疗及再次肝移植。 10 例中6 例通过肝脏穿刺引流治愈,2 例通过再次肝移植治愈,2 例死于脓毒血症;治愈率为80.0％。结论：OLT 后发生肝脓肿地原因复杂,可能与胆管吻合口狭窄或梗阻、胆道缺血坏死、肝癌复发灶介入治疗、肝动脉血栓或狭窄和激素冲击治疗等有关。OLT 后肝脓肿的预后较差,早期诊断和治疗是关键。     

碘油造影CT对肝硬化小肝细胞癌的诊断价值

对终末期肝病施行原位肝移植（OLT）前，通过影像学检查了解是否存在肝细胞癌（HCC），具有重要意义。癌灶的大小及数量是OLT后肿瘤复发的危险因素。以往报道认为，碘油造影CT（IOCT）对诊断HCC具有高度的敏感性，然而，这些报道均是基于对手术切除标本或针刺活检的组织学研究，不能确切地对全肝作出评价。本文则在对全肝进行病理学研究的基础上，评价IOCT对中晚期肝硬化的患者诊断HCC的敏感性。1993年7月至1994年12月，对50例慢性肝病终未期患者施行了OLT，术前影像学检查包括超声、增强CT和碘油肝动脉造影，并于10～15天后再…     

超声检查在活体肝移植受体术后胆道并发症诊断中的应用

目的探讨超声检查在活体肝移植术后胆道并发症诊断中的临床应用。方法对21例成人右半肝活体移植受体术后进行超声检查,观察移植肝及其胆道声像图表现,与经皮经肝穿刺胆道造影引流(PTCD)等影像学结果相对比。结果 21例病例经PTCD及临床随访证实为胆管吻合口狭窄5例,胆泥1例,胆漏1例。超声检查能够诊断并与之相符5例,为4例吻合口狭窄及1例胆泥,胆漏病例可见肝周积液。其中4例胆管吻合口狭窄病例超声诊断时间均明显早于临床出现黄疸或血清胆红素升高的时间。结论在活体肝移植术后胆道并发症的诊断中,超声检查操作简便、无创、可重复性强、准确性较高,可早期诊断胆管并发症,具有重要的临床应用价值。     

超声联合CT在膀胱癌早期诊断中的应用价值分析

目的:通过研究超声与螺旋CT两种影像学检查联合应用,以提高对膀胱癌的早期诊断,探讨其临床应用价值.方法:对随机选择的68例膀胱癌患者的超声、螺旋CT的检查结果进行回顾性分析.结果:膀胱癌超声检出率为82.35％,螺旋CT检出率为89.71％,两项检查联合应用的检出率为97.06％,二者联合应用与单独使用超声检查存在显著性差异(P＜0.01).结论:超声联合螺旋CT检查在膀胱癌诊断,尤其是早期诊断中有较高的应用价值.     

原发性胆管癌的螺旋CT诊断分析

目的分析原发性胆管癌的螺旋CT表现特征。方法回顾性分析经手术病理证实的87例胆管癌的螺旋CT平扫及动态增强表现特征。结果肝内周围型胆管癌（19例）平扫呈相对低密度或等密度肿块，增强扫描肝动脉期17例呈边缘环状强化，2例无强化，门静脉期12例呈中心强化，延迟期中心强化更明显，坏死区无强化；48例肝门区胆管癌中42例呈浸润性肿块，增强早期呈轻至中度强化，晚期强化明显，少数无强化；肝外胆管癌（20例）多呈浸润性生长或表现为腔内乳头状肿块，增强早期呈中度强化，晚期明显强化。结论螺旋CT多期增强扫描，是诊断原发性胆管癌的重要影像检查方法，能较准确地显示各类胆管癌的生长特征，延迟扫描对胆管癌的诊断和鉴别诊断有重要参考价值。     

多层螺旋CT诊断阑尾炎的临床价值

目的探讨多层螺旋CT检查诊断阑尾炎的临床价值。方法收集2015-01—2017-11间开封市中心医院诊治的55例阑尾炎患者。术前均经超声及多层螺旋CT检查。以术后病理检查结果为"金标准",比较多层螺旋CT与超声检查对阑尾炎的诊断符合率。结果多层螺旋CT检查对阑尾炎的诊断符合率高于超声检查,差异有统计学意义(P0.05)。结论多层螺旋CT诊断阑尾炎效果显著,尤其是急性化脓性阑尾炎的诊断符合率更突出。     

小于2 cm的肝脏肿块的影像学诊断比较分析

目的评价超声、多层螺旋CT、磁共振影像学检查在小于2 cm肝脏肿块诊断中的价值。方法回顾性分析2010年1月至2012年1月在华中科技大学同济医学院附属同济医院肝脏外科中心就诊的53例资料完整的肝脏肿块患者临床资料,分别进行超声造影、多层螺旋CT增强、磁共振(PWI+DWI)检查,结合临床特征得出相应的初步诊断,再与病理和随访结果比较,分析三种影像学诊断的敏感度、特异度、准确性。结果病理和随访证实27例为原发性肝癌,10例肝脏局造型结节增生,9例肝血管瘤,4例转移性瘤,2例肝脏血管平滑肌脂肪瘤,1例囊肿混合感染。肝脏的PWI+DWI在诊断中表现出较高的敏感度、特异度和准确性(91%、97%、93%),稍优于超声造影,明显优于增强CT(P0.05)。结论肝脏PWI+DWI和超声造影在小于2 cm肝脏肿块诊断中具有较高价值。     

肝移植术后肝动脉并发症的影像诊断及介入性治疗

肝移植术后肝动脉并发症是最常见而严重的并发症,对于移植术后肝动脉并发症的早期诊断和治疗是决定肝移植手术成功与否的关键因素。彩色多普勒及超声是观察移植后肝动脉的首选方法,螺旋CT及MR血管成像有很大的应用价值,而血管造影术则是诊断的金标准。介入放射学治疗以其微创性及集诊断和治疗于一体的优势对于肝移植术后肝动脉并发症的诊断与治疗具有重要作用。     

肝硬变结节性病变的影像学和相关病理学表现

目的 介绍1995年国际肝病工作组关于肝硬变结节的分类标准，总结与病理学特征相关的各种肝结节的影像学表现，并探讨各种影像学检查方法的诊断价值。方法 用超声、CT、MRI、血管造影性CT等各种影像学检查方法。结果 在肝硬变背景基础上肝癌的发生、发展，沿循从再生结节、低度非典型性结节、高度非典型性结节到小肝癌(SHCC)、大肝癌的逐步滨进过程，在此过程中同时伴有结节内血流供应和灌注的相应变化。结论 现代影像学检查技术的发展为肝内各种结节的检出、定性和鉴别诊断提供了多种十分有效的方法，为各类肝结节，特别是早期小肝癌结节的诊断、治疗创造了有利条件。     

对比16层螺旋CT薄层扫描与常规超声诊断成人急性阑尾炎的指导价值

目的对比16层螺旋CT薄层扫描与常规超声诊断成人急性阑尾炎的指导价值。方法选取2017年1月至2018年3月本院收治的成人急性阑尾炎患者80例,所有患者均接受16层螺旋CT薄层扫描检查与常规超声检查,分别作为研究组与对照组,术后判定结果作为两组检查的金标准。对研究组与对照组的诊断符合率进行比较,并对研究组诊断影像学特点进行总结分析。结果在诊断符合率方面,研究组91.3%与对照组71.3%比较明显提高(P0.05);与对照组比较,研究组单纯性、化脓性阑尾炎确诊率均明显提高,差异具有显著性(P0.05)。结论在成人急性阑尾炎诊断方面,16层螺旋CT薄层扫描检查与常规超声检查相比诊断符合率更高,可对阑尾位置、长短、粗细、粘连等情况进行有效反映,具有更高的临床指导价值。     

肝细胞癌微波消融术后CT及MRI表现

微波消融技术现已用于治疗肝脏肿瘤。肝细胞癌(HCC)是微波消融的主要适应证。正确认识HCC微波消融术后影像学改变对于评估疗效、及早发现肿瘤残余或复发以及防治并发症至关重要。本文就HCC微波消融术后消融区及其并发症的CT及MRI表现进行综述。     

Musculoskeletal Imaging Update: Current Applications of Advanced Imaging Techniques to Evaluate the Early and Long-Term Complications of Patients with Orthopedic Implants

Technical advances in imaging have increased their applicability to diagnosing conditions of the musculoskeletal system, especially in the postoperative setting, where traditionally metallic artifacts have hindered evaluation. Advances in computed tomography (CT), magnetic resonance (MR) imaging, ultrasound, and nuclear medicine have resulted in improved overall image quality. Specific modifications of imaging parameters, especially in CT and MRI, have improved the radiologist's ability to diagnose potential hardware complications such as loosening and osteolysis. Sonography can evaluate the periprosthetic soft tissues and enables both diagnostic information and therapeutic treatment at the same sitting. Lastly, diagnostic scintigraphic applications such as positron emission tomography (PET) have increased specificity in diagnosing potential infection in the arthroplasty setting. This review discusses some of the current applications of CT, MRI, ultrasound, and nuclear medicine in evaluating the postoperative orthopedic patient, concentrating on the appropriate imaging evaluation for the painful arthroplasty patient.     

应用MRCP对63例肝移植术后胆道并发症的临床分析

目的评价MRCP在诊断原位肝移植术后胆道并发症中的临床应用价值。方法分析63例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访证实结果进行对照。所有病例均在高场强1.5T磁共振上进行。MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像。结果MRCP诊断移植术后胆道并发症的敏感性为95.3%(41/43),阳性预测值97.6(41/42),假阴性率为4.54%(2/44),假阳性率为2.27%(1/44)。总诊断准确率为95.2%(60/63)。MRCP作为唯一的诊断方法能为96.8%(61/63)的患者提供特异性诊断结果,仅2例患者需要ERCP和PTHC检查3.2%(2/63)。直接胆道造影作为一项治疗手段应用于22.2%(14/63)的患者中。结论MRCP是评价肝移植术后胆道并发症的有效影像学方法。     

Inter- and intraobserver variability in the postoperative evaluation of transpedicular stabilization: computed tomography versus magnetic resonance imaging

Background contextComputed tomography (CT) represents the state of the art for the postoperative verification of the implant position after transpedicular stabilizations. Magnetic resonance imaging (MRI) has not challenged the CT, yet, because of susceptibility artifacts but would be favorable as a diagnostic tool for its excellent soft-tissue qualities.PurposeA study that analyzed if an artifact-reduced MRI could overcome this problem and provide sufficient data for the postoperative assessment was conducted.Study designThe study design was a radiologic comparison of CT and MRI techniques evaluating pedicle screw placement after spinal fusion.Patient sampleFifty consecutive patients were given an MRI and a CT after a transpedicular stabilization surgery. Thirty-eight patients suffered from degenerative spinal disorders; three surgeries had become necessary because of spondylodiscitis, eight patients suffered from metastatic vertebrae destruction, and one patient experienced a fracture.Outcome measuresAny contact of a malpositioned pedicle screw with the dura and/or radicular structures was identified as an implant-associated complication and was compared with postoperative clinical patient findings.MethodsIn total, 338 pedicular screws were analyzed in regard to their intrapedicular position. The double-blind evaluation of MRI and CT data was carried out by two radiologists and two spine surgeons. Accuracy of the CT analysis was calculated based on the interobserver agreement of 100%. Magnetic resonance imaging accuracy was calculated.ResultsThe interobserver accuracy of the CT data amounted to a median of 89.8% and in the MRI data of 86.7%. Intraobserver comparisons showed a significant difference between CT and magnetic resonance evaluations in one observer (κ=0.293). In all other observers, the results were concordant with kappa values from κ=0.328 to κ=0.702. There was a high degree of agreement regarding the diagnosis of malpositioned pedicle screw and corresponding clinical symptoms between both techniques.ConclusionsThe presented data show that artifact-reduced MRI is equivalent to CT imaging in the postoperative evaluation of titanium spinal rod-screw systems. We therefore conclude that MRI should be considered as an alternative tool for the golden standard CT for postoperative imaging controls for its advantages in soft-tissue analysis.     

Cirrhotomimetic type hepatocellular carcinoma diagnosed after liver transplantation--eighteen months of follow-up: a case report

Diffuse-type hepatocellular carcinoma (HCC) is a contraindication to liver transplantation (OLT). However, cirrhotomimetic HCC, which is a form of the diffuse type, is difficult to diagnose preoperatively, there are no published reports about its prognosis after OLT. We performed an OLT for a case of cirrhotomimetic HCC diagnosed postoperatively. This 41-years-old man was on the waiting list for OLT owing to hepatitis B virus-related liver cirrhosis and esophageal variceal bleeding. Three months before transplantation, newly developed small nodules were detected on computed tomography (CT); there were no interval changes on CT after 2 months. His serum value of alpha-fetoprotein (alpha-FP) was 327 ng/mL. The patient received a deceased donor liver transplantation and his postoperative course was uneventful. However, on pathologic findings, the explanted liver showed malignant cells in most cirrhotic nodules. So, the patient's pathologic diagnosis was cirrhotomimetic HCC. Triple immunosuppression was administered and steroid stopped at about 2 weeks after transplantation. Eighteen months after transplantation, alpha-FP was 1.5 ng/mL and there was no evidence of recurrence on follow-up CT. In conclusion, cirrhotomimetic HCC is rare and difficult to detect, preoperatively. Despite the short-term follow-up, we did not detect recurrence of HCC.     

影像学检查在活体供肝评估中的应用

目的 了解影像学检查在活体供肝评估中的应用现状。方法 采用文献回顾方法对活体供肝评估中影像学的应用研究进行综述。结果 术前CT和MRI可准确评估肝脏体积与粗略评估肝脏大泡型脂肪变性情况；CT血管成像可显示供肝肝动脉、门静脉与肝静脉的解剖结构，术中胆管造影可显示胆管系统的解剖变异。结论 影像学检查在活体供肝评估中的多个环节都得到广泛应用。     

Bile duct complications after liver transplantation

Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of this technique. Biliary complications have been reported to occur at a relatively constant rate of approximately 10-15% of all deceased donor full size OLTs. There is a wide range of potential biliary complications which can occur after OLT. Their incidence varies according to the type of graft, type of donor, and the type of biliary anastomosis performed. The spectrum of biliary complications has changed over the past decade because of the establishment of split liver, reduced-size, and living donor liver transplantation. Apart from technical developments, novel diagnostic methods have been introduced and evaluated in OLT, the most prominent being magnetic resonance imaging (MRI). Treatment modalities have also changed over the past years towards a primarily nonoperative, endoscopy-based strategy, leaving the surgical intervention for lesions which otherwise are not curable. The management of biliary complications after OLT requires a multidisciplinary approach. Conservative, interventional, and endoscopic treatment options have to be weighed up against surgical re-intervention. In the following the spectrum of specific bile duct complications after OLT and their treatment options will be reviewed.     

七例八次背驮式原位肝移植

对４例Ｗｉｌｓｏｎ病及３例晚期肝病患者施行了８次背驮式原位肝移植术，其中１例为减体积性背驮式原位肝移植。３例已分别存活２年、９个月、６个月，４例死于术后并发症。认为代谢性疾病是原位肝移植的最佳适应证，其次是肝硬变；术后感染、急性和慢性排斥、肺部并发症及胆道并发症是影响患者存活的重要因素；背驮式原位肝移植对全身血流动力学的影响较小。     

Laparoscopic Ultrasound-Guided Radiofrequency Ablation as a Bridge to Liver Transplantation for Hepatocellular Carcinoma: Preliminary Results

Introduction

The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).

Methods

Between January 2008 and January 2009, 12 consecutive patients, including 10 males and 2 females with unresectable HCC within liver cirrhosis, were treated with LTA under ultrasound (US) guidance. Most patients were in Child-Pugh class B (54.1%) with a mean age of 60.7 ± 7.74 years (range, 45-69; median, 60).

Results

The LTA procedure was completed in all patients with thermoablation of 23 HCC nodules. LTA identified 4 new malignant lesions (20%) undetected by preoperative imaging (<0.5 cm). The mean length of surgery was 96 minutes (range, 45-118). Six procedures were performed in 4 patients. No postoperative hepatic insufficiency was reported. The mean hospital stay was 4.5 days; no postoperative morbidity was reported. Complete tumor necrosis was achieved in 19/23 thermoablated nodules (82.6%) as evidenced computed tomography (CT) scan by at 3 weeks after the treatment. All patients underwent OLT without complications. The histology of the native liver showed complete necrosis in 17/23 (74%) treated nodules.

Discussion

There is currently no convincing evidence that LTA allows one to expand the current selection criteria for OLT, nor that LTA decreases dropout rates on the waiting list. However, LTA does not increase the risk of postoperative complications. There is insufficient evidence that LTA offers any benefit when used prior to OLT either for early or for advanced HCC.