华支睾吸虫病肝内胆管扩张的CT特征及其鉴别诊断

分析４２例华支睾吸虫病肝内胆管扩张的ＣＴ表现，并与４０例良、恶性阻塞性黄疸病例的ＣＴ表现进行比较，结果显示肝内胆管轻度弥漫型扩张为其主要ＣＴ表现。末梢囊状型扩张虽仅占１９％，但却是本病可靠且特异的ＣＴ征象。同时就四种肝内胆管扩张类型的机理、临床意义和本病的鉴别诊断进行了分析及探讨。     

原发性硬化性胆管炎的临床及影像诊断

目的：探讨原发性硬化性胆管炎（PSC）的临床及影像诊断。方法：回顾性分析15例PSC患者的临床表现、实验室检查及各种影像学检查特征。结果：15例PSC患者中，男性19例，女性6例，平均年龄19岁。临床表现以进行性黄疸、皮肤瘙痒、乏力、纳差为主，病程0．5～19年。碱性磷酸酶（ALP）Md=280U／L，谷氨酰胺基转肽酶（GGT）Md=300U／L。超声检查主要表现为胆管壁增厚、回声增强，胆管内径变细。CT检查表现为不同程度的肝内外胆管扩张、胆管壁增厚、钙化。核磁共振胰胆管造影术（MRCP）检查表现为肝外胆管狭窄及肝内胆管周围部狭窄伴扩张。内窥镜逆行胰胆管造影术（ERCP）检查13例患者均为阳性，表现为肝内胆管串珠样或剪枝样改变和肝外胆管憩室样凸出。8例纤维结肠镜检查6例合并溃疡性结肠炎。结论：原发性硬化性胆管炎好发于中年男性，临床表现以梗阻性黄疸，血清ALP、GGT明显升高为其显著特点，往往伴有溃疡性结肠炎。超声及CT检查对本病诊断具有提示和辅助诊断作用，确诊以ERCP为主，MRCP可弥补ERCP检查的不足并作为病变随访的有效方法。     

70例急性酒精性肝炎的CT影像分析

目的：探讨急性酒精性肝炎的CT影像特征。方法：回顾性分析经临床、化验、CT综合诊断的70例急性酒精性肝炎病例的CT影像资料;本组病例肝功能化验均无甲、乙肝炎表现。结果：急性酒精性肝炎CT影像表现为：点状、片状低密度急性肝损害征象以及胆汁淤积、肝内胆管扩张,重者可出现肝组织坏死液化、肝肿大。急性酒精性肝炎的并发症有：肝硬化、脾大、脂肪肝、腹水。根据急性肝损害的严重程度,分为轻度39例,中度23例,重度8例。治疗后复查CT,除2例死亡外,其他所有病例的急性肝损害征象可恢复。其并发症酒精性肝硬化为不可逆病变。结论：CT能够显示急性酒精性肝炎的影像学特征。     

CT在Caroli’s病中的诊断价值(附8例分析)

目的:探讨Caroli’s病的CT表现及诊断价值。方法:对2004~2006年经手术或病理证实的8例Caroli’s病的CT影像学资料进行回顾性分析,全部病例均行CT平扫,3例同时行增强扫描。结果:本组8例CT平扫均见肝内胆管扩张,呈多发囊状或柱状低密度影,3例增强扫描不强化,2例可见"蝌蚪征",2例可见"中心点征"。8例中,5例属于Ⅰ型,其中1例合并肝内胆管结石;3例属于Ⅱ型,均合并肝硬化及脾脏增大;8例中均未伴有髓质海绵肾。结论:CT扫描不但可清晰显示肝内胆管扩张及其与周围结构的关系,并且无创,对术前诊断Caroli’s病具有重要价值。     

CT evaluation of the bile ducts in patients with fatty liver

Computed tomographic (CT) evaluation of the bile ducts in the fatty liver can be difficult, since hepatic attenuation decreases with increased triglyceride content, and liver parenchyma may become isodense with bile. Forty-seven patients with fatty infiltration of the liver were retrospectively identified. In 7 of these patients, attenuation of liver and bile differed by less than 10 HU. In 2 patients, dilated intrahepatic ducts were invisible using CT, because bile was isodense with fatty liver parenchyma. Thus, the fatty liver presents a potential pitfall in CT evaluation of the bile ducts. Obstructive jaundice can be diagnosed in patients with fatty liver, if the extrahepatic ducts and peribiliary vascular plexus region are carefully scrutinized. For maximal accuracy, scans should be obtained both before and after administration of intravenous urographic contrast material.     

CT平扫与增强扫描对梗阻性黄疸的诊断价值

目的探讨CT对梗阻性黄疸的诊断价值。方法对38例经手术病理证实的梗阻性黄疸进行回顾性分析。其中，胆管癌9例，胰腺癌12例，胆总管结石16例，胆总管炎性狭窄1例。结果胆管癌中7例位于胆总管，2例位于肝门区胆管，均表现为梗阻上方胆管扩张。胰腺癌中8例表现为胰头增大，4例胰头增大不明显，增强扫描可见小结节状强化。胆总管结石中14例为阳性结石，表现为高密度影，2例为阴性结石，表现为低密度影。胆总管炎性狭窄1例，表现为肝内外胆管扩张，胆囊扩大，胆总管渐进性狭窄。结论CT除可以确定梗阻性黄疸的诊断以外，还能明确梗阻部位以及判断梗阻原因。     

肝华支睾吸虫病多层螺旋CT 表现的研究

目的：探讨肝华支睾吸虫病的多层螺旋C T表现。方法对经临床证实的65例肝华支睾吸虫病的多层螺旋C T表现进行分析总结。结果65例肝华支睾吸虫病均有肝内胆管呈囊状及杵状扩张,其中38例肝华支睾吸虫病扩张胆管内可见点状软组织密度虫体影,占58％（38/65）,13例胆囊内见点片状沉积物样及团状虫体影,占20％（13/65）。合并胆管结石6例,占9．2％（6/65）。合并胆囊结石8例,占12．3％（8/65）。合并胆管炎8例,占12．3％（8/65）。合并胆囊炎5例,占7．6％（5/65）。合并肝脓肿3例,占4．6％（3/65）。65例胆总管均未见扩张。多平面重建可更仔细的观察肝胆管扩张情况。结论肝内胆管呈囊状及杵状扩张,而胆总管无扩张是肝华支睾吸虫病的特征性CT表现。扩张胆管内点状及胆囊内沉积物样或团状虫体影,是肝华支睾吸虫病的特异征象。多平面重组可更细致观察肝胆管扩张情况和细节,结合实验室检查,可以做出准确的诊断。     

CT在阻塞性黄疸诊断中的应用

本文通过对135例确定病因的阻塞性黄疸患者的CT分析,判断CT检查对胆管阻塞平面和阻塞原因的价值。扩张的肝外胆管在腹部扫描时所见为低密度环影,按其解剖分四部分:肝门段、胰上段、胰腺段及壶腹段。依据末环的形态、结石和肿块的出现,进行回顾性分析,CT确定梗阻水平的准确率为100％,梗阻原因为90.5％。以上说明CT检查可免去一些损伤性检查。     

肝硬化门静脉性胆病的影像表现

目的：探讨肝硬化门静脉高压性胆病（PB）的MSCT及MRI表现。方法：回顾性分析16例肝硬化PB患者的MSCT及MRI表现,分析门静脉血栓导致PB的解剖位置和临床表现。结果：16例患者中门静脉海绵样变13例,其中8例合并门静脉血栓;门静脉和／或门静脉分支血栓3例。16例患者中3例表现为肝内胆管扩张,9例表现为肝外胆管及一侧肝内胆管扩张,4例表现为肝外胆管和两侧肝内胆管扩张。本组病例门静脉系统侧支循环的类型包括食道一胃底静脉曲张13例（13／16,81％）、胰腺周围静脉曲张10例（10／16,63％）和胆囊静脉曲张10例（10／16,63%）。结论：肝硬化门静脉高压患者出现肝外或肝内胆管扩张时应考虑门静脉高压性胆病的可能。     

Ultrasonography and computed tomography in diffuse liver disease with cholestasis

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.     

梗阻性黄疸的CT诊断(附32例分析)

目的 探讨CT对梗阻性黄疸诊断价值。方法 对32例经超声诊断不满意的梗阻性黄疸患者行CT平扫，增强扫描和梗阻局部薄层扫描。结果 32例梗阻性黄疸病例中，良性梗阻性黄疸23例，误诊2例（胆总管等密度结石及慢性炎性狭窄各1例）；恶性梗阻性黄疸9例中，误诊1例（胆总管癌）。结论 CT对梗阻性黄疸有极高的定位与定性诊断收信人.梗阻平面的判定及梗阻端的征象分析，正确解释梗阻原因，可提高术前诊断正确率。     

Peripheral cholangiocarcinoma and clonorchiasis: CT findings

Sixteen patients with peripheral cholangiocarcinoma of the liver were examined with computed tomography (CT). None of the 16 patients presented with jaundice or had documented cirrhosis. On scans obtained both before and after the injection of contrast material, the tumors were depicted as low-attenuation masses in all cases, with wide variations in homogeneity. The tumor margin was irregular in 12 cases, and there was minimal contrast enhancement of the tumor in 14 cases. In 11 (69%) patients, CT demonstrated masses of markedly low attenuation, which corresponded to areas of diffuse microcystic change seen at histologic examination of resected specimens. In ten (63%) patients, the results of stool or intradermal tests for Clonorchis sinensis were positive. In all ten cases of clonorchiasis, mild, diffuse dilatation of the intrahepatic bile ducts was seen in addition to the low-attenuation masses, but there was no dilatation of the extrahepatic biliary tree. In five of the ten patients with clonorchiasis, stippled or aggregated, powderlike areas of high attenuation were seen on precontrast CT scans; at pathologic examination, those areas were found to be mucin. Extrahepatic metastases were demonstrated in ten (63%) patients. Peripheral cholangiocarcinoma should be the primary diagnostic consideration when these characteristic CT findings are detected in a noncirrhotic patient.     

原发性硬化性胆管炎13例诊治体会

目的探讨原发性硬化性胆管炎诊断和治疗方法。方法对我院外科1999～2007年经影像学和穿刺活检病理检查的原发性硬化性胆管炎13例患者的诊断、药物治疗结果进行回顾性研究。结果患者均有阻塞性黄疸病史,7例应用了个体化的糖皮质激素治疗方案,6例采用了脱氧熊胆酸（ursodeoxycholicacid UDCA）治疗,无胆道手术的病例及肝移植病例,有4例患者获得长期缓解,而3例进展至胆汁性肝硬化,其中死亡1例。结论原发性硬化性胆管炎发病机制不明,临床表现不典型,药物治疗效果不理想。亦无法阻止病程的发展,肝移植可能是其相对有效的治疗方法。     

肝内胆管脓肿的CT特征探讨

目的 肝内胆管脓肿（intrahepatic bile duct abscess,IBDA）的CT表现特点及病理基础。方法 回顾性研究1989年10月至1999年2月经手术及临床抗炎治疗后复查证实的IBDA连续性病例31例的C T资料,病因包括多种原因所致的急性梗阻性化脓性胆管炎和胆道逆行感染。所有病例分别从肝脓肿征象、胆源性征象及反映两者间相关性的征象进行观察。结果 31例中均可见肝脓肿CT表现特征（31／31,100％）。胆源性CT表现包括各种梗阻病因的特征性 CT表现和其他胆道异常表现,包括胆管扩张（29／31,93.5％）、扩张的胆管与脓肿相通（5／31,16.1％）或相紧邻（8／31,25.8％）及胆道积气（10／31,32.2％）等。前两者间相关的CT表现,包括肝脓肿上与梗阻点及其近侧扩张胆管相一致（15／31,48.4％）,肝脓肿发生于无（7／31,22.6％）或有（４／３１,１２.９％）肝内胆管积气的肝叶、肝段等。结论 ＩＢＤＡ的ＣＴ表现包括肝脓肿征象、胆源性征象,并能反映两者间相关的具有一定特征的ＣＴ征象。     

Mirizzi''''s综合征的CT表现

本文总结分析了16例Mirizzi's综合征的临床资料和CT图象,16例病人的CT表现包括:(1)胰腺段以上的肝外胆管扩张,(2)胆囊萎缩、扩大或正常大小;(3)胆囊壁增厚;(4)胆囊周围炎性表现;(5)肝门区多囊多管征,肝门区各结构间脂间隙模糊、消失,肝外胆管壁增厚;(6)肝门区含钙结石位于囊、管结构内或位于其外;(7)可伴有肝硬化。上述征象中,肝门区多囊多管征、肝门区脂间隙改变及肝外胆管壁增厚,文献中未曾报道。本文病例的CT表现与手术结果相符合,这些征象是由于胆囊管的扩张、扭曲,以及胆囊周围炎累及肝门和肝外胆管造成的。在梗阻性黄疸的CT鉴别诊断中,当出现上述征象,特别是肝门区多囊多管征象,要考虑此综合征的可能。     

面积测量法MR胰胆管水成像在梗阻性黄疸病因诊断中的应用价值研究

目的:探讨面积测量法胰胆管水成像(MRCP)在梗阻性黄疸病因诊断中的应用价值。方法:对33例梗阻性黄疸患者禁食6~8h空腹行MRCP及多层螺旋CT检查,在每个患者MRCP及CT图像的标准轴位上,取相同长度扩张或狭窄的病变胆管,分别测量其截面积的最大值与最小值,并计算最大值与最小值的比值,命名为相对扩张度,将两组数据进行统计学分析。结果:33例中,良性梗阻10例,其中结石7例,炎性狭窄3例。恶性梗阻23例,其中肝门癌3例,胆管中段癌3例,胆管下段癌4例,胰头癌5例,壶腹癌8例。MRCP和CT两组截面积的最大值与最小值的差值经统计学处理,有显著差异;最大截面积之间的差值、最小截面积之间的差值以及相对扩张度之间的差值经统计学处理,无显著差异。结论:面积测量法MRCP在梗阻性黄疸病因诊断中具有很高的应用价值,相对扩张度可以反映病变胆管扩张与狭窄的程度,把影像特征数据化,对梗阻性黄疸的病因诊断具有临床意义。     

梗阻性黄疸病因的CT诊断分析

目的：探讨ＣＴ对梗阻性黄疸病因的诊断价值。方法：回顾性分析了１２４例经手术和病理证实的梗阻性黄疸病例的ＣＴ征象,并与Ｂ超诊断进行了对比。结果：１．ＣＴ诊断梗阻性黄疸病因的符合率９６％ ,高于Ｂ超的７９％ 。２．梗阻性黄疸病因最多为结石（７０ 例）,其次为肝脏、胆道肿瘤（４８例）。３．ＣＴ对硬化性胆管炎等少见病有３例漏误诊。结论：ＣＴ能明确显示扩张的胆管、胆管梗阻段的征象及对周围软组织的浸润和转移。应作为梗阻性黄疸诊断的首选方法,在疑难病例中应结合其他影像学方法诊断。     

Interventionen bei benignen Gallengangstenosen

Due to their potential for serious consequences, even including biliary liver cirrhosis, benign biliary strictures pose a considerable diagnostic and therapeutic challenge. In addition to inflammatory disease or an acute liver injury, iatrogenically caused biliary strictures following hepatobiliary surgery represent in 95% of cases the main cause for all benign entities. The diagnosis should be determined noninvasively with magnetic resonance cholangiopancreaticography (MRCP). Invasive techniques such as ERCP or percutaneous transhepatic cholangiography (PTC) should be reserved for unclear cases and first performed before the scheduled intervention. Depending on the site and cause of the stricture, surgical and interventional procedures are employed in the treatment of biliary strictures. The best results are obtained in short-segment strictures of the main bile duct. Interventional methods such as balloon dilation and/or stent application with concomitant drain insertion achieve patency rates of up to 75% after 5 and 55% after 12 years with a total complication rate of 5-8%. Due to the fact that most of the cases involve cicatricial fibroses, predisposition for recurrence of biliary strictures after interventional therapy can be very high, ranging up to 66% depending on the localization.     

胆囊癌的CT表现研究(附22例分析)

目的:研究胆囊癌的CT表现。方法:回顾性分析22例经手术病理证实的胆囊癌的CT表现,测量9例胆囊癌静脉期和延迟期CT值,并与同层面正常肝实质静脉期和延迟期CT值进行比较。结果:12例表现为胆囊区肿块,4例表现为腔内结节,6例表现为胆囊壁不规则增厚。肝脏侵犯8例,肝内转移3例,腹膜后淋巴结转移4例。胆道系统扩张8例。胆囊癌较正常肝实质延迟期CT值下降缓慢,表现为"强化持续"。结论:CT扫描可以明确胆囊癌的存在以及周围侵犯和转移情况。     

CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree

Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde cholangiopancreatography for the pre- and post-operative assessment of biliary disease. This article describes anatomical variants of the biliary tree with surgical significance, followed by comparison of CT and MR cholangiographies. Drip infusion cholangiography with CT (DIC-CT) enables high-resolution three-dimensional anatomical representation of very small bile ducts (e.g. aberrant branches, the caudate branch and the cystic duct), which are potential causes of surgical complications. The disadvantages of DIC-CT include the possibility of adverse reactions to biliary contrast media and insufficient depiction of bile ducts caused by liver dysfunction or obstructive jaundice. Conventional MRCP is a standard, non-invasive method for evaluating the biliary tree. MRCP provides useful information, especially regarding the extrahepatic bile ducts and dilated intrahepatic bile ducts. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRCP may facilitate the evaluation of biliary structure and excretory function. Understanding the characteristics of each type of cholangiography is important to ensure sufficient perioperative evaluation of the biliary system.