不典型肝脓肿的CT诊断

目的:分析不典型肝脓肿的CT表现,分析和探讨其影像学特点。方法:回顾近年经临床或病理证实的12例不典型肝脓肿患者的CT资料,所有患者均行CT平扫及增强检查。结果:不典型肝脓肿CT平扫表现为低密度肿块,增强可见周围强化征、肿块缩小征、蜂窝状强化和延时强化。结论:不典型肝脓肿CT平扫无特征表现,增强扫描有一定特征性表现,有助于不典型肝脓肿的诊断。     

早期细菌性肝脓肿的CT诊断

目的 :分析早期肝脓肿在病变发展过程中的CT表现 ,提高早期肝脓肿的CT诊断水平。方法 :回顾性分析12例经手术病理及临床治疗证实的早期肝脓肿的CT表现 ,并与肝癌、肝转移瘤、肝血管瘤等进行比较。结果 :早期肝脓肿CT平扫为均匀或不均匀的低密度影 ,增强扫描CT表现因肝脓肿病变发展阶段不同而异 ,可出现斑片状强化、细网格征、蜂窝征、簇型征、持续强化征 ,病灶范围缩小。结论 :增强及延时CT扫描有助于提高对早期肝脓肿的诊断及鉴别诊断。     

不典型肝脓肿的CT诊断

目的　研究不典型肝脓肿的CT表现 ,重点是增强CT和动态增强CT表现。方法　回顾分析了 92例手术、穿刺抽吸或临床证实的肝脓肿病例的CT资料 ,92例均行CT平扫 ,65例行增强扫描 ,其中不典型CT表现的肝脓肿 2 6例。结果　不典型肝脓肿多见于细菌性肝脓肿的化脓性炎症期或脓肿形成初期 ,CT平扫多表现为低密度肿块 ,增强扫描可见 :(1)肿块缩小征 ;(2 )周围充血征 ;(3 )“簇状征” ;(4 )“花瓣征” ;(5 )延时强化征。结论　不典型肝脓肿CT平扫表现无特征性 ,增强扫描尤其是动态增强和延时扫描有一定特征性 ,可提高不典型肝脓肿诊断的准确性     

不典型肝脓肿的CT动态增强表现及相关病理

目的:探讨不典型肝脓肿的CT动态增强表现及其病理基础,提高对肝脓肿的诊断水平。方法:回顾分析经临床证实的12例不典型肝脓肿的临床资料及CT表现。结果:不典型肝脓肿的CT表现具有多样性:CT平扫病灶呈均匀或不均匀低密度区,形态呈类圆形,边缘模糊或较清楚。增强扫描动脉期病灶呈轻度强化,门静脉期病灶呈小环状、蜂窝状、花瓣状、网格状、簇状表现,夹杂不明显强化的低密度区,延时期病灶仍有强化表现。其多样的CT征象与肝脓肿所处时期密切相关。结论:螺旋CT动态多期增强扫描有助于不典型肝脓肿的诊断,对判断脓肿的病理过程和指导临床工作具有重要意义。     

肝段MRI异常信号对肝脓肿诊断的价值

目的 分析肝脓肿的MRI表现,特别是肝段MRI异常信号,探讨其在肝脓肿诊断中的价值。资料与方法 对经临床或手术病理证实的24例肝脓肿的41个病灶的MRI资料进行回顾性分析。结果2 4例肝脓肿,单发13例,其中单房7例,多房6例;多发脓肿11例。肝段性异常信号灶29个,均表现为T2WI高信号,其中4个病灶T1WI呈低信号,其余T1WI无异常信号;22个表现为楔形,7个为圆形,范围、大小不一。8例行增强MRI者中,5例平扫表现肝段性异常信号的病灶均呈肝段性强化。另有2例MRI平扫呈肝段性T2WI高信号灶,CT增强检查见动脉期一过性肝段性强化。无论MRI增强还是CT增强其强化形态和范围与平扫MRI肝段性异常信号一致。结论 肝段MRI异常信号是炎症导致门静脉分支狭窄、血流减少,肝动脉血流代偿性增加所致,对肝脓肿诊断有重要价值。     

肝内胆管脓肿的CT诊断

目的 :探讨肝内胆管脓肿的CT诊断和鉴别诊断。方法 :回顾性分析经临床、病理证实的 2 7例肝内胆管脓肿患者的CT表现及临床资料。结果 :2 7例均可见肝脓肿及胆源性病变表现。肝脓肿CT平扫表现为低密度肿块 ,单发圆形(8例 )、多房或簇状 (9例 )或不规则多发 (10例 ) ,增强扫描示脓肿实质部分明显强化 ,呈“肿块缩小征”6例 ,“周围充血征”8例 ,“簇状征”9例 ,“环靶征”仅 4例。胆源性病变CT表现包括胆管扩张、胆管壁增厚并明显强化 ,胆道积气及胆道结石等。结论 :CT扫描可发现肝脓肿及胆道病变 ,是临床诊断肝内胆管脓肿最可靠的影像学方法。     

肝脓肿的CT诊断

目的探讨肝脓肿的CT特征,提高诊断准确性。方法搜集我院经临床证实的有完整CT检查资料的肝脓肿15例,男9例,女6例,年龄29～72岁,平均52．2岁。所有病例均经CT平扫和增强扫描。结果15例共20个病灶,单发脓肿13例,多发病灶2例。20个肝脓肿中,11个平扫表现为肝内低密度、边缘模糊的占位病变,6个脓肿内含气体,伴周围胆管积气,3个为多房脓肿。多期动态增强扫描,表现为脓肿周边强化者15个,多环状强化2个,蜂窝状强化3个。结论肝脓肿在CT平扫及增强扫描像上具有特征性表现,CT增强扫描,特别是多期动态扫描可进一步提高肝脓肿的诊断准确性。     

肝脓肿的CT诊断

目的:探讨肝脓肿的CT特征,提高诊断准确性.材料和方法:收集本院经CT检查,并经临床、CT随访和(或)穿刺病理证实的肝脓肿40例,男22例,女18例,年龄范围27～86岁,平均64.05岁.分析其临床表现、CT形态学特征.结果:40例66个脓肿中,单发脓肿28个(例)(70%),其中12个(42.86%)为单房脓肿,CT平扫均表现为肝内低密度、边缘模糊的占位病变,病灶最大达12cm×13em×10cm,最小为1.5cm×1cm×1cm;16个(57.14%)为单发多房脓肿,余12例(30%)为多发脓肿(发生于同一肝叶的7例,累及两叶以上者5例).66个脓肿中形态不规则者25个(37.88%),33个(50.00%)呈类圆形.8例为蜂窝状脓肿,表现为"簇状征".脓肿内含气或液气者4个(例).32例(62个病灶)又做了CT增强扫描,表现为脓肿边缘强化者45个(72.58%),多环形强化者12个(19.36%),不规则强化者5个(8.06%).5例行多期动态增强扫描,其中2例出现较具特征性的一过性"肝段强化"征象.结论:肝脓肿的CT平扫及增强表现多形性.当肝脓肿具"簇状征"和"肝段强化"征象时,与肝内其他占位病变可资鉴别.C T增强扫描,特别是多期动态扫描可进一步提高肝脓肿的诊断准确性,应常规采用.     

肿块型肝内胆管细胞癌与肝脓肿的CT特征及鉴别诊断

目的：探讨肿块型肝内胆管细胞癌(ICC)和肝脓肿的 CT 表现及误诊原因分析,减少误诊率。方法回顾分析经临床手术、穿刺病理证实的肿块型 ICC 21例和肝脓肿20例影像资料,其中10例肿块型 ICC 术前影像误诊为肝脓肿,41例均行 CT 平扫和三期增强扫描。结果边缘强化环不规则、延迟不规则斑片状或片絮状强化、动脉血管穿行或环绕病灶、肝被膜凹陷征、合并肝内胆管软组织结节、肝内胆管扩张、肝门区和腹膜后淋巴结肿大、门静脉受侵狭窄或闭塞提示肿块型 ICC 可能性大。形态规则、环壁光滑完整、环壁周围环状水肿征、延迟分隔状或多环状强化、肿块缩小征、环内低密度类似液性提示肝脓肿可能性大。异常灌注肝脓肿出现几率高且明显。结论肿块型 ICC 与肝脓肿的影像特征有相似之处,又有各自的特征性表现,结合多个征象综合分析有利于正确诊断。     

肝脓肿的CT分析(附78例报告)

目的探讨肝脓肿的CT表现特征,着重讨论其与肝癌(HCC)的鉴别诊断.方法将78例已证实的肝脓肿CT图像与手术病理所见及同期证实的一组肝癌CT图像对照分析.结果25例无病灶周边"双靶征”或"牛眼征”及病灶内均匀液化坏死和积气等典型肝脓肿CT表现.53例有中央均匀液化坏死、病灶周边"双靶征”及病灶内积气等特征性CT表现.不典型肝脓肿多为早期肝脓肿,CT平扫表现无特征性,增强扫描可见周边多囊征,边缘锐利征,蜘蛛征,持续强化征.结论肝脓肿特征性和非特征性CT表现,有助于肝脓肿的诊断和鉴别诊断.     

Low mechanical index contrast-enhanced sonographic findings of pyogenic hepatic abscesses

OBJECTIVE: Low mechanical index contrast-specific sonography is a new technique that uses the harmonic capabilities of second-generation contrast agents to produce real-time contrast-enhanced gray-scale images. We describe the contrast-specific sonographic findings of pyogenic hepatic abscesses. CONCLUSION: Contrast-specific sonography was used to assess eight cases of aspiration-confirmed pyogenic liver abscesses. All cases were correlated with multiphasic helical CT findings. Continuous sonographic exploration allowed recognition of morphologic details not detectable on CT images. Contrast-specific sonograms showed features including rim enhancement, arteries along abscess margins and internal septa, dense and persistent septal enhancement, absent microcirculation in fluid and necrotic components, transient arterial phase hypervascularity around abscesses, and portal phase hypovascularity around abscesses. This constellation of findings is suggestive of liver abscess.     

Complications of pyogenic hepatic abscess: computed tomography and clinical features

The purpose of this pictorial essay is to describe the computed tomography (CT) and clinical findings of the various complications of pyogenic hepatic abscesses. The CT and clinical findings of 81 patients who had a confirmed pyogenic hepatic abscess were analyzed retrospectively. Of the 81 patients, 21 cases of various complications from the pyogenic hepatic abscesses were encountered in 17 patients (21%). Two types of complications were observed in 4 patients. These complications included rupture into the pericardial cavity (n = 1), pleuropulmonary complications (n = 11), rupture into the gastrointestinal tract (n = 1), rupture into the peritoneal cavity (n = 3), rupture into the retroperitoneum (n = 1), vascular complications (n = 3), and biliary complications (n = 1). A knowledge of these complications is important for an early diagnosis and appropriate management.     

肝脓肿的CT特征探讨

目的　探讨不同病因肝脓肿的CT表现特征。方法　回顾性分析 5 4例肝脓肿CT表现及临床资料。结果　肝脓肿的CT表现均为较正常肝组织为低的低密度灶 ,肝脓肿的环靶征 ,簇集征和脓腔内气体为CT诊断的特征性征象。肝脓肿的病因诊断包括化脓性肝脓肿 ,胆源性肝脓肿 ,阿米巴性肝脓肿和肝癌经肝动脉途径栓塞化疗 (TAE)术后癌灶脓肿等CT征象有一定的特征。结论　CT特征不仅可明确肝脓肿的定位诊断 ,并可作出导致肝脓肿的性质和病因方面的诊断     

肝脓肿的CT表现

本文分析２６例肝脓肿（化脓性２４例、阿米巴２例）的ＣＴ表现。脓肿直径＜２０ｍｍ多发小脓肿７例，单发脓肿１４例，复杂多间隔脓肿５例。作者认为脓肿内积气、＂簇状征＂和＂双靶征＂为肝脓肿特征性表现。对延迟扫描在肝脓肿诊断和鉴别诊断中的作用进行了探讨。本研究表明ＣＴ诊断肝脓肿具有重要的临床价值。     

不典型肝脓肿多排螺旋CT影像表现及病理基础

目的：分析不典型肝脓肿多排螺旋CT影像表现及其病理基础,探讨其对不典型肝脓肿的诊断价值。方法回顾性分析27例不典型肝脓肿的病例资料,所有病例均行多排螺旋CT平扫及动态增强扫描。结果不典型肝脓肿多见于肝脓肿的化脓性炎症期或脓肿形成初期,肝脓肿病变发展具有个体化差异,平扫呈片状低密度病灶,或多房性低密度肿块,边界多不清晰,增强后可见相对典型征象。结论不典型肝脓肿多层螺旋CT动态增强后可显示特征性表现,大大提高了早期细菌性肝脓肿的诊断准确性。     

簇形征——化脓性肝脓肿的早期重要征象

目的：描述肝脓肿的ＣＴ表现，总结簇形征在肝脓肿的早期诊断中的作用。方法：回顾分析经证实的１７例肝脓肿的ＣＴ表现，并与霉菌性、结核性肝脓肿及肝转移瘤的ＣＴ表现进行了比较。结果：６例（占３５．３％）有小于２ｃｍ的多发性小脓肿，在ＣＴ上表现为簇形征。结论：簇形征是早期肝脓肿诊断的重要线索之一。     

Sonographic features of amebic and pyogenic liver abscesses: a blinded comparison

We blindly compared the sonographic findings in amebic (112 lesions) and pyogenic (30 lesions) liver abscesses. Two sonographic features were significantly more prevalent in amebic abscesses: the lesions had a round or oval shape and the lesions had an echogenicity that was lower than that of normal liver and were internally homogeneous on high-gain scans. Amebic abscesses were round or oval in 92 instances (82%), while 18 pyogenic abscesses (60%) (p less than .01) had these shapes. Fifty-nine (58%) of 101 amebic abscesses displayed low echogenicity and homogeneous internal echoes with high-gain settings compared with nine (36%) of 25 pyogenic abscesses (p less than .04). Despite these different sonographic patterns, image findings alone were inadequate in distinguishing pyogenic from amebic liver abscesses. However, when the sonographic findings were coupled with clinical and laboratory data, a correct diagnosis was possible in 83 (86%) of 96 patients with amebic abscess. It appears that, although some sonographic features of amebic abscess differ from those of pyogenic abscess, these differences are not sufficient to allow a specific diagnosis on the basis of sonography alone. Sonography can expedite abscess detection and, when coupled with clinical and laboratory data, can aid in differentiating pyogenic from amebic liver abscesses.     

CT of small pyogenic hepatic abscesses: the cluster sign

Of 36 consecutive patients with pyogenic liver abscesses evaluated by CT, five (14%) had multiple small abscesses less than 2 cm in size. The CT appearance of the small pyogenic abscesses was compared with that of 10 patients who had either fungal or mycobacterial abscesses and with that of 50 patients who had hepatic metastases. In all five patients who had small pyogenic abscesses, the abscesses appeared to cluster, or aggregate, in a pattern that suggested the beginning of coalescence into a single, larger abscess cavity (cluster sign). This cluster appearance was not seen in in any of the patients who had fungal or mycobacterial microabscesses. It was present in only one of the patients who had confirmed hepatic metastasis. Despite the small size of the abscesses, guided needle aspiration was successful in recovering pyogenic organisms in four of the five patients. In our experience, the presence of the cluster sign suggests that the lesions are pyogenic abscesses.