华支睾吸虫病的超声诊断研究

目的 :探讨华支睾吸虫病肝脏超声表现及诊断价值。材料和方法 :对 5只经实验感染华支睾吸虫的犬 ,进行实验病理及超声图观察。结果 :解剖见肝内胆管壁增厚 ,胆管阻塞扩张 ,肝边缘部毛细胆管扩张相对显著 ,严重感染时见肝内病变广泛 ,肝被膜下胆管高度扩张 ,胆管、胆囊及胰管内有大量虫体。超声肝内见散在分布的小点片状 ,小“ =”样强回声及内径不等的液性回声带。胆囊内可见点状、沉积物样无声影弱回声灶。结论 :超声对华支睾吸虫病诊断有应用价值。     

华支睾吸虫肝病的CT检查价值

目的：评估华支睾吸虫肝病的ＣＴ检查价值，方法：回顾性对比分析了３２例华支睾吸虫肝病与３６例肝外胆道阻塞所致肝内胆管改变的ＣＴ表现，结果；华支睾吸虫病所致肝内胆管改变特征是胆管扩张由周边小胆管向肝门区发展及Ⅲ级以下胆管扩张，特别是被膜下小胆管扩张（Ｐ〈０．０１），肝外胆管无扩张或以度扩张（Ｐ〈０．０１），肝内胆管扩张的形态在同部位其改变二者无显著性差异。结论：ＣＴ能清楚地显示华支睾吸虫肝病所致肝内管     

肝华支睾吸虫病CT诊断

目的：分析肝华支睾吸虫病的ＣＴ表现。方法：搜集经粪便检查证实的肝华支睾吸早 ２８例,其中男２３例,女５例,ＣＴ平扫１８例,增强扫描１０例。结果：２８例的ＣＴ表现均见肝内胆管扩张,肝外胆管不扩张。结论：结果表明,肝华支睾吸虫病结合临床ＣＴ检查有助于诊断。     

华支睾吸虫病368例B超检查肝脏的临床分析

目的：探讨B超在华支睾吸虫病诊断中的应用价值。方法：采用B起检查368例华支睾吸虫病患者肝胆有无异常。结果：368例华支睾吸虫病患者B超检查，发现肝胆异常者320例，符合疾病的病理、生理改变。结论：B超诊断华支睾吸虫病县有重要的价值。     

华支睾吸虫肝病的CT诊断：附139例报告

作者分析了１３９例华支睾吸虫肝病患者的ＣＴ表现。发现其肝内胆管扩张可分为四型、细长枝型：肝内胆管呈管状扩张为主且长度大于６ｃｍ，３４例（２４．４６％）；小囊型：胆管以囊状扩张为主，２０例（１４．３９％）；细短枝型：胆管以管状扩张为主，但长度小于６ｃｍ，１２例（８．６３％）；混合型：兼具上述２种或３种改变，７３例（５２．５２％）。     

飞行员华支睾吸虫病一例

一、临床资料患者男性,46岁,运输机飞行员,飞行时间3000h。因体检时发现嗜酸性细胞增多1个月,于2010年4月人我院。患者在2010年3月疗养体检时,血常规嗜酸性细胞0．174,嗜酸性细胞计数1．8×10。／L。入院后查体：体温35．80C,心率78次／min,呼吸16次／min,血压120／80mmHg（1mm Hg=0．133kPa）。     

螺旋CT在先天性胆管扩张症中的诊断价值

目的探讨螺旋CT在先天性胆管扩张症的诊断价值。方法回顾性分析6例先天性胆管扩张症息者的CT资料，并和US、ERCP和手术结果进行对比分析。结果所有病例的轴位、MPR和三维图像很好的显示肝内外胆管的解剖形态，清楚地显示扩张的肝内外胆管。其中Ⅰ型单纯性胆总管扩张3倒。Ⅳ肝内外胆管均扩张2例，Ⅴ型肝内胆管扩张（Caroli’s病）1例。结论螺旋CT可以很好的显示扩张的肝内外胆管的形态、部位以及周围组织结构。能为临床提供有价值的诊断信息，为手术提供可靠的依据。     

先天性胆管扩张症的CT诊断（附六例报告）

先天性胆管扩张症，又称先天性总胆管囊肿，文献上虽有报告，但利用CT检查此病国内尚未报道，我们自1985年以来经CT诊断并经手术及病理证实共6例，现报告如下。     

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。     

Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.     

肝吸虫病致肝内胆管及肝实质改变的CT表现

目的　探讨肝吸虫病致肝内胆管及肝实质改变的CT表现及其与临床症状和体征的关系。方法　收集 113例肝吸虫感染患者的临床及CT资料 ,对肝内Ⅱ、Ⅲ级胆管扩张进行分级。结果　肝内Ⅱ、Ⅲ级胆管分支直径轻微扩张 2 4例 ,轻度扩张 2 2例 ,中度扩张 31例 ,重度扩张 36例。无明显临床症状和体征者肝内胆管为轻微或轻度扩张。腹痛、畏寒、发热、黄疸及有并发症者以中、重度扩张为主 ;肝内胆管结石与胆管扩张无明显关系。 5例肝内胆管扩张伴肝实质小片状或小结节状低密度灶。结论　肝被膜下小胆管扩张为肝吸虫病的主要CT表现 ;肝内胆管扩张伴肝实质小片状或结节状低密度灶考虑肝吸虫病致肝实质炎性肉芽肿的可能 ;临床症状和体征明显程度与胆管扩张程度有关。     

肝胆管囊腺癌的螺旋CT诊断

目的探讨肝胆管囊腺癌的螺旋CT影像特征及鉴别诊断。方法回顾性分析4例经病理证实的肝胆管囊腺癌的CT表现,并复习文献。结果肝胆管囊腺癌的CT表现为单房或多房囊性病变,囊壁厚薄不均,有壁结节,周围可有卫星灶及远端胆管扩张。结论螺旋CT是诊断肝胆管囊腺癌的有效方法。     

Imaging Findings of Intrahepatic Bile Duct Adenoma (Peribiliary Gland Hamartoma): a Case Report and Literature Review

Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur.     

肾集合管癌的CT表现及诊断价值

目的探讨肾集合管癌的CT表现及其诊断价值,提高对本病的认识。方法结合文献回顾性总结并分析6例肾集合管癌的临床表现及影像学、病理学特征。5例行CT平扫及增强扫描,1例患者仅行CT平扫。结果6例中男3例,女3例,肿瘤位于左肾3例,右肾3例;肿瘤直径3～10 cm,平均5.8 cm;累及肾皮质和髓质者2例,同时累及肾皮质、髓质及肾盂者4例;平扫肿块呈实性成分者2例,囊实性混杂成分者4例;增强扫描肿块多呈轻中度强化;4例肾脏轮廓改变;4例肿瘤内可见钙化;肾门周围淋巴结转移者5例,肺转移1例,左侧胸壁转移者1例,腰骶椎椎体转移1例;术前诊断为肾癌者5例,肾淋巴瘤1例。结论肾集合管癌的CT表现具有一定的特征,起源于髓质、增强扫描轻中度强化并且呈浸润性生长的肿瘤应考虑到该病可能。     

恶性胆道梗阻的磁共振胰胆管造影诊断

目的 评价磁共振胰胆管造影（MRCP）对胆道恶性梗阻性疾病的诊断价值。材料与方法 43例恶性胆道梗阻患者（胆管癌15例,壶腹癌4例,胰头癌10例,转移性癌10例,原发性肝癌4例）行MRCP检查,结合PTC、ERCP检查、手术、病理结果、临床资料进行综合分析。结果 43例患者MRCP检查均一次成功,胆管及扩张胰管显示满意,定位诊断准确率为100％、定性准确率为83．7％。肝门区癌肿MRCP表现为肝门区不规则或类圆信号缺损,肝内胆管扩张以肝门区为中心呈“枯枝”状或“蟹足”样扩张;肝外胆管癌胆管断端呈模形或“鸟嘴”样截断;壶腹癌胆管断端呈横形、“鸟嘴”样或“鼠尾”状截断;胰头癌胆管断端呈“鸟嘴”样或“鼠尾”状截断,90％（9／10）伴“双管征”;转移性癌肿MRCP表现与转移部位有关;转移至肝门附近与肝门区癌肿相似,肝外转移者与相应部位胆管癌、胰头癌相似,常规MRI可见明显转移肿块或淋巴结。结论 MRCP是胆道恶性梗塞影像学检查的有效补充手段,可为恶性胆胰肿瘤术前可切除性提供评价,对不可切除的癌肿行介入治疗提供参考。     

螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病

目的　探讨螺旋CT胰胆管阴性成像 (N CTCP)对胆管高位梗阻的评估能力。资料与方法　 4 0例胆管高位梗阻病例 (其中 15例作过PTC或ERCP检查 )使用血管对比剂 (阴性对比剂 )作了增强扫描。扫描数据经工作站后处理 ,用最小强度投影 (MinIP)和表面遮盖显示 (SSD)法获得N CTCP图像。采用盲法 ,分别就N CTCP图像质量、胆管显示能力、梗阻定位和定性诊断作出评价。结果　 4 0例中 ,N CTCP成功率达 95 .0 % (38/ 4 0 )。 38例中 ,MinIP像显示胆管能力平均为 4 .4度 ,SSD像 4 .1度 ;15例PTC或ERCP显示胆管能力平均为 3.0度 ,与对应MinIP、SSD像比较均有显著差异 (P <0 .0 1;P <0 .0 5 )。对照病理等结果 ,MinIP、SSD像定位准确率均为 97.4 % (37/ 38) ,定性准确率分别为 81.6 % (31/ 38)、73.7% (2 8/ 38)。结论　N CTCP定位准确率高 ,显示扩张胆管能力强 ,可为临床治疗提供较充分的信息     

纤维胆道镜联合钬激光碎石治疗术后难取性胆管残留结石

目的总结经胆道镜联合钬激光碎石治疗术后难取性胆管残留结石的经验,探讨其效果和安全性。方法回顾性分析术后胆管残石患者108例,其中单发结石48例,多发结石60例,经纤维胆道镜导入激光光纤,光纤直径230μm。之后采用能量800～1200mJ,频率8Hz,功率6．4～9．6W的钬激光碎石取石治疗。术后随访6～12个月。结果经过1～7次胆道镜下钬激光碎石治疗,108例患者术后胆管残留结石全部取出,未出现胆道出血、胆漏、感染等明显并发症;随访6～12个月,87％患者无结石复发。结论经胆道镜钬激光碎石术是目前治疗术后胆管难取性残留结石的一种安全、有效的方法。     

胆总管下端结石的CT诊断

目的分析胆总管下端不同类型结石的CT表现、诊断和鉴别诊断.材料与方法回顾性分析47例经手术或临床治疗证实的胆总管下端结石的CT资料.结果CT能较准确地显示胆总管下端结石的密度、形态、位置等,诊断正确率为87.2%,并依结石形态、密度的不同分为高密度结石、泥沙样结石、软组织密度结石、混合密度结石.结论螺旋CT是目前诊断胆总管下端结石非损伤性检查中最好的方法之一.     

Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT)

PURPOSE: Suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract. This disease represents a true emergency. The purpose of this study was to compare the computed tomography (CT) findings between acute calculous suppurative and nonsuppurative cholangitis and to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: Fifteen patients with acute suppurative cholangitis were enrolled in this study. Findings at endoscopic retrograde cholangiopancreaticography (ERCP) were the standard of reference for suppurative cholangitis. To compare the findings of suppurative cholangitis with those of nonsuppurative cholangitis, 35 patients with nonsuppurative cholangitis were randomly selected. The following findings were evaluated: the presence of papillitis, the presence of stones in the ampulla, the presence of intrahepatic stones, the presence of early inhomogeneous enhancement of the liver, the degree of bile duct dilatation, the degree of bile duct wall thickening and presence of cholecystitis. Sensitivity and specificity for each of the individual findings were calculated. Statistical analyses were performed the Pearson chi(2) test, Fisher's exact test and the Mann-Whitney U test. RESULTS: Papillitis showed the highest specificity 86% with 60% sensitivity. Marked inhomogeneous enhancement of the liver during the arterial phase showed 80% specificity with 60% sensitivity. In multivariate logistic analysis, papillitis and marked early inhomogeneous enhancement of the liver were the most significant predictors of acute suppurative cholangitis. The combination of these two CT findings improved specificity (97% specificity) for the diagnosis of suppurative cholangitis. CONCLUSION: Papillitis and marked early inhomogeneous enhancement of the liver were found to be the most discriminative CT findings for the diagnosis of acute suppurative cholangitis and the differentiation between suppurative and nonsuppurative cholangitis.