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     

恶性梗阻性黄疸的ERC写CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶怀胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

恶性梗阻性黄疸的ERCP与CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶性胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

肝门部胆管癌影像学诊断

本文对５６例经手术和病理证实的肝门部胆管癌进行了影像学回顾性分析，直接法胆道造影（ＤＣ）表现征象可分为胆道梗阻、狭窄、息肉样变和右肝管狭窄伴左肝管梗阻。ＵＳ显示肝内胆管的扩张，肝门区低回声占位，胆管内低回声肿块，门静脉癌栓。ＣＴ可表现，肝内胆管扩张，肝门区软组织密度肿块，肝门区肿块有增强，胆囊变小或萎缩，左肝萎缩和右肝增大，作者认为：ＤＣ加上ＵＳ或ＣＴ是诊断肝门区胆管癌的首选方法。     

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。     

Klatskin瘤的CT诊断

本文报告１７例Ｋｌａｔｓｋｉｎ瘤的ＣＴ诊断。其中１３例经手术病理证实为胆管腺癌,４例由ＣＴ,Ｂ超或ＰＴＣ等联合检查并结合临床诊断。本文提出本病的ＣＴ诊断要点：１．肝内特征性扩张的胆管树影。２．肝内异常钙化与肝内血管郁张;３．肝门部结构模糊不清;４．肝门部软组织肿块;５．肝脏的增生一萎缩复合改变;６．肝门部未见肝总管与总胆管扩张;７．胆管空虚与结囊结石。     

肝外胆管梗阻病变CT诊断的评价

目的：通过分析良恶性肝外胆管梗阻病变的ＣＴ表现，总结出有鉴别诊断意义的征象。材料与方法：复查分析经手术和病理证实、术前均做了ＣＴ检查的肝外胆管梗阻病变１１７例，良性３８例，恶性７９例。结果：肝外胆管远段梗阻，梗阻部胆管呈漏斗样改变，肝外胆管壁呈环形弥漫型增厚，肝内胆管呈竹节状或小囊状轻、中度扩张，梗阻部肿块内钙化，边界清楚对良性病变诊断有重要意义；肝外胆管中、近段梗阻或肝外胆管未显影者，梗阻部胆管呈截断型或突然狭窄型并伴肿块，肝外胆管壁呈环形局限型增厚，肝内胆管呈藤状或蟹足状中度或重度扩张，梗阻部肿块边界不清，其内可见坏死等征象，高度提示恶性病变。结论：良恶性肝外胆管梗阻病变均有其特征性的ＣＴ征象，注意观察胆管的形态改变，以及与周围组织结构关系，并紧密结合临床综合分析，有助于提高诊断准确性。     

胆道阻塞的CT诊断—与直接胆管造影的比较研究

本文对８２例手术病理证实的阻塞性黄疸作前瞻性ＣＴ诊断，并与直接胆道造影比较研究。发现胆管逐渐尖削，明显的肝外胆管壁环状增厚是良性阻塞可靠且特异的ＣＴ征象。肝内外胆管不一致扩张（内轻外重），扩张胆管腔内ＣＴ值大于２０ＨＵ对良性阻塞的判断有一定帮助。管突断伴或不伴肿块，胆管壁局根不规则增厚是恶性阻塞相对可靠且特异的ＣＴ征象。ＣＴ能清楚显示肝内胆管扩张及它们汇合处解部剖及变异。比较直接胆管造影，ＣＴ对肝     

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％）。     

胆管内生长型肝内胆管细胞癌的CT诊断

目的:探讨胆管内生长型肝内胆管细胞癌(IICC)的CT表现特征。方法:对手术及病理证实的11例IICC的临床及CT资料进行回顾性分析总结。结果:11例ICIG中4例为周围型,5例为肝门型,2例同时侵润肝门及肝内胆管(下称混合型)。肝叶或肝段肝内胆管扩张,伴有或不伴有胆管内乳头状肿块、无定形态结构或只有轻度的扩张胆管密度增高是IICC的CT特点,管内肿块的大小决定了其是否在CT表现出来。结论:IICC的CT表现具有一定的特征性,对提高本病的术前CT诊断的准确性有一定的价值。     

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。     

肝吸虫性胆管炎的CT表现与误诊分析

目的：探讨肝吸虫性胆管炎的CT表现特点及误诊原因。方法：本组48例临床表现急性胆管炎的肝吸虫病例行螺旋CT检查,并对照逆行性胰胆管造影加内镜下奥狄括约肌切开术和胆总管探查术结果进行回顾性分析。结果：肝内胆管扩张48例,末梢胆管囊状扩张38例;肝外胆管扩张32例和胆总管壁增厚12例,胆总管内高密度影6例;胆囊增大20例,胆囊内団状软组织影2例。本组15例术前CT误诊,其中误诊为胆管结石8例,因胆总管壁增厚并有强化而误诊胆总管下端癌4例和壶腹癌1例,误诊为肝内周围型胆管癌2例。结论：在肝吸虫疫区,当CT表现为胆管炎征象并伴有肝包膜下小胆管囊状扩张时,需要考虑吸虫所致。     

MR Imaging Findings of Clonorchiasis

Objective

The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis.

Materials and Methods

We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1- and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists.

Results

Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16(62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy.

Conclusion

MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.     

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.     

CT findings of clonorchiasis

Clonorchiasis is a snail-transmitted trematodiasis caused by Chinese liver fluke, Clonorchis sinensis. Forty-two patients with the disease were examined with CT. Seventeen patients had clonorchiasis alone, and 25 patients had clonorchiasis with hepatobiliary malignancies (20 cholangiocarcinomas, four hepatocellular carcinomas, one carcinoma of the ampulla of Vater). In three of the 17 patients with clonorchiasis alone, the CT scans were normal. In 14 patients (82%), CT showed diffuse, minimal, or mild dilatation of the intrahepatic bile ducts. None of the patients had marked dilatation. The extrahepatic biliary tree was normal in all 17 patients. All 25 patients with clonorchiasis and hepatobiliary malignancies had diffuse dilatation of the intrahepatic bile ducts on CT, including 18 patients with minimal or mild dilatation and seven patients with marked dilatation. All seven patients with marked dilatation had extrahepatic biliary malignancies. Clonorchis sinensis per se or thickening of the bile duct wall could not be recognized on CT scans. Additional abnormalities evident on CT included pyogenic liver abscesses in two patients and gallstones in five patients. The diagnosis of clonorchiasis can be suspected when CT shows diffuse, uniform, and minimal or mild dilatation of the intrahepatic bile ducts, particularly in the periphery of the liver, without evidence of extrahepatic biliary dilatation.     

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。     

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。     

Clonorchiasis: sonographic findings in 59 proved cases

Clonorchiasis is a parasitic disease of the bile ducts that occurs in endemic areas after ingestion of the raw flesh of freshwater fish. We analyzed the sonographic findings in 59 patients with clonorchiasis, suspected prospectively from sonographic findings and proved subsequently by demonstration of eggs in their stools. Diffuse dilatation of the small intrahepatic bile ducts with no or minimal dilatation of the large intra- and extrahepatic ducts was observed in all cases. The extrahepatic ducts were patent throughout in all except one case. This characteristic finding reflects diffuse intrahepatic bile duct obstruction and resultant proximal dilatation caused by an adult worm or aggregates of worms, as worms reside diffusely in the medium and small intrahepatic bile ducts. Cholangitis and multifocal periductal fibrosis with proximal dilatation may play an additional role. Increased echogenicity of the intrahepatic bile duct wall was present in 39 cases (66%), reflecting cholangitis and periductal fibrosis. In 17 cases (29%), floating or dependent, discrete, nonshadowing, intraluminal, echogenic foci caused by adult worms in the bile were demonstrated in the gallbladder. These echogenic foci were distinguished from stones because they were fusiform, weak in echogenicity, and floated with a change in position. Clonorchiasis should be considered when sonography discloses the characteristic pattern of bile duct dilatation with increased wall echogenicity and nonshadowing, discrete, echogenic foci in the gallbladder lumen.     

肝门部胆管癌CT与MRI的诊断价值

目的 探讨CT与MRI对肝门部胆管癌的诊断价值。资料与方法 回顾性分析18例经手术病理证实的肝门部胆管癌的CT与MRI表现,评价两种检查方法对病灶的显示情况及定位诊断的准确率。结果 CT与MRI对肝门部胆管癌的定位诊断准确率分别为88．89％、100％;18例肝门部胆管癌CT与MRI均表现为肝内胆管不同程度扩张;MBI示肝门部软组织肿块16例,胆管壁浸润2例,门静脉受侵10例,淋巴结肿大8例;而相应的CT显示为11、0、5和6例。结论 CT与MRI是检查肝门部胆管癌的有效方法,MRI在显示肝门部肿块大小、范围,沿胆管壁浸润,门静脉侵犯及淋巴结肿大方面比CT更有价值。     

肝内胆管细胞癌的多层螺旋CT诊断价值

目的:探讨肝内胆管细胞癌的CT表现,加深对肝内胆管细胞癌的认识。方法:回顾性分析14例经病理证实的肝内胆管细胞癌的CT影像学表现。结果:14例中8例边界模糊的类圆形低密度肿块,11例伴肝内胆管扩张,6例边界较清晰。增强扫描8例早期肿块周边呈不规则强化;4例周边呈环形或结节状明显强化;2例无明显强化;延时扫描所有病灶均延迟强化。结论:多层螺旋CT扫描显示肝内胆管细胞癌有一定的特征性,具有较高的诊断价值。