肝结核的CT表现

目的：报告７例肝结核并结合有关文献讨论肝结核的ＣＴ表现。材料和方法：报告的７例患者均经手术或肝穿病理证实。男３例，女４例；年龄２４～５８岁（平均５０岁）。其中包括粟粒型肝结核、结节型肝结核和结核性胆管炎三个病理类型。结果：（１）粟粒型肝结核ＣＴ表现为肝脏弥漫性肿大、密度减低或表现为肝脏肿大伴有多发性粟粒状低密度灶，增强扫描无明显强化。（２）结节型肝结核可表现为肝内局灶性低密度区，增强扫描可有周边性强化；亦可表现为肝内结节状混杂密度灶，其特点是病灶中心密度高，尤其是伴有“粉末”状钙化，周围密度低，增强扫描有轻至中度的环形强化。（３）结核性胆管炎罕见，沿胆管壁走行的钙化、管型结石可能是本病的特点。结论：粟粒型肝结核ＣＴ表现缺乏特征性，除非有结核病史或伴有其他脏器结核，否则ＣＴ不能做出正确诊断。结节型肝结核和结核性胆管炎的ＣＴ表现有一定的特征性，可提示肝结核的诊断。

CTmanifestationofhepatictuberculosis

Purpose:ToanalysetheCTmanifestationsofhepatictuberculosiswithreviewoflit-eratures.Materialsandmethods:CTscanwasperformedin7patientswithhepatictuberculosisin-cludinghepaticmiliarytuberculosis,nodulartypeofhepatictuberculosisandtuberculosischolangi-tis.Thesepatientsrangedinagefrom24to48years(meanage,50years);3weremalesand4werefemales,alprovedbybiopsyorsurgery.Results:TheCTfindingswere(1)Hepaticmiliarytuber-culosisshoweddifuseenlargementoftheliverwithhypodensityormiliarylow-densityfociintheliv-er.Therewerenoenhancementfolowingcontrastinjection.(2)Nodulartypeofhepatictuberculosisshowedfocallow-densitylesionwithperipheralenhancementaftercontrastadministration.Somele-sionsdemonstratedmixeddensitywithcentralhyperdensityandpowderycalcificationandperipherallow-densitywithanenhancingrim.(3)Tuberculosischolangitiswasrare,andcalcificationalongthecourseofthebileductswithcaststoneweresuggestiveofthediagnosis.Conclusion:CTmanifesta-tionsofhepaticmiliarytuberculosiswerenospecific,diagnosiscouldhardlybemadeonCTappear-ancesalonewithoutamedicalhistoryoftuberculosisandtuberculosischolangitishadcertaincharac-teristicfeatures,whichwerehelpfultosuggestthediagnosis.