肝窦阻塞综合征CT和MRI表现

目的观察肝窦阻塞综合征(HSOS)的CT和MRI表现。方法回顾性分析45例经临床或肝穿刺活检证实的HSOS患者的临床及影像学资料。结果41例患者接受CT检查,平扫显示20例肝脏增大,7例肝左叶及尾状叶增大,21例肝实质密度不均匀性减低,36例出现不同程度腹腔积液、2例胸腔积液;增强扫描31例肝实质不均匀强化,21例呈“地图状”强化,9例斑片状不均匀强化,1例轻微小片强化;门静脉期均表现为斑片状、“地图状”强化,延迟期强化范围进一步扩大;均未见胆管扩张及肝内外侧支血管形成。12例接受MRI检查,平扫均表现为肝内信号欠均匀,10例肝脏增大,5例下腔静脉肝后段受压变细,胆囊形态均正常;增强后肝实质强化不均,表现为片状强化减低区及异常强化灶,呈“地图状”。结论HSOS的CT和MRI表现具有一定特征性,有助于临床诊断。

CT and MRI features of hepatic sinusoidal obstruction syndrome

Objective To observe CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS). Methods Clinical and imaging data of 45 HSOS patients were retrospectively analyzed. Results Forty-one patients underwent CT examination. Plain CT showed liver enlargement in 20 cases, including enlargement of left lobe and caudate lobe in 7 cases. Decreased density of liver parenchyma was observed in 21 cases, different degrees abdominal effusion in 36 cases, and pleural effusion in 2 cases. Contrast-enhanced CT scan showed uneven enhancement of liver parenchyma in 31 cases, map-like enhancement in 21 cases, patchy uneven enhancement in 9 cases and minor enhancement in 1 case. Patchy map-like enhancement of the portal venous phase was detected in all patients, and the enhancement range further expanded during delayed phase. No bile duct dilatation nor angiogenesis of the medial and lateral hepatic branches was observed. Twelve patients underwent MR examination. Plain MRI showed uneven liver signals, the liver enlargement in 10 cases, and compressed and tapered posterior segment of inferior vena cava in 5 cases. No morphologic abnormality of gallbladder was found in 12 cases. Enhanced MRI showed uneven enhancement of liver parenchyma, and the reduced area of lamellar enhancement and abnormal enhancement foci were all map-shaped. Conclusion CT and MRI manifestations of HSOS have certain characteristics, which are helpful for clinical diagnosis.