肝脏泡状棘球蚴病的多层螺旋CT影像特征

目的分析肝泡状棘球蚴病的多层螺旋CT（MSCT）表现特点，评价MSCT的诊断价值。方法26例病人全部进行MSCT检查，原始数据经过图像高级处理工作站行冠矢状面重建和血管成像处理，MSCT所见与手术病理结果行对照分析。结果26例共检出28个病灶，所有病例均表现为不均质的低密度肿块，平扫时界线欠清而增强后境界清楚；26例的主要影像学特征还包括病灶内出现数量不等的钙化（26／26）；中心液化坏死（20／26）；边缘区域的小囊泡征象（15／26）；病灶所在的肝脏边缘有收缩凹陷（12／26）和健叶代偿性肥大（18／26）。位于肝门区或者累及肝门的病灶伴有胆管扩张（9／26），脾肿大（12／26），腹水（1／26）。MSCT血管成像（MSCTA）显示24例伴有肝脏血管分支的受压、推移、包绕或者闭塞改变。MSCTA所见与手术结果比较，对肝动脉（HA）评价的敏感度、特异度和阳性预测值分别为88％、96％和93％；对门静脉（PV）分别为95％、100％和95％；而对肝静脉（HV）分别为96％、86％和96％。结论MSCT能够全面地显示肝脏泡状棘球蚴病特征性图像和血管侵犯的状况，为正确的诊断和合理的治疗提供了可靠的影像学依据。

Evaluation of hepatic alveolar echinococcosis with multi-slices spiral CT

Objective To analyze the multi-slices spiral CT (MSCT) findings of hepatic alveolar echinococcosis(HAE), and to evaluate the value of MSCT for diagnosis of HAE. Methods Twenty-six cases with HAE were scanning by MSCT. The raw data were transmitted to advanced workstation for reconstruction imaging. Correlated studies were made between the CT features and pathology or other imaging results. Results Altogether 28 lesions were detected. They all revealed as heterogeneous hypodense mass with ill-defined boundary in plain CT but were easily being distinguished from surrounding parenchyma after contrast medium injection.Characteristics of the lesions include different amount of calcification (26/26), liquefied necrosis in center area (20/26), peripheral lacunae or alveolar signs (15/26), compensatory hypertrophy of healthy hepatic part (18/26) and the retraction in the involved hepatic lobe or segment (12/26). The lesions that located at or extended to hepatic hilum caused dilatation of intra-hepatic biliary ducts(9/26), splenomegaly (12/26), and ascites (1/26). MSCT angiography (CTA) depicted signs of abnormalities of hepatic vessels such as compression, displacement, encasement and occlusion. Compared with findings of operation, the sensitivity, specificity and positive prediction value of CTA for evaluating the hepatic artery system disorders were 88%, 96% and 93%, respectively; and for portal venous system were 95%, 100% and 95%, respectively; while for hepatic venous system were 96%, 86% and 96%, respectively. Conclusion MSCT is able to comprehensive display the CT features and vessels complication of HAE. It provides reliable imaging for both accuracy diagnosis and proper treatment of the disease.