肝包虫病与肝囊肿CT表现比较*

目的 探讨使用256排CT检查在鉴别肝包虫病与肝囊肿方面的临床价值。方法 2017年4月～2020年11月我院诊治的肝囊肿患者77例和肝包虫病患者34例接受256排CT增强扫描检查,采用ELISA法检测血清抗囊液抗原抗体(EgCF)、抗头节抗原抗体(EgP)、抗囊液半纯化抗原抗体(EgB)和抗泡球蚴抗体(Em2)。结果 本组肝包虫病患者术前血液嗜酸性粒细胞计数为(0.3±0.1)×10⁹/L,显著高于肝囊肿患者【(0.1±0.1)×10⁹/L,P＜0.05】;肝包虫病患者血清抗EgCF抗体和抗EgB抗体阳性率分别为85.3%和61.8%,均显著高于肝囊肿患者【分别为31.2%和0.0%,P＜0.05】;增强CT扫描,肝包虫病患者肝内存在类圆形、圆形或分叶状囊性灶,囊壁钙化;在入组的111例患者中,CT检查将3例(2.7%)肝包虫病误诊为肝囊肿,1例(1.0%)肝包虫病被误诊为肝转移癌,2例(1.8%)肝囊肿被误诊为肝包虫病。结论 CT检查能很好地显示肝包虫病囊性病灶的影像学特征,对鉴别肝包虫病与肝囊肿有帮助,为临床治疗提供可靠的影像学依据。

Comparison of CT imaging in patients with hepatic echinococcosis and hepatic cysts

Objective The aim of this study was to explore the clinical value of 256-slice CT scan in differentiating hepatic echinococcosis from hepatic cysts. Methods 77 patients with hepatic echinococcosis and 34 patients with hepatic cysts were enrolled in our hospital between April 2017 and November 2020, and all underwent CT scan. Serum anti-cystic fluid antigen antibody (anti-EgCF antibody), anti-cephalomere antigen antibody (anti-EgP antibody), anti-cyst fluid semi-purified antigen antibody (anti-EgB antibody) and anti-echinococcus multilocularis antibody (anti-Em2 antibody) were detected by ELISA. Results Before surgery, the blood eosinophil count in patients with hepatic echinococcosis was (0.3±0.1)×10⁹/L, significantly higher than (0.1±0.1)×10⁹/L, P<0.05] in patients with hepatic cysts; serum anti-EgCF and anti-EgB positive rates in patients with hepatic echinococcosis were 85.3% and 61.8%, significantly higher than (31.2% and 0.0%, respectively, P<0.05) in patients with hepatic cysts; the CT scan showed hepatic round, round-like or lobulated cysts with calcified cyst walls in patients with hepatic echinococcosis, significantly different to that in patients with hepatic cysts; out of the 111 patients, the CT scan misdiagnosed hepatic echinococcosis as hepatic cysts in 3 cases(2.7%), as hepatic metastasis in 1 case (1.0%), and misdiagnosed hepatic cysts as hepatic echinococcosis in 2 cases (1.8%). Conclusion The 256-slice CT examination can display the characteristic imaging of hepatic echinococcosis lesions, which can help differentiating hepatic echinococcosis from hepatic cysts, and provide a reliable imaging evidence for management of patients with hepatic cysts.