肝圆韧带与脐静脉曲张的影像鉴别诊断

目的 探讨肝圆韧带影像及脐静脉曲张影像的表现,提高鉴别两者的能力.方法 回顾性分析我院2015年2月至2016年1月间1643例行螺旋CT扫描+三期动态增强肝脏扫描(7例行MR平扫)患者影像资料,其中男性1023例,女性620例,年龄15~89岁,分析肝圆韧带及脐静脉曲张影像特点,比较两者在CT平扫及增强扫描时CT值的差异性.结果 共有1601例未见明确肝圆韧带显示,27例于肝左叶肝裂区见结节样边缘清晰稍低密度影,增强扫描三期呈轻度强化,程度始终低于周围肝实质;另有15例门静脉高压患者,可见左脐静脉曲张,增强扫描与门静脉同步强化,并与肝门静脉左支相通.肝圆韧带显影组与脐静脉曲张组在CT平扫时CT值比较差异无统计学意义(P>0.05),而动态增强扫描时,动脉期、门脉期及平衡期脐静脉曲张组患者的CT值显著高于肝圆韧带显影组,差异均有显著统计学意义(P<0.01).结论 提高对肝圆韧带影像的认识,有助于更好地与肝内其他异常密度影像进行鉴别诊断.

Imaging differential diagnosis of hepatic round ligament and varicomphaius

Objective To investigate the imaging features of hepatic round ligament and varicomphaius, and to improve the ability of identifying the two. Methods The image data of 1643 patients (including 1023 males and 620 females, aged 15-89 years) who underwent spiral CT scan and three-phase dynamic enhanced scanning of liver cases (7 cases of MR plain scan) in our hospital from February 2015 to January 2016 were retrospectively analyzed. The imag-ing features of hepatic round ligament and varicomphaius were analyzed. The difference of CT value between the two groups in CT plain scan and enhanced scan were compared. Results A total of 1601 cases showed no clear round liga-ment of liver. Twenty-seven cases in the left hepatic lobe of the liver showed clear nodular edge and slightly low density. Enhanced scan showed mild enhancement in the three phases, and the degree was always lower than the surrounding liv-er parenchyma. The 15 cases of patients with portal hypertension showed visible left umbilical varicose vein, synchro-nous enhancement in enhanced scan and portal vein, which is communicated with the left hepatic portal vein. There were no significant differences in CT value between the round ligament of liver group and varicomphaius group in CT plain scan (P>0.05). In the dynamic enhanced scanning, the CT value in arterial phase, portal venous phase and equilibrium stage of varicomphaius group was significantly higher than round ligament of liver group (P<0.01). Conclusion To im-prove the understanding of hepatic round ligament imaging is helpful to distinguish and diagnose the abnormal density shadow of the liver.