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目的探讨多层螺旋CT(MSCT)在肝泡状棘球蚴病的诊断及可切除性评估中的价值。方法回顾性分析2013年12月至2015年5月期间四川大学华西医院收治的28例经手术及病理学检查证实为肝泡状棘球蚴病患者的CT表现,并将MSCT所见与手术病理结果行对照分析。结果 28例共检出肝内病灶45个,主要表现为形态不规则、不均质的浸润性低密度影,伴高密度钙化及更低密度的坏死区,平扫边界模糊而增强后界限清楚,增强扫描病灶未见明显强化,部分边缘及分隔轻度强化。MSCT血管三维重建图像显示血管受累表现为肝内血管的推挤、受压、移位、狭窄、包绕或中断。MSCT所见与手术结果比较,对判断血管受累的敏感度及特异度,肝动脉为67%及97%,门静脉为83%及93%,肝静脉为84%及91%,下腔静脉为85%及100%。12例MSCT评估认为可根治切除者与手术结果判断基本一致,16例MSCT评估不能根治切除中仅2例通过对受累的大血管及胆管进行部分切除、修复和重建得以根治性治疗。结论 MSCT能对肝泡状棘球蚴病进行准确的术前诊断及显示血管受侵犯情况,对于评价可切除性及手术方式的制定具有重要价值。
Objective To investigate the value of multislice spiral CT (MSCT) in the diagnosis and resectability of hepatic alveolar hydatid disease. Methods The CT findings of 28 patients with alveolar hydatidosis confirmed by surgery and pathology from December 2013 to May 2015 in Huaxi Hospital of Sichuan University were analyzed retrospectively. The findings of MSCT and surgical pathology Results line control analysis. Results A total of 45 intrahepatic lesions were detected in 28 cases. The main manifestations were irregular, inhomogeneous infiltrative low density, high density calcification and lower density necrotic area. , No significant enhancement enhanced scan lesions, part of the edge and separated slightly enhanced. Three-dimensional reconstruction of MSCT images showed vascular involvement manifested as pushing, compression, displacement, stenosis, wrapping or interruption of intrahepatic vessels. The sensitivity and specificity of MSCT to determine vascular involvement were 67% and 97% for hepatic artery, 83% and 93% for portal vein, 84% and 91% for hepatic vein, and 85 for inferior vena cava % And 100%. 12 cases of MSCT assessment that the radical resection and surgical findings are basically the same, 16 cases of MSCT assessment can not be cured in only 2 cases by the affected part of the large vessels and bile resection, repair and reconstruction of radical treatment. Conclusion MSCT can accurately diagnose hepatic alveolar hydatid disease and show the invasion of blood vessels, which is of great value in the evaluation of resectability and surgical approach.