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目的探讨自身免疫性肝炎(autoimmune hepatitis,AIH)致肝硬化的MRI诊断特点,以提高其诊断准确性。资料与方法回顾分析经临床确诊为AIH所致肝硬化患者7例,所有患者均按肝功能Child-Pugh分级(A级2例,B级2例,C级3例)并行MR T1WI、T2WI、扩散加权成像(DWI)及动态增强扫描。2例行肝穿刺活检,2例经1～2年随访,分析其MRI表现并与病理、肝功能分级对照。结果 (1)肝脏形态学改变:5例(ChildB、C级)全肝萎缩。3例(Child C级)肝脏内可见多个大小不等结节形成,可见结节融合,横径最大约为53mm,结节信号表现多样,但在DWI上均呈低信号,部分结节增强后可见强化,随访后强化信号消失。(2)继发门静脉高压改变:除1例(Child A级)无明显继发门静脉高压表现,余6例门静脉主干增粗、胃底及脾静脉延长迂曲。7例脾均增大,2例(Child C级)脾内可见含铁血黄素沉积,其中1例伴有脾梗死。3例(Child C级)腹腔积液形成。(3)其他:1例(Child A级)肝内胆管轻度扩张。所有患者均无淋巴结改变。肝穿刺病理结果符合AIH致肝硬化表现。结论 AIH致肝硬化的MRI表现特点为:随着肝功能Child-Pugh分级的加重,肝脏形态学及继发门静脉高压改变随之加重;全肝萎缩,肝左外叶及尾状叶的代偿性增大少见;肝硬化结节形态、信号改变多样,癌变罕见;可伴有肝内胆管扩张;较少伴有淋巴结肿大。MRI可作为AIH致肝硬化的有效检查手段。
Objective To investigate the diagnostic features of MRI in cirrhosis caused by autoimmune hepatitis (AIH) in order to improve its diagnostic accuracy. Materials and Methods Retrospective analysis of 7 cases of liver cirrhosis clinically diagnosed as AIH, all patients according to liver function Child-Pugh grading (A grade 2 cases, B grade 2 cases, C grade 3 cases) parallel MR T1WI, T2WI, Diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging. Two patients underwent liver biopsy, and 2 patients were followed up for 1 to 2 years. The MRI findings were analyzed and compared with pathological and liver function grading. Results (1) Liver morphological changes: 5 cases (ChildB, C grade) of total liver atrophy. In 3 cases (Child C grade), multiple nodules of different sizes were seen in the liver. The nodules could be seen to be fused with the largest diameter of about 53 mm. The nodules showed various signs but showed low signal on DWI and enhanced nodules Can be seen after strengthening the signal disappeared after follow-up. (2) Secondary portal hypertension changes: Except one child (Grade A), there was no significant secondary portal hypertension, while the remaining six cases of portal vein thickening, gastric fundus and splenic vein prolonged tortuosity. Seven cases of spleen were enlarged, 2 cases (Child C grade) spleen hemosiderin deposition was found, of which 1 cases accompanied by splenic infarction. Three cases (Child C grade) formed ascites. (3) other: 1 case (Child A grade) intrahepatic bile duct mild dilatation. All patients had no lymph node changes. Liver biopsy results in line with AIH caused by cirrhosis. Conclusions MRI features of liver cirrhosis caused by AIH are as follows: With the grading of Child-Pugh liver function, the changes of liver morphology and secondary portal hypertension will aggravate. The atrophy of total liver atrophy, left external lobe and caudate lobe Increased rare rare; liver cirrhosis nodules, diverse signal changes, rare cancerous; may be associated with intrahepatic bile duct dilatation; less associated with lymph nodes. MRI can be used as an effective measure of liver cirrhosis caused by AIH.