肝脓肿一过性异常肝灌注的MDCT表现及其意义

摘要

目的 探讨肝脓肿伴随的一过性肝灌注异常(THPD)的CT表现及其可能形成机制.方法 44例临床证实的肝脓肿病例纳入研究,男25例,女19例,年龄33～84岁,平均66岁;采用16层螺旋CT机完成平扫、动脉期和门脉期的三期扫描.动脉期为开始注射对比剂后约23～30 s,门脉期为约55～75 s.两位有经验的放射科医生共同回顾性分析所有图像.结果 共出现THPD18例(40.9 %),仅见于动脉期10例,同时见于动脉期和门脉期7例,仅见于门脉期1例.6例THPD明显大于病变,呈肝叶型分布,其余呈肝段、亚段或楔形分布,与血管性解剖一致.2例动脉期MIP显示肝动脉门脉瘘.结论 肝脓肿伴随的THPD有一定特点,有助于肝脓肿的诊断;多种机制造成THPD现象的发生.%Objective To explore the MDCT features and mechanism of transient hepatic perfusion disorder (THPD)in hepatic abscess.Methods Forty- four consecutive patients (25 male, 19 female; mean age: 66 years; range 33- 84 years) with hepatic abscesses were enrolled in our study.Unenhanced and contrast- enhanced scans were acquired in the arterial and portal venous phases at 23- 30 s and 55- 75 s after injection of contrast respectively using a GE Light Speed 16 MDCT scanner.Two experienced radiologists reviewed all images retrospectively.Results The THPD was found in 18 patients, with 10 only seen in arterial, 7 in both arterial and portal venous, and 1 only in portal venous phases.The extent of THPD with lobar distribution in 6 patients was larger than the size of abscesses.THPD in other patients was segmental or sub- segmental.Two hepatic arterio-portal fistulas were demonstrated in arterial phase with MIP.Conclusion There are some features of THPD in hepatic abscesses that are helpful for diagnosis.More than one mechanism may exist.