慢性病毒性肝炎的CT表面及与肝炎严重程度的关系
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摘要
[目的] 描述慢性乙型病毒性肝炎的各种CT表现,探讨其CT征象与肝炎严重程度、预后评估之间的相关性,评价CT检查在慢性病毒性肝炎中的应用价值。
[材料和方法] 按照纳入与排除标准,回顾性收集慢性乙型病毒性肝炎120例的全部临床与实验室资料,其中轻度肝炎34例,中度肝炎22例,重度肝炎26例,重症肝炎38例。全部病例均经标准化的螺旋CT增强双期扫描,并由两名熟练专业影像医师阅片,着重观察和记录肝脏本身、胆道系统、门静脉系统、上腹部淋巴结状态、腹腔/胸腔等的形态学改变,将上述CT征象与临床及实验室指标作相关分析。
[结果] 1、慢性乙型病毒性肝炎的异常CT表现包括:①肝脏质地不均、密度降低;②肝脏外形、轮廓不光滑;③肝脏内血管周围“晕环征”;④胆囊壁增厚和胆囊窝水肿;⑤脾脏增大;⑥腹腔淋巴结肿大、增多;⑦腹腔积液;⑧侧支循环建立等肝硬化表现;⑨继发胸部改变(胸膜增厚、
[Purpose] To investigate the CT manifestations of chronic viral hepatitis and to address the relationship between CT features and the severity of chronic viral hepatitis.[Materials and Methods] According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis were reviewed retrospectively. They were classified into mild (34 cases), moderate (22), severe hepatitis (26) and hepatitis gravis (38) respectively based on international standardized clinical criteria. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. CT images were interpreted by two experienced radiologists through consensus reading. The morphological changes of the liver, bile duct, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Correlation analysis was applied for the relationship of CT imaging features and the severity indices of chronic hepatitis.
[Results] (1) CT manifestations of chronic viral hepatitis were as follows: ?changes of the configuration and shape of the liver, ? changes of the density of the liver, ?intrahepatic perivascular lucency, ?thickening of gallbladder wall and edema of the gallbladder fossa, ?splenomegaly, ?enlargement of abdominal lymph nodes, ?ascites, ?abnormalities related to portal hypertension (collateral circulation), ?secondary thoracic changes (pleural and pericardial effusion). (2) There was some close association between certain CT features of chronic hepatitis and the clinical status of chronic hepatitis. With the progression and deterioration of chronic hepatitis, serum albumin level went down and value of ALT went up, the incidences of ? intrahepatic perivascular lucency, ?edema of the gallbladder fossa, ? enlargement of abdominal lymph nodes, ? ascites and ?secondary and thoracic changes increased markedly. Correlation between these CT manifestations and clinical severity of chronic viral hepatitis was of statistical significance.[Conclusions] Chronic viral hepatitis can demonstrate several abnormal findings on contrast-enhanced CT scanning. To certain extent, some CT features, such as intrahepatic perivascular lucency, edema of gallbladder fossa, enlargement of abdominal lymph nodes, ascites and secondary thoracic changes, can reflect the clinical severity of chronic viral hepatitis.
[材料和方法] 按照纳入与排除标准,回顾性收集慢性乙型病毒性肝炎120例的全部临床与实验室资料,其中轻度肝炎34例,中度肝炎22例,重度肝炎26例,重症肝炎38例。全部病例均经标准化的螺旋CT增强双期扫描,并由两名熟练专业影像医师阅片,着重观察和记录肝脏本身、胆道系统、门静脉系统、上腹部淋巴结状态、腹腔/胸腔等的形态学改变,将上述CT征象与临床及实验室指标作相关分析。
[结果] 1、慢性乙型病毒性肝炎的异常CT表现包括:①肝脏质地不均、密度降低;②肝脏外形、轮廓不光滑;③肝脏内血管周围“晕环征”;④胆囊壁增厚和胆囊窝水肿;⑤脾脏增大;⑥腹腔淋巴结肿大、增多;⑦腹腔积液;⑧侧支循环建立等肝硬化表现;⑨继发胸部改变(胸膜增厚、
[Purpose] To investigate the CT manifestations of chronic viral hepatitis and to address the relationship between CT features and the severity of chronic viral hepatitis.[Materials and Methods] According to the inclusion and exclusion criteria, the clinical data and laboratory information of 120 patients with chronic virus hepatitis were reviewed retrospectively. They were classified into mild (34 cases), moderate (22), severe hepatitis (26) and hepatitis gravis (38) respectively based on international standardized clinical criteria. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. CT images were interpreted by two experienced radiologists through consensus reading. The morphological changes of the liver, bile duct, portal venous system, lymph node of the upper abdomen, peritoneal cavity and pleural cavity were observed and noted. Correlation analysis was applied for the relationship of CT imaging features and the severity indices of chronic hepatitis.
[Results] (1) CT manifestations of chronic viral hepatitis were as follows: ?changes of the configuration and shape of the liver, ? changes of the density of the liver, ?intrahepatic perivascular lucency, ?thickening of gallbladder wall and edema of the gallbladder fossa, ?splenomegaly, ?enlargement of abdominal lymph nodes, ?ascites, ?abnormalities related to portal hypertension (collateral circulation), ?secondary thoracic changes (pleural and pericardial effusion). (2) There was some close association between certain CT features of chronic hepatitis and the clinical status of chronic hepatitis. With the progression and deterioration of chronic hepatitis, serum albumin level went down and value of ALT went up, the incidences of ? intrahepatic perivascular lucency, ?edema of the gallbladder fossa, ? enlargement of abdominal lymph nodes, ? ascites and ?secondary and thoracic changes increased markedly. Correlation between these CT manifestations and clinical severity of chronic viral hepatitis was of statistical significance.[Conclusions] Chronic viral hepatitis can demonstrate several abnormal findings on contrast-enhanced CT scanning. To certain extent, some CT features, such as intrahepatic perivascular lucency, edema of gallbladder fossa, enlargement of abdominal lymph nodes, ascites and secondary thoracic changes, can reflect the clinical severity of chronic viral hepatitis.
引文
1 中华医学会传染病与寄生虫病学分会和肝病学分会.病毒性肝炎防治方案.传染病信息 2000:13(4):141-150
2 Thomas L, Lawson M, Thorsen K, Erickson SJ, Perret RS, Quiroz FA, and Foley WD. Periportal halo: a CT sign of liver disease. Abdom Imaging 1993; 18: 42-46
3 Koslin DB, Stanley RJ, Berland LL, Shin MS, Dalton SC. Hepatic perivascular lymphedema: CT appearance. AJR 1988; 150: 111-113
4 Macrander SJ, Lawson TL, Foley WD, Dodds WJ, Erickson SJ, Quiroz FA. Periportal tracking in hepatic trauma: CT features. JCAT 1989; 13: 952-957
5 Matsui O, Kadoya M, Takashima T, Kameyama T, Yoshikawa J, Tamura S. Intrahepatic periportal abnormal intensity on MR images: an indication of various hepatobiliary disease. Radiology 1989; 171: 335-338
6 Wechsler RJ, Santiago JM, Needleman L, et al. The periportal collar: a CT sign of liver transplant rejection. Radiology 1987; 165: 57-60
7 Hammerman AM, Kotner LM, Doyle TB. Periportal contrast enhancement on CT scans of the liver. AJR 1991: 156: 313-315
8 郭金玉.病毒性肝炎病人合并胆道系统损害的超声诊断分析[J].中西医结合肝病杂志 2001:11(2):98—99
9 Federle MP, Moss AA, et al. Computer tomography of the body with magnetic resonance. Second edition. 1992: 1062-1063
10 Williams PL, Dysom M, et al. Gray's anatomy. 37th ed. London 1989: 827-828
11 Robert E, Michael B, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991; 180: 319-322
12 Aspestrand F, Mathisen O, Bergan A. Perivascular low attenuation zone at CT of liver transplants: a follow-up study. Acta Radiol 1991; 32: 244-246
13 顾明,徐元昌,何乾文.肝脏淋巴动力学异常改变的CT征象.实用放射学杂 志 1995,6;11(6):342-345
14 段建军,欧强,沙新平.肝炎和肝硬化病人胆囊超声改变的观察与分析.中国现代医学杂志 2003,7:13(14):67-68
15 杨炜,李山山.超声对慢性乙型肝炎肝门区肿大淋巴结的观察分析.中国超声诊断杂志 2004,5;4:289—291
16 Lyttkens K, Forseberg L, Hedestrom E. Ultrasound examination of lymph nodes in the hepato-duodenal ligament. Br J Radiol 1990; 63: 26-30
17 Cassani F, Zoli M, Baffoni L, et al. Prevalence and significance of abdominal lymphadenopathy in patients with chronic liver disease: an ultrasound study. J Clin Gastroenterol 1990; 12: 42-46
18 Lyttkens K, Prytz H, Forseberg L, Hedestrom E, Hagerstrand Ⅰ. Ultrasound, hepatic lymph nodes and primary biliary cirrhosis. J Hepatol 1992; 15: 136-139
19 Lyttkens K, Prytz H, Forseberg L, Hedestrom E, Hagerstrand Ⅰ. Ultrasound, hepatic lymph nodes and chronic active hepatitis. J Hepatol 1994;21:578-580
20 Dietrich CF, Viel K, Braden B, Caspary WF, Zeuzern S. Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C? Z Gastroenterol 2000; 38: 143-152
21 Soresi M, Bonfissuto G, et al. Ultrasound Detection of Abdominal Lymph Nodes in Chronic Liver Diseases. A Retrospective Analysis. Clinical Radiology 2003; 58(5): 372-377
22 任卫英,张顺财,胡德昌.血清甲胎蛋白、前白蛋白及总胆汁酸测定对慢性肝炎的诊断价值.Chinese Hepatology 2001:6(3):198-199
23 邹正升,辛绍杰,李保森等.胆碱酯酶、凝血酶原活动度及白蛋白与肝组织病理损害关系的研究.中华实验与临床病毒学杂志 2001:15(4):349—351
24 苏菲,刘家琴,李鸿宾.肝胆疾病的血清肝酶谱变化及其比较.疾病控制杂志 2001,6:5(2):173—174
25 陈文彬等.诊断学(第五版).人民卫生出版社 2001:394—404
26 Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: Diagnosis, Grading and Stagion. Hepatology 1994; 19: 1513
27 Soresi M, Carroccio A, Agate V, et al. Evaluation by ultrasound of abdominal lymphadenopathy in chronic hepatitis C. Am J Gastroenterol 1999; 94(2): 497-501
2 Thomas L, Lawson M, Thorsen K, Erickson SJ, Perret RS, Quiroz FA, and Foley WD. Periportal halo: a CT sign of liver disease. Abdom Imaging 1993; 18: 42-46
3 Koslin DB, Stanley RJ, Berland LL, Shin MS, Dalton SC. Hepatic perivascular lymphedema: CT appearance. AJR 1988; 150: 111-113
4 Macrander SJ, Lawson TL, Foley WD, Dodds WJ, Erickson SJ, Quiroz FA. Periportal tracking in hepatic trauma: CT features. JCAT 1989; 13: 952-957
5 Matsui O, Kadoya M, Takashima T, Kameyama T, Yoshikawa J, Tamura S. Intrahepatic periportal abnormal intensity on MR images: an indication of various hepatobiliary disease. Radiology 1989; 171: 335-338
6 Wechsler RJ, Santiago JM, Needleman L, et al. The periportal collar: a CT sign of liver transplant rejection. Radiology 1987; 165: 57-60
7 Hammerman AM, Kotner LM, Doyle TB. Periportal contrast enhancement on CT scans of the liver. AJR 1991: 156: 313-315
8 郭金玉.病毒性肝炎病人合并胆道系统损害的超声诊断分析[J].中西医结合肝病杂志 2001:11(2):98—99
9 Federle MP, Moss AA, et al. Computer tomography of the body with magnetic resonance. Second edition. 1992: 1062-1063
10 Williams PL, Dysom M, et al. Gray's anatomy. 37th ed. London 1989: 827-828
11 Robert E, Michael B, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991; 180: 319-322
12 Aspestrand F, Mathisen O, Bergan A. Perivascular low attenuation zone at CT of liver transplants: a follow-up study. Acta Radiol 1991; 32: 244-246
13 顾明,徐元昌,何乾文.肝脏淋巴动力学异常改变的CT征象.实用放射学杂 志 1995,6;11(6):342-345
14 段建军,欧强,沙新平.肝炎和肝硬化病人胆囊超声改变的观察与分析.中国现代医学杂志 2003,7:13(14):67-68
15 杨炜,李山山.超声对慢性乙型肝炎肝门区肿大淋巴结的观察分析.中国超声诊断杂志 2004,5;4:289—291
16 Lyttkens K, Forseberg L, Hedestrom E. Ultrasound examination of lymph nodes in the hepato-duodenal ligament. Br J Radiol 1990; 63: 26-30
17 Cassani F, Zoli M, Baffoni L, et al. Prevalence and significance of abdominal lymphadenopathy in patients with chronic liver disease: an ultrasound study. J Clin Gastroenterol 1990; 12: 42-46
18 Lyttkens K, Prytz H, Forseberg L, Hedestrom E, Hagerstrand Ⅰ. Ultrasound, hepatic lymph nodes and primary biliary cirrhosis. J Hepatol 1992; 15: 136-139
19 Lyttkens K, Prytz H, Forseberg L, Hedestrom E, Hagerstrand Ⅰ. Ultrasound, hepatic lymph nodes and chronic active hepatitis. J Hepatol 1994;21:578-580
20 Dietrich CF, Viel K, Braden B, Caspary WF, Zeuzern S. Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C? Z Gastroenterol 2000; 38: 143-152
21 Soresi M, Bonfissuto G, et al. Ultrasound Detection of Abdominal Lymph Nodes in Chronic Liver Diseases. A Retrospective Analysis. Clinical Radiology 2003; 58(5): 372-377
22 任卫英,张顺财,胡德昌.血清甲胎蛋白、前白蛋白及总胆汁酸测定对慢性肝炎的诊断价值.Chinese Hepatology 2001:6(3):198-199
23 邹正升,辛绍杰,李保森等.胆碱酯酶、凝血酶原活动度及白蛋白与肝组织病理损害关系的研究.中华实验与临床病毒学杂志 2001:15(4):349—351
24 苏菲,刘家琴,李鸿宾.肝胆疾病的血清肝酶谱变化及其比较.疾病控制杂志 2001,6:5(2):173—174
25 陈文彬等.诊断学(第五版).人民卫生出版社 2001:394—404
26 Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: Diagnosis, Grading and Stagion. Hepatology 1994; 19: 1513
27 Soresi M, Carroccio A, Agate V, et al. Evaluation by ultrasound of abdominal lymphadenopathy in chronic hepatitis C. Am J Gastroenterol 1999; 94(2): 497-501