肝包虫的CT诊断与鉴别诊断

目的：分析肝囊性包虫和泡性包虫的CT表现。讨论CT对肝包虫的诊断价值。方法：通过经手术证实的100例包虫病的CT表现进行分析。结果：肝囊性包虫65例，单房性包虫囊肿38例，多房性包虫囊肿20例，含子囊性包虫42例。钙化30例，合并感染7例，破例7例。肝泡性包虫5例。大多成密度不均匀的低密度浸润灶，病灶边界不清，包膜不明显，大部分有钙化。结论：CT对肝包虫的分析及鉴别诊断都有较高的诊断价值。是肝包虫术前诊断的重要手段。     

超声诊断肝包虫32例分析

目的：探讨肝包虫超声影像的不同表现特点及诊断价值。方法：对32例经超声诊断肝包虫的并成功进行追踪随访患者,与外科手术结果进行对比。结果：超声诊断32例肝包虫病例中,其中27例手术后病理证实为肝包虫,符合率为84.4%;2例为肝囊肿合并感染;1例为肝脏圆韧带多房性囊肿;1例为肝囊虫合并局部钙化,另1例为腹腔包虫。结论：超声诊断是该病的首选方法且安全有效,应尚需结合化验室等其它检查手段。     

小儿体部棘球蚴病CT表现

目的探讨小儿体部棘球蚴病的CT表现特点。方法经手术及病理证实的20例小儿体部棘球蚴病,其中单发棘球蚴病7例,多发棘球蚴病13例,共有32个囊肿,包括肝包虫囊肿17个,肺包虫囊肿9个,腹腔包虫囊肿4个,颈部包虫囊肿1个,胸膜包虫囊肿1个。20例患儿全部接受CT扫描,其中14例同时接受增强扫描。结果 20例患儿32个病灶中,21个表现为单纯性囊肿,11个呈囊肿破裂表现,未见钙化和多子囊征象。结论小儿体部棘球蚴病以多发和单纯性囊肿为主,CT表现特点与成人棘球蚴病存在差异。     

CT诊断肝脏包虫病的价值及误诊分析

目的：探讨CT检查在肝脏包虫病诊断中的价值,并进行误诊分析。方法：收集经病理证实的18例肝脏包虫病病例,并以术后病理结果为金标准,回顾分析患者的CT影像特点,并评估CT检查诊断肝脏包虫病的价值。结果：18例肝脏包虫病患者中,经CT检查准确诊断者为14例,CT诊断准确率为77.8%,另4例患者分别被误诊为肝囊肿2例,血管瘤1例,肝癌1例。肝细粒棘球蚴病患者为17例,其中单纯囊肿型9例,CT图像上表现为肝内囊性低密度灶,单发或多发,呈圆形或类圆形,其中2例可见囊壁弧形或蛋壳样钙化,长短、厚薄不一;1例囊内钙化,CT图像上表现为类圆形或球形钙化灶;1例为多发钙化,既可见囊壁钙化型,也可见球形钙化灶型;含子囊型6例,表现为囊中囊、轮状或蜂窝状改变;混合型1例,可见钙化型病灶及含子囊型病灶。合并感染后,患者的CT表现为囊内密度增高,囊壁增厚。肝泡状棘球蚴病患者1例,CT平扫表现为密度不均匀,边界模糊的斑片低密度影,并伴肺播散,该例CT表现为肝内病灶范围广泛、两肺多发类似病灶,被误诊为原发性肝癌伴两肺转移。另有2例患者的CT表现为病灶单发囊性病灶,无囊壁,增强CT图像上未见强化,被误诊为肝囊肿;1例患者的CT表现可见球形钙化,被误诊为硬化性血管瘤。结论：CT检查能准确显示肝包虫病的类型、发生部位、范围和程度,但表现为单纯囊肿型时,需要与肝囊肿鉴别;肝泡状棘球蚴病的影像学表现复杂,需与原发性肝癌鉴别。     

肺包虫囊肿的CT诊断

目的:观察肺包虫囊肿的CT表现,评价CT对本病的临床应用价值。材料和方法:回顾性地分析了17例经临床手术病理证实的肺包虫囊肿的CT表现。以10mm层厚。行平扫后增强扫描。结果:17例肺包虫囊肿中,单发12例,多发5例。共29个病灶。75％分布于肺边缘区域。破裂7例。感染9例。主要征像为园形或卵园形均匀的水样密度的囊性病灶。特征性的征象为囊壁上点状或细弧线形钙化;囊内多于囊的显示;破裂时的新月征、水上浮莲征、腔内蛇影征。继发感染时囊周片状炎性实变。结论:将CT应用于肺包虫囊肿的诊断能发现隐蔽区的病灶。定位准确。并能有效显示肺包虫囊肿的特征及并发症的表现,提高对本病诊断的准确性。正确指导临床治疗。     

不同手术方式治疗肝包虫病89例临床疗效及体会

目的总结肝包虫病89例手术治疗的临床疗效及经验体会。方法回顾分析2007年1月至2014年1月收治的89例资料完整的肝包虫病手术治疗患者的临床资料。结果 89例患者中104个包虫性囊肿,囊壁钙化47例,其中有74个包虫性囊肿行肝包虫腔内注射95%乙醇内囊摘除术,14个包虫性囊肿行包虫外囊摘除术,16个包虫性囊肿行肝部分切除术,均临床治愈,术后随访1~7年,失访13例,复发2例,1例合并胆管细胞癌死亡。结论外科手术是肝包虫病的主要治疗方法,根据患者病情、肝包虫囊壁形态和周围解剖关系实施个体化手术方案;肝包虫内囊摘除术采用95%乙醇具有安全有效、复发率低、并发症少等优点。     

CT对肝包虫囊肿的诊断价值与分型

目的：探讨ＣＴ对肝包虫囊肿的诊断价值与分型。材料与方法：收集我们两院经手术病理证实的肝包虫囊肿５２例,根据病理结果及ＣＴ表现进行对照分析。结果：囊型肝包虫在ＣＴ上因病程和病理的不同,表现为单囊单房型、单囊多房型、单囊假分隔型、实变钙化型及感染型。结论：ＣＴ不仅可早期诊断出无症状带虫者,并能准确地检测出各种病理形态的典型影像。     

超声及CT对囊性肝包虫病的诊断价值

目的：探讨超声及CT对囊性肝包虫病的诊断价值。方法：回顾性分析我院2014年9月至2016年6月105例经手术病理或穿刺活检证实的肝包虫囊肿患者的超声和CT图像资料，采用WHO分型标准将肝包虫囊肿分为CE 1、CE 2、CE 3a、CE 3b、CE 4和CE 5型。结果：肝包虫囊肿CE 1型9例、CE 2型13例、CE 3a型12例、CE 3b型24例、CE 4型22例、CE 5型25例，超声和CT测得囊肿最大径与术后标本比较均无统计学差异（P < 0.05）。结论：超声和CT不仅能准确判断包虫囊肿的位置、数量和大小，而且能反映不同时期包虫囊肿的病理变化对其进行分型，对囊性肝包虫病的诊断具有重要价值。     

儿童肝包虫病的CT特点

目的 探讨儿童肝包虫病的CT表现。方法 回顾性分析27例经病理和/或血清学证实的肝包虫病患儿的临床和CT资料。结果 27例肝包虫病中,肝囊型包虫病26例,肝泡型包虫病1例;单纯肝包虫病10例,合并其他器官包虫病17例;肝内单发包虫18例,多发包虫9例。共发现囊型病灶47个,其中单囊型囊肿占51.06%（24/47）,内囊塌陷型囊肿占42.55%（20/47）,钙化型囊肿占4.26%（2/47）,多子囊型囊肿占2.13%（1/47）,未见实变型囊肿;泡型病灶1个。74.47%（35/47）的囊肿直径>5 cm。结论 CT可定性诊断儿童肝包虫病,是可靠的检查方法。     

CT在肝结核临床诊断中的应用

目的：探讨肝结核CT表现特点及CT在肝结核诊断与鉴别诊断中的价值。方法：分析9例经手术、病理证实的肝结核病的CT资料。结果：9例肝结核患者CT平扫病灶均为低密度影，其中4例的患者病灶内可见钙化，“粉末状”钙化是其特征。增强扫描动脉期病灶无明显强化，静脉期和平衡期病灶有不同形式的轻微强化。结论：肝结核病CT的表现虽无特异性，但综合分析临床资料和CT表现，多能作出正确的诊断。     

囊型肝包虫病CT诊断价值与分型

目的 探讨囊型肝包虫病CT诊断价值、病理基础与分型。方法 收集我们两院经手术病理及临床随访证实的肝包虫囊肿66例,根据CT表现和病理结果进行对照分型。结果 囊型肝包虫病在CT上因病程和病理的不同,表现为单囊单房型、单囊多房型、单囊假分隔型、实变钙化型及多囊型。结论 囊型肝包虫病在CT上有特征性表现,不仅可早期诊断无症状带虫者,并可准确地显示各种病理形态的典型影像。     

肝包虫病的CT和MR诊断

目的 探讨肝包虫病的CT和MRI表现.方法 临床手术、病理证实的肝包虫病42例,就其CT和MRI表现回顾性分析并就相关文献进行复习.结果 本组肝细粒棘球蚴病占85.71%,蛋壳样或条带状钙化、"囊内囊"、"飘带征"等为其主要表现;肝泡球蚴病占14.29%,钙化、"小泡征"、"半岛征"及囊腔或液化、坏死等为其主要表现;MR T2WI显示囊壁及纤维间隔、飘带征等优于CT,但钙化显示逊于CT.结论 CT和MR均可诊断肝包虫病,CT在综合诊断方面优于MR.     

Endoscopic retrograde cholangiography and sphincterotomy for complicated hepatic hydatid cyst

We report on the results of 20 endoscopic cholangiographies indicated for hepatic hydatid disease: 14 for pre-operative investigation and 6 for post-surgical complications. In 4 out of 14 cases, endoscopic retrograde cholangiography (ERC) was not an effective procedure for the pre-operative diagnosis of complicated hepatic hydatid cyst in the biliary tract. Endoscopic sphincterotomy was performed without complications in 9 patients and permitted pre- or post-surgical removal of intrabiliary hydatid fragments in 6, successful treatments of 2 post-surgical external biliary fistulae and in association with transhepatic drainage, improvement of the clinical and biological course of one case of secondary sclerosing cholangitis. Endoscopic sphincterotomy might be indicated not only in the case of ERC diagnosis of complicated hepatic hydatic cyst, but also in the case of isolated cholangitis in patients with hepatic hydatid disease, and for complications of surgical treatment.     

Hydatid hepatic cysts rupture into the biliary tract, the peritoneal cavity, the thoracic cavity and the hepatic subcapsular space: specific computed tomography findings

Background: This study attempts to demonstrate the role of computed tomography in the diagnosis of hepatic hydatid cyst rupture based on specific imaging findings and to propose combinations of the imaging findings diagnostic for specific types of rupture. Methods: Eleven patients were studied with computed tomography of the abdomen, with 4–8 mm slice thickness, after the oral administration of contrast material and intravenous contrast material in 6 cases. Results: Based on a combination of imaging findings the types of hepatic hydatid cyst rupture were: intrabiliary rupture in 7 patients, intraperitoneal rupture in 1 patient, intrathoracic rupture in 1 patient, hepatic subcapsular rupture in 2 patients. Structural deformity of the cyst was present in all cases, combined with: dilatation of the intrahepatic bile ducts (intrabiliary rupture); intraperitoneal fluid collections with diffuse haziness and stranding of the mesenteric fat (intraperitoneal rupture); an inhomogeneous lesion in the thorax with ipsilateral pleural effusion (intrathoracic rupture); a hydatid cyst located peripherally, with discontinuity of its adjacent to the hepatic capsule wall and subcapsular fluid collection (subcapsular rupture). The imaging findings were surgically and pathologically confirmed. Conclusions: Using combinations of specific imaging findings we correctly diagnosed the type of hepatic hydatid cyst rupture in all cases.     

Intrabiliary rupture of hepatic hydatid cyst: multidetector-row CT demonstration

Rupture of a hydatid cyst into the biliary tract, also known as cystobiliary communication, is the most common complication of hepatic hydatid cyst. This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality. Imaging plays an important role in the preoperative diagnosis of this condition which facilitates its management. We studied six patients with rupture of hepatic hydatid cyst into a large bile duct in whom multidetector-row CT (MDCT) suggested the diagnosis. The imaging findings included a single hepatic cyst less than 10 cm in diameter in all the cases; interruption of the cyst wall adjacent to a bile duct signifying cyst-bile duct communication was seen in five patients. The common bile duct was dilated in all the patients, with linear membranes in four and diffuse irregular high dense intrabiliary material observed within the common bile duct in two of them. Intrahepatic ducts were dilated in all the six cases and two patients showed linear dense contents within distended gallbladder. Subcapsular and intrathoracic rupture was associated in one patient each. MDCT demonstration of hydatid cyst in the liver together with a dilated common bile duct and distended gallbladder containing high density hydatid material suggest rupture of the cyst into biliary tree. MDCT enhances demonstration of the dilated common bile duct with hydatid material inside. The diagnosis is reinforced by the demonstration of the cystobiliary communication itself.     

Complications of hepatic hydatid cysts: Ultrasound,computed tomography,and magnetic resonance diagnosis

A total of 179 hepatic hydatid cysts (HHCs) were studied by ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of HHC complications was established by US and CT, which permitted a distinction between intact cysts and those presenting with contained rupture, as demonstrated by a collapsed endocyst or a globally echogenic appearance. The diagnosis of HHC perforation into the main biliary tree was made by detection of a discontinuity in the cyst wall and/or the presence of hydatid material within the biliary system. Similarly, direct HHC rupture into different thoracoabdominal spaces was diagnosed by demonstrating cyst wall discontinuity and the presence of hydatid material within these spaces. Ruptured and infected cysts were difficult to distinguish from ruptured cysts with sterile content. The role of MRI is yet to be defined in the assessment of HHC complications.     

MRI对肝包虫病的诊断价值

目的:探讨肝包虫病的磁共振成像(MRI)特征,评价MRI对肝包虫病的诊断价值。方法:23例经手术病理证实的肝包虫患者,对其术前MRI资料作回顾性对照分析。结果:23例肝包虫诊断正确22例,误诊1例,诊断正确率为95.65%(22/23)。结论:MRI对肝包虫病有较高的诊断价值,可作为CT及B超等影像学检查方法的有效补充。     

Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree

Hepatic hydatid disease is usually silent and discovered incidentally. Rupture of a hydatid cyst into the biliary tree is a serious complication and produces a clinical picture of biliary obstruction. We present the cases of 2 patients who had only nonspecific symptoms and laboratory test results indicative of biliary tract obstruction. The results of sonographic examinations of both patients strongly suggested the presence of hepatic hydatid cysts communicating with the biliary tree. CT examination provided additional information in 1 patient but only confirmed the sonographic findings in the other. Both cases were surgically confirmed. Demonstration of the cyst and intrabiliary hydatid contents should form the basis for the diagnosis of a hydatid cyst's rupture into the biliary tree; detecting the point of communication further supports the diagnosis. An accurate preoperative diagnosis of this disease is essential for its prompt surgical management.