Giovine S, Pinto A, Crispano S, Lassandro F, Romano L
Dipartimento di Diagnostica per Immagini, Ospedali Palasciano e Melorio, S.Maria Capua Vetere e Capua, ASL Caserta 2, Napoli, Italy.
Radiol Med. 2006 Feb;111(1):11-21. doi: 10.1007/s11547-006-0002-y.
The aim of this study was to retrospectively review the cases of hepatic infarction diagnosed at our institute using conventional, spiral and multislice computed tomography (CT) over the last decade in order to describe its morphological and density characteristics and define its possible etiopathogenesis.
Twenty-three consecutive patients aged 27-65 years with hepatic infarction were studied by CT at our institute over a period of about 10 years. A conventional CT unit was used in seven patients, a helical CT scanner in ten and a multislice CT in six. CT was performed before and after the administration of 130-150 cc of contrast material infused at a rate of 3-3.5 ml/s.
CT showed hepatic infarction due to arterial causes in 19 cases, 11 of which were in liver transplant patients. The infarction was related to right hepatic artery embolisation to control haemorrhage (one case), chemoembolisation of a multifocal hepatocarcinoma in a cirrhotic liver (one case), arterial mesenteric infarction due to thromboembolism (two cases), necrotising pancreatitis (one case), surgery in pancreatic cancer invading the hepatic artery (one case), pancreaticoduodenectomy (two cases), portal thrombosis in a young woman with pregnancy-related clotting disorder (one case), haemolytic anaemia, elevated liver enzymes, low platelet count (HELLP) syndrome (one case); eclampsia and disseminated intravascular coagulation (DIC) (one case) and acute exacerbation of Budd-Chiari syndrome (one case). At CT scans, hepatic infarction was depicted as a hypodense parenchymal area, at times triangular in shape, with sharp peripheral contours (12 cases) or as a rounded central or marginal area (four cases) with irregular appearance (three cases), with lobar extension (two cases) and ill-defined shape (two cases). Moreover, CT showed intralesional gas not correlated to bacterial infection (two cases). In all surgical cases, the results were confirmed by pathology.
CT is the method of choice in the diagnosis of hepatic infarction, providing useful information regarding site, morphology, and extent of the lesion. Furthermore, in most cases, CT is able to suggest the possible aetiology and guide appropriate management.
本研究旨在回顾性分析我院过去十年间通过传统CT、螺旋CT及多层螺旋CT诊断的肝梗死病例，以描述其形态学及密度特征，并明确其可能的病因发病机制。
我院在约10年时间里对23例年龄在27 - 65岁的肝梗死患者进行了CT研究。其中7例使用传统CT设备，10例使用螺旋CT扫描仪，6例使用多层螺旋CT。在静脉注射130 - 150 cc造影剂（注射速率为3 - 3.5 ml/s）前后进行CT检查。
CT显示19例肝梗死由动脉原因引起，其中11例为肝移植患者。梗死原因包括：为控制出血行右肝动脉栓塞（1例）、肝硬化肝脏多灶性肝癌的化疗栓塞（1例）、血栓栓塞导致的肠系膜动脉梗死（2例）、坏死性胰腺炎（1例）、侵犯肝动脉的胰腺癌手术（1例）、胰十二指肠切除术（2例）、一名患有妊娠相关凝血障碍的年轻女性的门静脉血栓形成（1例）、溶血、肝酶升高、血小板减少（HELLP）综合征（1例）；子痫和弥散性血管内凝血（DIC）（1例）以及布加综合征急性加重（1例）。CT扫描时，肝梗死表现为实质低密度区，有时呈三角形，周边轮廓清晰（12例），或呈圆形中央或边缘区（4例），外观不规则（3例），有叶状扩展（2例），形状不明确（2例）。此外，CT显示病灶内气体与细菌感染无关（2例）。所有手术病例均经病理证实。
CT是诊断肝梗死首选的方法，能提供有关病变部位、形态及范围的有用信息。此外，在大多数情况下，CT能够提示可能的病因并指导恰当的治疗。
