Chamadol Nittaya, Laopaiboon Vallop, Techasatian Pennapa, Sukeepaisanjaroen Wattana, Sripanuskul Anan
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Med Assoc Thai. 2010 Jul;93(7):838-48.
To compare the computerized tomographic (CT) findings of hepatic fascioliasis (HF) vs. melioidosis-caused liver (ML) abscesses.
CT images of 15 patients with hepatic fascioliasis (HF) and 16 patients with melioidosis-caused liver (ML) abscesses were retrospectively reviewed. The authors evaluated and compared HF and ML abscesses (by chi2 and Fisher exact tests) vis-a-vis their location of liver involvement, size, shape, number margins, enhancement patterns, subcapsular lesions, internal architecture, dilatation of intrahepatic bile duct and combination with splenic abscesses.
Fourteen HF patients had only liver abscesses and 1 had combined liver and splenic abscesses. Four ML patients had liver abscesses alone while 12 had combined liver and splenic abscesses (p = 0.000). Eight of the 15 HF (53.3%) and 2 of the 16 ML (12.5%) patients had subcapsular lesions (p = 0.019). The liver abscesses were round or oval with linear tracts in 8 of the 15 HF (53.3%) and none of the ML patients (p = 0.001). Between the respective HF and ML patients, there was a significant difference in those with round shaped in ML (p = 0.008), multiple and conglomerately distributed in HF (p = 0.050), multiple and discretely distributed in ML (p = 0.001) no (or minimal) peripheral contrast enhancement in HF (p = 0.011) and moderate or mark peripheral enhancement in ML (p = 0.011).
The CT findings of liver abscesses that helped to differentiate hepatic fascioliasis from melioidosis liver abscesses were: their number shape, enhancement pattern, presence of subcapsular lesion (s) and co-occurrence with splenic abscesses. The diagnosis of hepatic fascioliasis by CT is suggested when the following characteristics were seen: (1) multiple, small round or oval (with linear tracts) conglomerates presenting as hypodense lesions; (2) no (or minimal) peripheral contrast enhancement; (3) subcapsular lesions; or (4) less frequent co-occurrence with splenic abscesses.
比较肝片形吸虫病（HF）与类鼻疽所致肝脓肿（ML）的计算机断层扫描（CT）表现。
回顾性分析15例肝片形吸虫病患者（HF）和16例类鼻疽所致肝脓肿患者（ML）的CT图像。作者通过卡方检验和Fisher精确检验，评估并比较了HF和ML脓肿在肝脏受累部位、大小、形状、数量、边缘、强化模式、包膜下病变、内部结构、肝内胆管扩张以及合并脾脓肿方面的情况。
14例HF患者仅有肝脓肿，1例合并肝脾脓肿。4例ML患者仅有肝脓肿，12例合并肝脾脓肿（p = 0.000）。15例HF患者中有8例（53.3%）、16例ML患者中有2例（12.5%）有包膜下病变（p = 0.019）。15例HF患者中有8例（53.3%）的肝脓肿呈圆形或椭圆形且有线性条索，ML患者中无一例如此（p = 0.001）。在各自的HF和ML患者之间，ML中圆形者（p = 0.008）、HF中多发且聚集分布者（p = 0.050）、ML中多发且离散分布者（p = 0.001）、HF中无（或极少）周边强化者（p = 0.011）以及ML中有中度或明显周边强化者（p = 0.011）存在显著差异。
有助于鉴别肝片形吸虫病与类鼻疽肝脓肿的肝脓肿CT表现为：数量、形状、强化模式、包膜下病变的存在以及合并脾脓肿情况。当出现以下特征时，建议通过CT诊断肝片形吸虫病：（1）多个小圆形或椭圆形（有线性条索）团块表现为低密度病变；（2）无（或极少）周边强化；（3）包膜下病变；或（4）合并脾脓肿的频率较低。
