Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Hepatobiliary Pancreat Sci. 2017 Aug;24(8):485-491. doi: 10.1002/jhbp.487. Epub 2017 Jul 30.
Histological examination is useful for the diagnosis of acute severe (fulminant) autoimmune hepatitis (AIH), but it is sometimes difficult to perform liver biopsy due to the complicated coagulopathy and ascites. We have shown that heterogeneous hypoattenuation on unenhanced computed tomography (CT) is a characteristic imaging feature of acute severe (fulminant) AIH. In the present study, we examined the utility of the imaging feature by applying the score to diagnose acute severe (fulminant) AIH.
Twenty-three patients with acute severe (fulminant) AIH were analyzed retrospectively. Modified AIH score was created by adding three points to AIH score with/without histological points in case of the presence of heterogeneous hypoattenuation on unenhanced CT.
Areas of hypoattenuation were present in 15 (65%) patients, all of which were heterogeneous pattern. Five (22%) patients were diagnosed as "definite" AIH, 16 (69%) as "probable" and two (9%) as "non-diagnosis" by the revised original score without histological score. By adding three points, two of "non-diagnosis" changed to "probable" AIH, and all patients were diagnosed as AIH.
Modified AIH score using heterogeneous CT image finding would be beneficial especially for patients in whom histological examinations cannot be performed because of complications.
组织学检查有助于诊断急性重症（暴发性）自身免疫性肝炎（AIH），但由于复杂的凝血功能障碍和腹水，有时难以进行肝活检。我们已经表明，增强 CT 上不均匀的低衰减是急性重症（暴发性）AIH 的特征性影像学特征。在本研究中，我们通过应用该评分来诊断急性重症（暴发性）AIH，检验了该影像学特征的实用性。
回顾性分析了 23 例急性重症（暴发性）AIH 患者。在增强 CT 上存在不均匀低衰减的情况下，在 AIH 评分（无论是否存在组织学评分）上加 3 分，创建改良 AIH 评分。
15 例（65%）患者存在低衰减区，均呈异质性表现。5 例（22%）患者经改良原始评分（无组织学评分）诊断为“明确”AIH，16 例（69%）为“可能”AIH，2 例（9%）为“非诊断”。加 3 分后，2 例“非诊断”改为“可能”AIH，所有患者均诊断为 AIH。
使用异质性 CT 图像发现改良 AIH 评分，特别是对于因并发症而无法进行组织学检查的患者，可能会有所帮助。
