Jun-Hu Bai, Yong-Hai Zhang, Xiu-Min Han, Yao-Dong Li, Yong-Xing Dong
Qinghai Provincial People's Hospital, Xining 810007, China.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi. 2019 Feb 21;30(6):674-677. doi: 10.16250/j.32.1374.2018121.
To analyze the imaging manifestations of 79 cases of hepatic echinococcosis retrospectively, so as to provide evidences for improving the diagnosis and differential diagnosis of the disease.
Seventy-nine patients with hepatic echinococcosis who underwent imaging examinations and pathologic confirmation in Qinghai Provincial People's Hospital from 2014 to 2017 were chosen as the investigation objects, and the data of their medical records and imaging manifestations were collected and analyzed.
Among the 79 cases of hepatic echinococcosis, 57 were suffered from cystic echinococcosis (CE) and 22 were suffered from alveolar echinococcosis (AE) . Among the patients with CE, those in single cystic type, multiple cysts type, internal capsule collapse type, solid type, and calcification type were 21, 16, 9, 4 cases and 7 cases respectively. The imaging signs of 62 cases were common. The image of the single cystic type was characterized by intrahepatic cystic water-like lesions, the cystic wall was thin and uniform without any enhancement. The multiple cysts were characterized by "cyst in the cyst", "rose petals", and "spoke wheel". The collapse and separation of the internal capsule was manifested as "drift belt sign" and "double ring sign", the calcification of the cyst wall was curved and eggshell-shaped, the contents of the cyst were cotton-shaped or the whole lesion was calcific. The image of the patients with AE was manifested as a solid mass in the liver, the density and signal were heterogeneous, the edge was irregular and not obviously enhanced, the "small vesicles" scattered in the lesion were often accompanied by calcification, and the whole lesion showed a map appearance. The other 17 cases of hepatic echinococcosis showed complex and rare imaging features. The capsules of 6 cases of CE contained fat, the images presented single or multiple fat density nodules in the hepatic hydatid cyst, and CT value was -28 to -84 HU; in 4 cases of echinococcosis, the lesions were broken into the bile duct, the density of adjacent bile duct was increased, with bile duct wall thickening and peripheral biliary dilatation. For the 4 cases of echinococcosis combined with primary liver cancer, the imaging manifestations of the hepatic cysts presented solid-mass enhancement, with "fast forward and fast out" performance. For the image of the 3 cases of CE with infection, the cystic wall was thickening and enhanced obviously, of these, 2 cases had gaseous shadows in the cyst, 1 patient's cyst was complicated with infection and it invaded the abdominal wall.
The imaging manifestations of hepatic echinococcosis are varied and complicated, which need careful analysis for differential diagnosis.
回顾性分析79例肝包虫病的影像学表现，为提高该病的诊断及鉴别诊断提供依据。
选取2014年至2017年在青海省人民医院接受影像学检查及病理确诊的79例肝包虫病患者作为研究对象，收集并分析其病历资料及影像学表现。
79例肝包虫病患者中，囊型包虫病（CE）57例，泡型包虫病（AE）22例。CE患者中，单囊型、多囊型、内囊塌陷型、实变型、钙化型分别为21例、16例、9例、4例和7例。62例患者的影像学表现较为常见。单囊型表现为肝内囊性水样病变，囊壁薄且均匀，无强化。多囊型表现为“囊中囊”“玫瑰花瓣”及“车轮辐条”样。内囊塌陷分离表现为“飘带征”及“双环征”，囊壁钙化呈弧形、蛋壳样，囊内容物呈棉絮状或整个病灶钙化。AE患者表现为肝脏实性肿块，密度及信号不均匀，边缘不规则，强化不明显，病灶内散在的“小泡”常伴有钙化，整个病灶呈地图样。另外17例肝包虫病患者表现为复杂少见的影像学特征。6例CE患者的囊内含有脂肪，影像表现为肝包虫囊肿内单个或多个脂肪密度结节，CT值为-28至-84 HU；4例包虫病患者病灶破入胆管，相邻胆管密度增高，胆管壁增厚，周围胆管扩张。4例包虫病合并原发性肝癌患者，肝囊肿影像表现为实性肿块强化，呈“快进快出”表现。3例合并感染的CE患者，囊壁增厚，强化明显，其中2例囊内有气体影，1例患者囊肿合并感染并侵犯腹壁。
肝包虫病的影像学表现多样复杂，需仔细分析以进行鉴别诊断。
