Monzawa S, Uchiyama G, Ohtomo K, Araki T
Department of Radiology, Yamanashi Medical College, Japan.
AJR Am J Roentgenol. 1993 Aug;161(2):323-7. doi: 10.2214/ajr.161.2.8333370.
The purpose of this study was to determine the findings on contrast-enhanced CT scans in patients with hepatic schistosomiasis japonica and to determine their pathologic basis.
Unenhanced and contrast-enhanced CT scans of 113 patients with histologically proved schistosomiasis were reviewed. Radiologic and pathologic findings were correlated after autopsy in 19 patients.
Unenhanced CT scans showed septal calcification in the liver parenchyma in 53 patients (47%) and capsular calcification along the hepatic surface in 29 patients (26%). Twenty-seven patients (24%) had both types of calcification. Fifty-four patients (48%) showed one or more types of enhancement. Septal enhancement (i.e., linear enhancement of hepatic parenchyma looking like septa in the liver) was seen in 52 patients (46%). Forty-seven of the 53 patients who had septal calcification on unenhanced CT scans had septal enhancement on scans obtained after the administration of contrast material. The enhancement was found at sites of septal calcification in 44 patients and at noncalcified sites in 18 (15 had enhancement at both calcified and noncalcified sites). Five of 60 patients who did not have septal calcification on unenhanced CT scans had septal enhancement at noncalcified sites on scans obtained after the administration of contrast material. Amorphous enhancement (i.e., poorly defined and irregularly shaped enhancement) was seen in six patients (5%). Capsular enhancement (i.e., curvilinear enhancement along the hepatic surface) was seen in 12 patients (11%). Histologic studies showed broad fibrous septa at sites of septal enhancement.
CT findings in patients with schistosomiasis japonica involving the liver include septal, amorphous, and capsular contrast enhancement. Septal enhancement occurs in broad fibrous septa. CT evidence of septal enhancement may suggest the diagnosis of hepatic schistosomiasis japonica, especially when no calcification is seen on unenhanced CT scans.
本研究旨在确定日本血吸虫病患者的增强CT扫描表现，并确定其病理基础。
回顾性分析113例经组织学证实为血吸虫病患者的平扫及增强CT扫描资料。19例患者尸检后对影像学和病理学表现进行了对照分析。
平扫CT显示53例（47%）肝实质内有间隔钙化，29例（26%）肝表面有包膜钙化。27例（24%）两种钙化均有。54例（48%）表现为一种或多种强化类型。52例（46%）可见间隔强化（即肝实质呈线状强化，类似肝内间隔）。53例平扫CT有间隔钙化的患者中，47例增强扫描有间隔强化。44例强化位于间隔钙化部位，18例位于非钙化部位（15例钙化和非钙化部位均有强化）。60例平扫CT无间隔钙化的患者中，5例增强扫描在非钙化部位有间隔强化。6例（5%）可见无定形强化（即强化边界不清、形态不规则）。12例（11%）可见包膜强化（即沿肝表面的曲线状强化）。组织学研究显示间隔强化部位有广泛的纤维间隔。
日本血吸虫病累及肝脏的CT表现包括间隔、无定形和包膜强化。间隔强化发生在广泛的纤维间隔内。间隔强化的CT表现可能提示日本血吸虫病性肝病的诊断，尤其是平扫CT未见钙化时。
