黄伟浪　林歆　郭顺成

[摘要] 目的 研究多层螺旋CT动态增强扫描对不典型肝脓肿的诊断价值。 方法 回顾性分析我院2012年5月～2015年2月收治的46例经手术病理或穿刺活检证实的不典型肝脓肿患者的多层螺旋CT动态增强扫描及平扫的表现特征。 结果 CT平扫结果显示：患者病灶形态呈片状或类圆形、边界多不清楚的低密度区。多层螺旋CT动态增强扫描结果显示：（1）动脉期：25例患者病灶周围呈楔形或片状的肝段短暂强化，发生率为54.35%；（2）门静脉期：16例出现晕征，发生率为34.78%，20例出现蜂窝征及细网格征，发生率为43.48%，10例出现周边多囊征，发生率为21.74%；（3）延迟期：30例病灶范围比平扫时缩小，表现为持续强化征，发生率为65.22%。 结论 与常规CT比较，多层螺旋CT动态增强扫描对不典型肝脓肿的三期具有特征性表现，对判断不典型肝脓肿的病理过程具有重要的价值，更有利于提高不典型肝脓肿的诊断准确性。

[关键词] 多层螺旋CT；动态增强；不典型肝脓肿；诊断

[中图分类号] R575.4 [文献标识码] B [文章编号] 2095-0616（2016）01-177-04

[Abstract] Objective To investigate the analysis of dynamic enhanced multi-slice spiral CT in the diagnosis of atypical hepatic abscess. Methods The performance characteristics by multislice spiral CT dynamic enhancement scanning and unenhanced of 46 patients with pathologically confirmed or biopsy in patients with atypical hepatic abscess in our hospital from May 2012 to February 2015 were retrospectively analyzed. Results CT scan showed： patients form lesions were flaky or oval， clear boundary more low-density areas. Dynamic enhanced multi-slice spiral CT scan results show： （1） in the arterial phase： 25 cases of patients with lesions around the wedge-shaped or sheet of liver segments briefly strengthening， the rate was 54.35%； （2） portal venous phase： 16 cases of halo sign， the rate was 34.78%， 20 cases appeared cellular levy and levy a fine mesh， incidence， 43.48%， 10 cases surrounding polycystic levy， the rate was 21.74%； （3） the delay period： 30 cases of lesions in scope than flat When sweep shrink， the performance continued to strengthen levy， the rate was 65.22%. Conclusion The comparison with conventional CT， multislice spiral CT dynamic enhancement scanning for three atypical hepatic abscess has a characteristic performance， has important value judgment on the pathological process atypical hepatic abscess， more conducive to improving the diagnosis of atypical hepatic abscess accuracy.

[Key words] Multi-slice CT； Dynamic enhancement； Atypical hepatic abscess； Diagnosis

肝脓肿的CT表现多种多样，典型的肝脓肿CT表现具特征性，主要为多种形态及大小不等的低密度灶，可单发或多发，以单发多见，肝的任何部位均可发病，以肝右叶发生率最高。可随着抗生素的广泛应用，恶性肿瘤化疗患者、糖尿病患者等免疫力低下患者的增多等因素致使大部分肝脓肿病例缺乏特征性的CT表现，此不典型肝脓肿较难区别与鉴别诊断[1-3]。对于肝脓肿的预后，早期的正确诊断和及时的治疗起着至关重要的作用。……