CT findings of focal eosinophilic infiltration and metastasis in the liver
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摘要:
目的 比较肝脏局灶性嗜酸性粒细胞浸润(FEI)与转移瘤(HMs)的CT影像特征。 方法 回顾性分析25例临床诊断为肝脏FEI及30例肝脏HMs患者的临床及CT影像资料,比较两组病灶数目、大小、分布、形态、密度、三期强化特点及特征表现,采用秩和检验或t检验分析两者差异。 结果 共发现136个病灶,其中FEI 84个、HMs 52个,所有病灶边界均不清晰。肝脏FEI平扫表现为稍低或等密度,低密度占77.4%,直径5~59 mm,85.7%病灶分布于肝包膜下或门静脉周围肝实质,89.3%病灶形态为楔形和不规则形;三期增强扫描,呈均质渐进性强化,绝大部分病灶门静脉期显示最清晰,可见“门脉穿行征”、平衡期“病灶缩小征”。肝脏HMs病灶绝大部分平扫表现为低密度,约占90.4%,直径8~65 mm,67.3%病灶分布于肝脏包膜下,部分分布于深部肝实质,96.2%病灶形态为圆形或类圆形;增强扫描,82.7%病灶表现为不均质强化,边缘环形强化是其特征,其中61.5%病灶可以呈“牛眼征”,其余病灶呈均质强化。 结论 肝脏FEI可出现“渐进性强化”、“门静脉穿行征”、平衡期“病灶缩小征”等特征;肝脏HMs多有明确原发病灶病史,边缘环形强化,特别是“牛眼征”。这些特征对鉴别肝脏FEI与HMs有重要意义。 Abstract:Objective To compare the CT imaging findings between focal eosinophilic infiltration (FEI) of liver and hepatic metastases (HMs). Methods A retrospective study including 25 patients with confirmed FEI of liver and 30 patients with confirmed HMs was performed. The lesions’ number, size, distribution, shape, margin, density characteristic, enhancement pattern, and other special features were evaluated. Chi-square test and t –test were used to analyze the differences. Results In all, 136 lesions were detected in 55 cases, including 84 lesions from FEI cases and 52 lesions from HMs cases, and all lesions showed ill-defined margins. Pre-contrast CT images of hepatic FEI demonstrated slightly low attenuation or iso-attenuating, with the size of lesions ranging from 3 to 61 mm. Most lesions (85.7%) were located in subcapsular parenchyma or surrounding the portal vein, and most subcapsular lesions (89.3%) were wedge-shaped or irregular-shaped. Triple-phase enhanced scanning showed progressive enhancement in all lesions, and all the lesions showed the most clearly in the portal vein phase, with portal vein traversal sign in portal vein phase and focal narrowing sign in equilibrium phase detected. However, most of hepatic HMs lesions showed low attenuation on CT pre-contrast images, with size ranging from 8 to 65mm. 67.3% lesions were located in subcapsular parenchyma and partly in the deep hepatic parenchyma, and 82.7% lesions showed inhomogeneous enhancement, with rim enhancement pattern as its feature. 61.5% lesions showed bull eyes signs. Conclusion The clinical and imaging findings of FEI and HMs of liver have certain characteristics. The FEI of liver can be characterized by progressive enhancement, portal vein traversal sign in portal vein phase and focal narrowing sign in equilibrium phase. However, the HMs tends to show clear history of primary lesions and rim enhancement pattern, especially bull eyes signs. These features entertain great significances in differentiating hepatic FEI from HMs. -
Key words:
- eosinophilia /
- hepatic infiltration /
- magnetic resonance imaging /
- computed tomography /
- metastasis
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表 1 病灶形态及分布
指标 楔形或不规则形 圆形或类圆形 肝包膜下或门静脉周围 深部肝实质 FEI 转移瘤 FEI 转移瘤 FEI 转移瘤 FEI 转移瘤 病灶数(n) 75 2 9 50 72 35 12 17 百分比(%) 89.3 3.8 10.7 96.2 85.7 67.3 14.3 32.7 P <0.05 <0.05 >0.05 >0.05 FEI: 肝脏局灶性嗜酸性粒细胞浸润. 表 2 病灶平扫、三期强化表现及特征表现
组别 平扫 强化方式 病灶缩小征 特征表现 低 等 均质 不均质 缩小 不变 门脉穿行征 牛眼征 FEI(n=84) 65 19 78 6 82 2 76 0 HMs(n=52) 47 5 9 43 20 32 0 32 FEI: 肝脏局灶性嗜酸性粒细胞浸润; HMs: 肝脏转移肿瘤. -
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