肝脏影像学检查在土三七引起的肝小静脉闭塞性疾病中的诊断价值

陈华忠; 邵辉; 耿才正; 吕计算; 张智勤

肝脏影像学检查在土三七引起的肝小静脉闭塞性疾病中的诊断价值

1. 温州医学院附属台州医院
2. 仙居县人民医院
3. 仙居县中医院

基金项目:

浙江省中医药科技计划基金资助项目(No.2010ZB160)；

详细信息

中图分类号: R575
计量
- 文章访问数: 2948
- HTML全文浏览量: 18
- PDF下载量: 694
- 被引次数: 0
出版历程
- 出版日期: 2012-05-20

Value of liver imaging scan in diagnosing hepatic veno-occlusive disease caused by Sedum Aizoon

Research funding:

摘要

摘要: 目的探讨肝脏影像学改变在肝小静脉闭塞性疾病(HVOD)患者诊断中的价值。方法对45例HVOD患者临床表现、肝脏影像学检查及肝穿刺组织学变化进行分析。结果 45例患者肝脏超声检查有28例患者可见"斑片状"或"豹纹状"低回声区;CT检查均有"地图状"密度改变,肝脏MRI T1WI均呈大片状低信号,T2WI信号呈略高信号,增强后呈"地图状"不均匀强化。肝脏超声诊断HVOD符合率62.2%(28/45);肝脏CT、MRI诊断HVOD符合率100%,二者差异有统计学意义(χ2=15.06,P<0.05)。21例作肝组织穿刺确诊的HVOD患者,检查均显示肝脏有"地图状"的高、低密度改变。结论肝脏CT、MRI诊断HVOD较肝脏超声检查有更高敏感性和特异性。肝脏CT、MRI可替代肝穿刺组织学检查诊断HVOD。
- 肝静脉闭塞性疾病 /
- 土三七 /
- 体层摄影术,螺旋计算机 /
- 磁共振成像
Abstract: Objective To investigate the liver imaging characteristics of acute and subacute hepatic veno-occlusive disease (HVOD) .Methods Clinical data of 45 cases who developed HVOD were collected and the clinical manifestation, imaging examination, histological examination of liver puncture biopsy, and the outcomes of changes were reviewed.Results 28 cases showed panther-stripe or patching low echogenic area of liver by ultrasonography.Map-like density changes was noticed in liver CT scan in all patients;Uniform signal intensity (SI) of liver showed in liver MR scan was big shape of low SI on TW1, slightly high SI on TW2, and map-like inhomogeneous enhancement.The diagnostic coincidence rates of HVOD were 100% on CT and MRI, as 62.2% (28/45) on ultrasonography.The difference between them was of statistical significance (χ2=15.06, P<0.05) .Map-like density changes showed in the liver CT and MR scan of 21 cases which were made sure by histological examination of liver.Conclusion Liver CT and MRI scan had higher sensitivity and specificity than ultrasonography in the diagnosis of HVOD.HVOD can be diagnosed by liver CT and MRI scan instead of histological examination.
- hepatic veno-occlusive disease /
- sedum aizoon /
- tomography /
- spiral computer

HTML全文

参考文献(16)

[1]Al Beihany A, Al Omar H, Sahovic E, et al.Successful treat-ment of hepatic veno-occlusive disease after myeloablativeallogeneic hematopoietic stem cell transplantation by earlyadministration of a short course of methylprednisolone[J].Bone Marrow Transplant, 2008, 41 (3) :287-291.

[2]Rubbia-Brandt L.Sinusoidal obstruction syndrome[J].ClinLiver Dis, 2010, 14 (4) :651-668.

[3]张国华, 孔阿照, 方军伟, 等.肝小静脉闭塞病的CT表现[J].中华放射学杂志, 2006, 40 (3) :250-254.

[4]陈华忠, 董米连, 邵辉, 等.土三七致HBsAg阳性患者肝小静脉闭塞病的诊断和治疗[J].中华临床感染病杂志, 2010, 3 (2) :76-79.

[5]邢雪.肝静脉外科[M].北京:人民卫生出版社, 2005:391-394.

[6]Li SL, Lin G, Fu PP, et al.Identification of five hepatotoxic pyr-rolizidine alkaloids in a commonly used traditional Chinese me-dicinal herb, Herba Senecionis scandentis (Qianliguang) [J].Rapid Commun Mass Spectrom, 2008, 22 (4) :591-602.

[7]Zuckerman M, Steenkamp V, Stewart MJ.Hepatic veno-oc-clusive disease as a result of a traditional remedy:confirmationof toxic pyrrolizidine alkaloids as the cause, using an in vitrotechnique[J].J Clin Pathol, 2002, 55 (9) :676-679.

[8]Deleve LD, Mccuskey RS, Wang X, et al.Characterizationof a reproducible rat model of hepatic veno-occlusive dis-ease[J].Hepatology, 1999, 29 (6) :1779-1791.

[9]杨丽, 朱洪怡, 陈哲, 等.3种药物诱导肝小静脉闭塞病小鼠模型的比较[J].中华肝脏病杂志, 2010, 18 (12) :944-945.

[10]Laurie D.Deleve, Dominique-Charles valla, GuadalupeGari-ca-Tsao.vascular disorders of liver[J].Hepatology, 2009 (49) :1729-1764.

[11]马新光.肝小静脉闭塞病的彩超表现[J].浙江临床医学, 2008, 10 (5) :593-594.

[12]Dai N, Yu YC, Ren TH, et al.Gynura root induces hepatic ve-no-occlusive disease:a case report and review of the litera-ture[J].World J Gastroenterol, 2007, 13 (10) :1628-1631.

[13]耿才正, 高燕, 樊树峰.四例土三七引起肝窦阻塞综合征的MRI表现[J].中华放射学杂志, 2009, 43 (3) :312-314.

[14]Mccarville MB, Hoffer FA, Howard SC, et al.Hepatic veno-occlusive disease in children undergoing bone-marrowtransplantation:usefulness of sonographic findings[J].Ped-iatr Radiol, 2001, 31 (2) :102-105.

[15]Ho VT, Revta C, Richardson PG.Hepatic veno-occlusivedisease after hematopoietic stem cell transplantation:updateon defibrotide and other current investigational therapies[J].Bone Marrow Transplant, 2008, 41 (3) :229-237.

[16]宋宇, 樊艳华.土三七所致肝小静脉闭塞病102例临床分析[J].临床肝胆病杂志, 2011, 27 (5) :496-499.

施引文献

资源附件(0)

访问统计