CT and MRI Findings of Multiple Infarcted Regenerative Nodules in Liver Cirrhosis after Variceal Hemorrhage
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摘要: 目的：探讨肝硬化患者静脉曲张出血后多发再生结节梗死的CT和MRI表现。方法：共收集21例诊断为肝硬化患者静脉曲张出血后多发再生结节梗死的患者纳入本研究，其中男13例，女8例，检查采用3.0T MR扫描仪或256排螺旋CT，所有病例均行动态增强扫描，分析病变的强化模式、信号强度、形状、数量、大小、边缘、位置和分布。结果：在CT或MRI成像中，3例患者病灶在10个及以下，19例患者病灶在10个以上；肝脏病灶直径3～26 mm；大部分病灶为圆形结节、呈簇状聚集分布；病灶主要分布于肝包膜下区域；CT和MRI动态增强后，大部分结节未见明显强化；少数可以有边缘强化；在T1WI所有病灶呈等信号或稍低信号；在T2WI大部分病变为边界限清晰的高信号；CT和MRI随访13例患者病灶消失，8例患者病灶缩小或明显减少。结论：CT和MRI可显示肝硬化静脉曲张出血后再生结节梗死的影像特征，通过影像随访、临床病史、肿瘤指标可与肝脏恶性肿瘤相鉴别。Abstract: Objective: To investigate the CT and MRI features of multiple infarcted regenerative nodules in cirrhosis after variceal hemorrhage. Methods: A total of 21 patients, including 13 males and 8 females, who were diagnosed with multiple infarction regenerating nodules in cirrhosis after variceal hemorrhage, were included in this study. All patients were examined by a 3.0 T MR scanner or 256 slice spiral CT, and the enhancement pattern, signal intensity, shape, number, size, edge, location, and distribution of the lesions were analyzed . Results: In CT or MRI imaging, 3 patients had 10 or less lesions and 19 patients had more than 10 lesions. The diameter of the liver lesions was 3~26 mm, and most lesions were round nodules which were clustered and distributed . Moreover, the lesions were mainly distributed in the subcapsular region of the liver. After dynamic enhancement of the CT and MRI, most nodules had no obvious enhancement and a few had marginal enhancement . On T1WI images, all lesions showed equal signal or slightly low signal, while on T2WI images, most lesions had high signals with clear boundaries. During CT and MRI follow-up, the lesions disappeared in 13 patients and shrank or significantly reduced in 8 patients. Conclusions: CT and MRI can show the imaging features of multiple infarcted regenerative nodules in liver cirrhosis after variceal hemorrhage, which can be differentiated from liver malignancy by imaging follow-up, clinical history, and tumor indicators.
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Key words:
- CT /
- MRI /
- liver cirrhosis /
- infarcted regenerative nodules /
- variceal hemorrhage
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图 1 女，67岁，乙肝肝硬化患者30余年，消化道出血14 h
（a）～（d）分别是CT平扫、动脉期、门脉期、延迟期，图像显示肝内多发小结节状、类圆形低密度灶，呈簇状分布，多位于肝包膜下，直径约5～13 mm，增强后大部分病灶未见明显强化，少部分边缘轻度强化。
Figure 1. Imaging of a 67-year-old female Hepatitis B cirrhosis patient of more than 30 years, who was admitted within 14 h of gastrointestinal bleeding
图 2 男，46岁，乙肝肝硬化患者10余年，上消化道出血16 h
（a）～（d）分别是CT平扫、动脉期、门脉期、延迟期示肝内多发小结节状、类圆形低密度灶，呈簇状分布，多位于肝包膜下，直径约10 mm，增强后病灶未见明显强化、呈低密度。（e）～（h）为该患者入院后4天行MRI检查，（e）为T2WI示肝内多发小结节状类圆形高信号灶，（f）为DWI示病灶呈稍高信号，（g）为T1WI平扫示病灶呈稍低信号，（h）为增强后门脉期示病灶未见强化呈低信号。
Figure 2. Imaging of a 46-year-old male Hepatitis B cirrhosis patient of more than 10 years, who was admitted within 16 h of gastrointestinal bleeding
图 3 为图1同一患者MRI检查
（a）和（b）为T2 WI、DWI显示肝内多发小结节状、类圆形高信号灶，呈簇状分布，多位于肝包膜下。（c）和（d）为该患者一年后随访复查，肝内病灶全部消失。
Figure 3. MRI examination of the same patient as in Figure 1
表 1 患者的临床基本资料
Table 1. The basic clinical data of the patients
类别 结果 男性︰女性 13︰8 平均年龄/岁 57±7.23 肝硬化原因（乙型肝炎︰丙型肝炎︰酒精性） 17︰1︰3 肝癌史（有︰无） 3︰18 肝功能（正常︰升高） 0︰21 肿瘤标志物（正常︰升高） 21︰0 
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表 2 结节特征
Table 2. Characteristics of the nodules
类别 结果 结节形状（圆形︰不规则形） 88.8％︰12.2％ 结节数目（≤10︰11～30︰31～50︰＞50） 3︰8︰7︰3 结节大小（≤0.5 cm︰0.6～1.0 cm︰1.1～2.0 cm︰≥2.1 cm） 22.5％︰51.3％︰25.8％︰0.4％ 边缘（清楚：不清） 15︰6 位置（肝包膜下︰中心︰两者皆有） 16︰1︰4 分布（聚集：散发） 18︰3 强化方式（无强化︰边缘轻度强化） 80.6％︰19.4％ CT平扫 等密度或稍低密度 T1WI信号 等信号或稍低信号 T2WI信号 高信号 DWI 稍高信号或等信号
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