肝包虫病的影像诊断

肝包虫病的影像诊断与鉴别
包虫囊肿,CE 泡球蚴病, AE
包虫病在中国的流行分布
包虫囊肿,CE 泡球蚴病, AE 肝包虫病的影像检查方法
• X-ray (X-ray) 平片
• Ultrasound (US) 超声
• Computed tomography (CT)
• Magnetic resonance image (MRI)
• Positron Emission Tomography (PET-CT)
影像方法的优选应用
•头面颈部CT MR
•胸部X-ray CT MR
•腹部盆腔US MSCT MR •肌肉和骨关节 X-ray CT ／MR
Hepatic CE pulmonary CE inner cyst
Multiple CE in abdominal and pelvis cavity splenic CE renal CE spinal CE sarcous CE cardic CE cerebral CE Cyst echinococcosis (CE) from Head to Toe
病理
Comparison
影像 肝包虫囊肿 cystic Eechinoccoccosis 图解
WHO 包虫病工作组依据超声所显示的包虫囊肿不同的表现作出的分型
Echinococcosis of the liver. Abdom Imaging (2008) 33:133–143
包虫囊肿的分型
CE1： 单纯型 (active lesion)
水样密度 均质性 清楚边界
囊膜 包膜
CE2: 含子囊型 (active lesion)
US 清楚显示因子囊存在而使包虫囊肿呈现‘蜂窝状’外观
多子囊包虫囊肿， 母囊壁回声强，内容物因漂浮囊砂而呈现“落雪征”
具有厚壁的母囊，内部多发子囊沿着母囊壁排列呈“玫瑰花瓣征”，子囊的密度总是低于母囊液。

……蜂窝征‟‟ 代表着母囊内有较多的子囊相互拥挤存在.
CE2: 含子囊型 (active lesion) T1W “风车征”
T2W “玫瑰花瓣征”
CE2: 含子囊型 (active lesion)
CE2: 含子囊型 (active lesion)
MRI 显示从外囊上剥离 下来的低信号的内囊膜呈现典型的 “双层壁影 ”
CE3: 内囊剥离型 (transitional lesion)
超声 显示“双层壁” CT 显示剥离的内囊
膜呈现“双层壁影 ”
CE3: 内囊塌陷型(transitional lesion)
包虫囊肿因内囊剥离并塌陷而形成的 “水上百合 / 水蛇征”, “飘带征”
CE4 :囊内容物变性 (inactive lesion)
CE5 : 囊壁及部分内容物钙化 (inactive lesion)
Complication ：破裂和感染
包虫囊肿破裂，囊液漏出到膈下间隙，请注意通向膈下间隙的瘘管（红箭）
因包虫囊肿内在破裂而导致其外观不规则（绿箭），囊内有多发子囊，其中有些已经变形（红箭）表明也有破裂，注意包膜下子囊（蓝箭）
增强 CT 显示包虫囊肿变形，多发子囊和气泡（红箭），母囊壁模糊，部分区域不连续（绿箭），表明包虫破入结肠，病灶旁的楔形低密度区，表明包虫的感染蔓延到邻近肝质
Complication ：破裂和感染
包虫破裂，导致包虫在腹膜腔内弥漫播散
胆道及血管并发症: compression of surrounding biliary duct or vessle
CT 胆系成像显示肝右叶内有一较大的包虫囊肿压迫邻近的胆道. CT 血管成像显示包虫囊肿与邻近门静脉左支血管的关系
US 显示胆道与包虫囊肿直接想通（箭头）)
肝内外胆管扩张，CT 胆系成像显示囊肿胆道瘘，胆总管内包虫囊砂。

.
T2W 冠状面 MRCP 显示扩张的胆道内有多发小子囊（箭头）
胆道并发症: rupture or fistulizing into the biliary ducts
* 囊性包虫病的分型
单发型、多发型、子囊型、钙化型、 实变型、感染型/破裂型
基本征象:囊肿
特征表现:囊壁及钙化 子囊征象
囊膜剥离征象
* 囊性包虫病的诊断
泡球蚴示意图 Alveolar echinoccosis
cacti
泡球蚴的病理
HE stain（X200）SM stain（X100）锯齿状边缘
小囊泡
混合密度
肝泡球蚴的影像特征
锯齿状边缘平扫增强
地图征熔岩征泡球蚴纤维、钙化
B超显示不均质强
回声光团散在液性暗区
CT显示病灶纤维化
收缩呈“内陷征”
CT显示浸润病灶
内含钙化及液化
B超显示不均质
强回声光团
CT显示左叶
病灶钙化
CT显示右叶
钙化病灶
泡球蚴液化腔 B 超显示不规整暗区 后壁钙化及声影
CT 显示左叶液化 透光空洞及钙化边缘 MRI 显示浸润带, 钙化带,液化空洞
B 超显示不规则液性暗区 后壁强回声及声影 CT 显示浸润带“小泡征” 钙化带及液化空洞 MRI 显示浸润带,钙化边缘 及空洞形成“地图征”
泡球蚴浸润带与钙化带相间分层
B 超显示不均质强光团
CT 显示浸润带与钙化 带相间呈“年轮征” MRI 显示同前病例 “年轮征”
肝内两个泡球蚴
B 超显示不均质强回声
光团含液性暗区 CT 显示两个不均质 浸润、钙化及液化病灶
CT 显示两个病灶
AE 多模态影像 US
CT
MRI
Characterizing the HAE
T2W MRCP
DWI cacti
tai
AE ---实体型
男性， 47岁，
CT 钙化实性肿块， MRI 散在的小囊泡
CT
MRI
AE ---假囊肿型
T1
T2
男，36 year ，HAE ，
病灶中心液化坏死腔.
AE ---假囊肿型
MRI
CT 增强
male ，43 years-old, HAE of “mixed type”. Enhanced CT image shows two lesions in right and left lobes with central irregular liquid necrosis(white arrow) and
punctuate calcification; Axial T2 wight image shows an isointense solid component with multiple small cysts and central irregular liquid necrosis (white arrow).
AE ---混合型
CT
MRI
The central necrotic area is well delineated as a hypointense on T1 and hyperintense on T2, low density on CT and no
enhancement after injecting contrast media; Cholangio-MRI :Invasion of the biliary tree by the parasitic tissue (arrow).
AE ---混合型
T1
T2
CT MRC
a 42-year-old woman is diagnosed of biliary fistula caused by alveolar echinococcosis (AE), confirmed by intraoperative cholangiography.
MRC demonstrates biliary fistula, presented as two small tributaries of bile duct communicating with cystic cavity of the right lobe lesion; note the severe dilatation of left intra-hepatic bile duct.
CTC shows the relationship between the lesion and the bile duct. Moreover, CTC displays multiple small air bubbles in cavity of AE lesion.
胆道并发症: biliary fistula
MRC
CTC
a 47-year-old woman is diagnosed of multiple hepatic alveolar echinococcosis (AE).
Contrast-enhanced CT reveals huge AE lesion developed in both lobes of the liver, parasite infiltrating of the hepatic hilum leads to dilatation of intra-hepatic bile ducts. Note infiltration of the portal vein (black arrow) and encasing of the inferior vena cava.
CT cholangiography (CTC) minimum intensity projection (MIP) shows interruption of the proximal CHD and both hepatic ducts (short arrow) caused by AE lesion and dilatation of intra-hepatic bile ducts. Note a small AE lesion in the right lobe.
MRC image demonstrates the same findings as CTC. Note multiple small cysts, representing the metacestodal vesicles.
胆道并发症: compression of surrounding biliary duct
MRC
CTC CT 血管侵犯征象
A 42-year-old man with AE infection of the liver. Coronal
reformation of enhanced CT image and MRI reveal infiltration of the hepatic hilum by parasitic tissue. Note infiltration of the portal vein.
CT MPR : IVC and right posterior branch of portal were involved
by AE lesion
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COMPAN
Y
* 泡性包虫病的诊断
基本特征：不均质的实质性肿块，不强化 特异征象: 小囊泡，钙化，中心液化坏死 重要征象：肝质边缘收缩凹陷，
健叶或段的代偿扩大
* 泡型包虫病的并发症
胆道侵犯、门/
腔血管受累、转移
cacti
包虫病的诊断依据
囊肿 + 3个特征表现中1条
包虫囊肿
不均质的肿块 增强后不强化 + 5条特征 中的2条
泡球蚴病
单纯囊肿 VS 包虫囊肿。