CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage
10.3760/cma.j.issn.1007-8118.2019.12.008
- VernacularTitle: 肝脾手术及上消化道出血后肝脏缺血/坏死灶CT和MR特征
- Author:
Jianzeng ZHANG
1
;
Haidong HU
1
;
Zeng ZHENG
1
;
Hailong YU
1
;
Jinghui DONG
1
;
Weimin AN
1
;
Yunfang LI
2
Author Information
1. Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
2. Department of Internal Medicine, The Second Outpatient Affiliated to Logistical Support Department of PLA, Beijing 100071, China
- Publication Type:Journal Article
- Keywords:
Hepatectomy;
Splenectomy;
Upper gastrointestinal hemorrhage;
Ischemia;
Necrosis;
Computed Tomography, X-ray;
Magnetic resonance imaging
- From:
Chinese Journal of Hepatobiliary Surgery
2019;25(12):915-920
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.
Methods:A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected, including 9 patients with liver cancer resection, 5 patients with liver cancer ablation (microwave ablation/radiofrequency ablation, argon-helium knife, alcohol injection), 11 patients with spleen resection, and 11 patients with upper gastrointestinal bleeding. Conventional liver CT and / or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.
Results:(1) Number of lesions: All cases had multiple lesions. (2) Distribution of lesions: scattered in the liver lobes, clustered or regional distribution, mainly in the periphery of the liver. (3) Size of lesions: the boundary of the nodular lesion was clear, and the single maximum diameter was 1.0-1.5 cm. It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect. (4) CT density or MR signal characteristics: CT plain scan showed slightly low density; MR plain scan showed slightly low signal on T1WI, high signal on T2WI, slightly high signal on DWI and no lipid/fat on dual phase imaging; 24 out of 36 cases (66.7%) showed no enhancement, while some lesions showed thin ring enhancement on the edge; emboli were found in the main and/or branches of portal vein (21/36 cases, 58.3%). (5) In the short-term review (minimum 5 days), the lesions became smaller or disappeared, and the local liver volume became smaller or the surface was depressed.
Conclusions:Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage. The imaging manifestations are multiple nodular or flaky hypovascular foci, and the short-term review shows a markedly improvement. It needs to be differentiated from infection and metastasis of malignant tumors after operation.
