Liver Abscess: CT Imaging and Clinical Evaluation in 100 Cases

肝膿瘍：一百例病患的電腦斷層影像與臨床評估

陳振德(Jen-Dar Chen) ； 黃振義(Jen-I Hwang) ； 姜仁惠(Jen-Huey Chiang) ； 周宜宏(Yi-Hong Chou) ； 張政彥(Cheng-Yen Chang) ； 于俊(Chun Yu)

《中華放射線醫學雜誌》 20卷3期 (1995/09) Pp. 205-216

摘要

由於肝膿瘍的罹病率和死亡率仍不容忽視，早期準確診斷與適當的治療對預後極重要。電腦斷層是診斷肝膿瘍的主要影像學檢查。此研究即著重對其電腦斷層之各種表現，致病來源，與預後因素加以評估。對過去一百例經證實的肝膿瘍之臨床發現，電腦斷層影像表現，與可能有關的致死因素作回朔分析。
發燒、白血球增多和肝功能異常是最常見之表現。糖尿病或惡性腫瘤見於39%及16%病例。克列伯氏菌是最常見之致病菌(45%)。首要的致病來源爲膽道疾患(40%)。電腦斷層影像大部份呈現壁層不分明(86%)，邊緣不規則(82%)，及中心呈近水性或低密度(97%)。內部形態呈現三類：單房性(18%)、多房性(66%)、叢聚狀(16%)。對比劑強化方式有五種：(1)不強化(10%)、(2)均質性強化(1%)、(3)異質性強化(47%)、(4)邊緣強化(22%)、(5)異質性暨邊緣強化(20%)。氣體出現於肝膿瘍者佔27%，皆爲化膿性者。肋膜肺部之反應是肝病灶以外最常見的發現(48%)。併有膽道疾患、多發病灶與氣體產生之肝膿瘍呈現較高的死亡率。
雖然肝膿瘍的電腦斷層表現缺少特異性，電腦斷層卻在膿瘍的偵測尤其當使用對比劑時有高敏感性。重要的電腦斷層影像表現配合適切的臨床資料，有助於及早正確診斷肝膿瘍，尤其是對那些無特異性症狀，但具有糖尿病、膽道疾患或惡性腫瘤的老年病患。當電腦斷層發現有合併膽道疾患、多發性膿瘍及膿瘍內含氣體時，需要注意病患之預後可能較差。

關鍵字

肝，膿瘍 ； 肝，電腦斷層

並列摘要

Early accurate diagnosis and relevant treatment of liver abscess (LA) is important for prognosis because of its certain morbidity and mortality. CT scan has become a primary diagnostic imaging modality for LA detection. This study concerned florid CT features, predisposing etiology and prognostic factors of LA. Clinical findings, CT images, and related mortality factors of 100 patients with proved LA were analyzed retrospectively.
Fever, leukocytosis and abnormal liver function were the most common clinical features. Coexistence of DM or malignancy was remarkable (39% and 16%, respectively). Klebsiella pneumoniae was the most common organism (45%). The leading predisposing etiology was biliary tract disorders (40%). On CT imaging, most LA showed an ill-defined wall (86%), irregular margin (82%), and central near-water or hypodensity (97%). There were three patterns of interior configuration: unilocular (18%), multi-loculated (66%), and cluster pattern (16%). There were five contrast enhancing patterns: (1) no enhancement (10%), (2) homogeneous enhancement (1%), (3) heterogeneous enhancement (47%), (4) marginal enhancement (22%), and (5) mixed heterogeneous and marginal enhancement (20%). Exclusively pyogenic, gas was present in 27% of the LA. Pleuropulmonary reaction was the most common extrahepatic finding (48%). LA with biliary tract disease, multiplicity of lesions and gas content showed a higher mortality rate (p＜0.05). Despite non-specificity of CT features, CT scan demonstrates high sensitivity for abscess detection, especially with contrast administration. When associated with appropriate clinical settings, relevant CT features aids earlier accurate diagnosis of LA for patients with nonspecific constitutional symptoms, especially in aged people who have DM, biliary tract disease or concurrent malignancy. Poor prognosis exists, when CT demonstrates associated biliary tract diseases, multiplicity of lesions and presence of gas content within the abscess cavity.

並列關鍵字

liver, abscess ； liver, CT