CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage / 中华肝胆外科杂志

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 diag-nosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepato-splenic 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),1 1 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 com-prehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesionsAU cases had multiple lesions.(2)Distribution of lesionsscattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesionsthe boundary of the nodu-lar lesion was clear.and the single maximum diameter Was 1.0-1.5 ca.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 sig-nal characteristicsCT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1 WI,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 be-came smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis OCCURS after hepato-splenic 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 differentia-ted from infection and metastasis of malignant tumors after operation.