Original Article
CT and MR features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage
Jianzeng Zhang, Haidong Hu, Zeng Zheng, Hailong Yu, Jinghui Dong, Weimin An, Yunfang Li
Published 2019-12-28
Cite as Chin J Hepatobiliary Surg, 2019, 25(12): 915-920. DOI: 10.3760/cma.j.issn.1007-8118.2019.12.008
Abstract
ObjectiveTo investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.
MethodsA 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.
ConclusionsHepatic 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.
Key words:
Hepatectomy; Splenectomy; Upper gastrointestinal hemorrhage; Ischemia; Necrosis; Computed Tomography, X-ray; Magnetic resonance imaging
Contributor Information
Jianzeng Zhang
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Haidong Hu
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Zeng Zheng
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Hailong Yu
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Jinghui Dong
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Weimin An
Department of Radiology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Yunfang Li
Department of Internal Medicine, The Second Outpatient Affiliated to Logistical Support Department of PLA, Beijing 100071, China
