• 四川大學(xué)華西醫(yī)院放射科（成都 610041）;

目的  綜合評述當(dāng)前多排螺旋CT（multi-detector row CT, MDCT）和各種磁共振成像（magnetic resonance imaging，MRI）技術(shù)在評價(jià)彌漫性肝臟實(shí)質(zhì)疾病中的價(jià)值。
方法  收集國內(nèi)、外最新相關(guān)文獻(xiàn)，總結(jié)MDCT和各種MRI技術(shù)在評價(jià)各類彌漫性肝臟實(shí)質(zhì)疾病中的應(yīng)用及研究進(jìn)展。結(jié)果  彌漫性肝實(shí)質(zhì)疾病種類繁多，分為儲存性、血管性及炎性疾病3大類。MDCT能夠較好地顯示肝臟彌漫性疾病的形態(tài)學(xué)變化，MRI尤其是MR功能成像除了反映形態(tài)學(xué)變化外，還能夠反映肝臟細(xì)胞代謝活動(dòng)情況，從而為肝臟彌漫性疾病的診斷及療效評估提供定性和定量的信息。
結(jié)論  影像學(xué)技術(shù)尤其是功能性MRI技術(shù)發(fā)展迅速，在彌漫性肝臟實(shí)質(zhì)疾病的診斷和嚴(yán)重程度評價(jià)中具有較好的應(yīng)用前景。

引用本文： 陳錦秀,陳光文,宋彬. 彌漫性肝臟實(shí)質(zhì)疾病的CT和MRI評價(jià). 中國普外基礎(chǔ)與臨床雜志, 2010, 17(2): 195-199. doi: 復(fù)制

1. Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis [J]. JAMA， 2003; 289（22）: 30003004.
2. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology [J]. Semin Liver Dis， 2001; 21（1）: 316.
3. Bravo AA, Sheth SG, Chopra S. Liver biopsy [J]. N Engl J Med ， 2001; 344(7): 495500.
4. Siegelman ES, Mitchell DG, Semelka RC. Abdominal iron deposition: metabolism, MR findings, and clinical importance [J]. Radiology， 1996; 199（1）: 1322.
5. Adams P, Brissot P, Powell LW. EASL International Consensus Conference on Haemochromatosis [J]. J Hepatol， 2000; 33(3): 485504.
6. Brissot P, Bourel M, Herry D, et al. Assessment of liver iron content in 271 patients: a reevaluation of direct and indirect methods [J]. Gastroenterology， 1981; 80(3): 557565.
7. Abenoza P, Sibley RK. Farber’s disease: a fine structural study [J]. Ultrastruct Pathol， 1987; 11(4): 397403.
8. Ros PR, Ji H. Special focus session: multisection (multidetector) CT: applications in the abdomen [J]. Radiographics， 2002; 22(3): 697700.
9. Raptopoulos V, Karellas A, Bernstein J, et al. Value of dualenergy CT in differentiating focal fatty infiltration of the liver from lowdensity masses [J]. AJR Am J Roentgenol， 1991; 157(4): 721725.
10. Hamer OW, Aguirre DA, Casola G, et al. Imaging features of perivascular fatty infiltration of the liver: initial observations [J]. Radiology， 2005; 237(1): 159169.
11. Guyader D, Gandon Y, Deugnier Y, et al. Evaluation of computed tomography in the assessment of liver iron overload. A study of 46 cases of idiopathic hemochromatosis [J]. Gastroenterology， 1989; 97(3): 737743.
12. Howard JM, Ghent CN, Carey LS, et al. Diagnostic efficacy of hepatic computed tomography in the detection of body iron overload [J]. Gastroenterology， 1983; 84(2): 209215.
13. Levenson H, Greensite F, Hoefs J, et al. Fatty infiltration of the liver: quantification with phasecontrast MR imaging at 1.5 T vs biopsy [J]. AJR Am J Roentgenol， 1991; 156(2): 307312.
14. KatzBrull R, Rofsky NM, Lenkinski RE. Breathhold abdominal and thoracic proton MR spectroscopy at 3 T [J]. Magn Reson Med， 2003; 50(3): 461467.
15. Chmelík M, Schmid AI, Gruber S, et al. Threedimensional highresolution magnetic resonance spectroscopic imaging for absolute quantification of 31P metabolites in human liver [J]. Magn Reson Med， 2008; 60(4): 796802.
16. Kim YK, Kim CS, Lee YH, et al. Comparison of superparamagnetic iron oxideenhanced and gadobenate dimeglumineenhanced dynamic MRI for detection of small hepatocellular carcinomas [J]. AJR Am J Roentgenol， 2004; 182(5): 12171223.
17. 王秋實(shí), 郭啟勇, 梁長虹， 等. MR彌散加權(quán)成像評價(jià)肝纖維化的初步實(shí)驗(yàn)研究 [J]. 解剖學(xué)研究， 2007; 29(3): 212216.
18. 管生, 趙衛(wèi)東, 周康榮， 等. 磁共振彌散功能成像對肝臟早期彌漫性病變診斷價(jià)值的試驗(yàn)研究 [J]. 中華肝病雜志， 2005; 13（7）: 524527.
19. Xu L, Gao PY. “Palpation by imaging”： magnetic resonance elastography [J]. Chin Med Sci J， 2006; 21(4): 281286.
20. Cobbold JF, Morin S, TaylorRobinson SD. Transient elastography for the assessment of chronic liver disease: ready for the clinic? [J]. World J Gastroenterology， 2007; 13(36): 47914797.
21. Garbow JR, Lin X, Sakata N, et al. In vivo MRS measurement of liver lipid levels in mice [J]. J Lipid Res, 2004; 45(7): 13641371.
22. Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study [J]. Gut, 2005; 54(1): 122127.
23. Szczepaniak LS, Nurenberg P, Leonard D, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population [J]. Am J Physiol Endocrinol Metab, 2005; 288(2): E462 E468.
24. Alústiza JM, Artetxe J, Castiella A, et al. MR quantification of hepatic iron concentration [J]. Radiology， 2004; 230(2): 479484.
25. Westphalen AC, Qayyum A, Yeh BM, et al. Liver fat: effect of hepatic iron deposition on evaluation with opposedphase MR imaging [J]. Radiology， 2007; 242(2): 450455.
26. Gandon Y, Olivié D, Guyader D, et al. Noninvasive assessment of hepatic iron stores by MRI [J]. Lancet， 2004; 363(9406): 357362.
27. Andrews NC. Disorders of iron metabolism [J]. N Engl J Med， 1999; 341（26）: 19861995.
28. Horton KM, Bluemke DA, Hruban RH, et al. CT and MR imaging of benign hepatic and biliary tumors [J]. Radiographics， 1999; 19（2）: 431451.
29. Lorigan JG, Charnsangavej C, Carrasco CH, et al. Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings [J]. AJR Am J Roentgenol， 1988; 150（6）: 12911295.
30. Mathieu D, Vasile N, Menu Y, et al. BuddChiari syndrome: dynamic CT [J]. Radiology， 1987; 165（2）: 409413.
31. Kawamoto S, Soyer PA, Fishman EK, et al. Nonneoplastic liver disease: evaluation with CT and MR imaging [J]. Radiographics， 1998; 18（4）: 827848.
32. Proujansky R, Vinton N. Acute hepatitis [J]. Adolesc Med， 1995; 6（3）: 437446.
33. Semelka RC, Kelekis NL, Sallah S, et al. Hepatosplenic fungal disease: diagnostic accuracy and spectrum of appearances on MR imaging [J]. AJR Am J Roentgenol， 1997; 169（5）: 13111316.
34. Sallah S, Semelka RC, Wehbie R, et al. Hepatosplenic candidiasis in patients with acute leukaemia [J]. Br J Haematol， 1999; 106（3）: 697701.
35. Thanos L, Zormpala A, Brountzos E, et al. Nodular hepatic and splenic sarcoidosis in a patient with normal chest radiograph [J]. Eur J Radiol， 2002; 41（1）: 1011.
36. Sakai T, Maeda M, Takabatake M, et al. MR imaging of hepatosplenic sarcoidosis [J]. Radiat Med， 1995; 13（1）: 3941.
  1. 1. Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis [J]. JAMA， 2003; 289（22）: 30003004.
  2. 2. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology [J]. Semin Liver Dis， 2001; 21（1）: 316.
  3. 3. Bravo AA, Sheth SG, Chopra S. Liver biopsy [J]. N Engl J Med ， 2001; 344(7): 495500.
  4. 4. Siegelman ES, Mitchell DG, Semelka RC. Abdominal iron deposition: metabolism, MR findings, and clinical importance [J]. Radiology， 1996; 199（1）: 1322.
  5. 5. Adams P, Brissot P, Powell LW. EASL International Consensus Conference on Haemochromatosis [J]. J Hepatol， 2000; 33(3): 485504.
  6. 6. Brissot P, Bourel M, Herry D, et al. Assessment of liver iron content in 271 patients: a reevaluation of direct and indirect methods [J]. Gastroenterology， 1981; 80(3): 557565.
  7. 7. Abenoza P, Sibley RK. Farber’s disease: a fine structural study [J]. Ultrastruct Pathol， 1987; 11(4): 397403.
  8. 8. Ros PR, Ji H. Special focus session: multisection (multidetector) CT: applications in the abdomen [J]. Radiographics， 2002; 22(3): 697700.
  9. 9. Raptopoulos V, Karellas A, Bernstein J, et al. Value of dualenergy CT in differentiating focal fatty infiltration of the liver from lowdensity masses [J]. AJR Am J Roentgenol， 1991; 157(4): 721725.
  10. 10. Hamer OW, Aguirre DA, Casola G, et al. Imaging features of perivascular fatty infiltration of the liver: initial observations [J]. Radiology， 2005; 237(1): 159169.
  11. 11. Guyader D, Gandon Y, Deugnier Y, et al. Evaluation of computed tomography in the assessment of liver iron overload. A study of 46 cases of idiopathic hemochromatosis [J]. Gastroenterology， 1989; 97(3): 737743.
  12. 12. Howard JM, Ghent CN, Carey LS, et al. Diagnostic efficacy of hepatic computed tomography in the detection of body iron overload [J]. Gastroenterology， 1983; 84(2): 209215.
  13. 13. Levenson H, Greensite F, Hoefs J, et al. Fatty infiltration of the liver: quantification with phasecontrast MR imaging at 1.5 T vs biopsy [J]. AJR Am J Roentgenol， 1991; 156(2): 307312.
  14. 14. KatzBrull R, Rofsky NM, Lenkinski RE. Breathhold abdominal and thoracic proton MR spectroscopy at 3 T [J]. Magn Reson Med， 2003; 50(3): 461467.
  15. 15. Chmelík M, Schmid AI, Gruber S, et al. Threedimensional highresolution magnetic resonance spectroscopic imaging for absolute quantification of 31P metabolites in human liver [J]. Magn Reson Med， 2008; 60(4): 796802.
  16. 16. Kim YK, Kim CS, Lee YH, et al. Comparison of superparamagnetic iron oxideenhanced and gadobenate dimeglumineenhanced dynamic MRI for detection of small hepatocellular carcinomas [J]. AJR Am J Roentgenol， 2004; 182(5): 12171223.
  17. 17. 王秋實(shí), 郭啟勇, 梁長虹， 等. MR彌散加權(quán)成像評價(jià)肝纖維化的初步實(shí)驗(yàn)研究 [J]. 解剖學(xué)研究， 2007; 29(3): 212216.
  18. 18. 管生, 趙衛(wèi)東, 周康榮， 等. 磁共振彌散功能成像對肝臟早期彌漫性病變診斷價(jià)值的試驗(yàn)研究 [J]. 中華肝病雜志， 2005; 13（7）: 524527.
  19. 19. Xu L, Gao PY. “Palpation by imaging”： magnetic resonance elastography [J]. Chin Med Sci J， 2006; 21(4): 281286.
  20. 20. Cobbold JF, Morin S, TaylorRobinson SD. Transient elastography for the assessment of chronic liver disease: ready for the clinic? [J]. World J Gastroenterology， 2007; 13(36): 47914797.
  21. 21. Garbow JR, Lin X, Sakata N, et al. In vivo MRS measurement of liver lipid levels in mice [J]. J Lipid Res, 2004; 45(7): 13641371.
  22. 22. Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study [J]. Gut, 2005; 54(1): 122127.
  23. 23. Szczepaniak LS, Nurenberg P, Leonard D, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population [J]. Am J Physiol Endocrinol Metab, 2005; 288(2): E462 E468.
  24. 24. Alústiza JM, Artetxe J, Castiella A, et al. MR quantification of hepatic iron concentration [J]. Radiology， 2004; 230(2): 479484.
  25. 25. Westphalen AC, Qayyum A, Yeh BM, et al. Liver fat: effect of hepatic iron deposition on evaluation with opposedphase MR imaging [J]. Radiology， 2007; 242(2): 450455.
  26. 26. Gandon Y, Olivié D, Guyader D, et al. Noninvasive assessment of hepatic iron stores by MRI [J]. Lancet， 2004; 363(9406): 357362.
  27. 27. Andrews NC. Disorders of iron metabolism [J]. N Engl J Med， 1999; 341（26）: 19861995.
  28. 28. Horton KM, Bluemke DA, Hruban RH, et al. CT and MR imaging of benign hepatic and biliary tumors [J]. Radiographics， 1999; 19（2）: 431451.
  29. 29. Lorigan JG, Charnsangavej C, Carrasco CH, et al. Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings [J]. AJR Am J Roentgenol， 1988; 150（6）: 12911295.
  30. 30. Mathieu D, Vasile N, Menu Y, et al. BuddChiari syndrome: dynamic CT [J]. Radiology， 1987; 165（2）: 409413.
  31. 31. Kawamoto S, Soyer PA, Fishman EK, et al. Nonneoplastic liver disease: evaluation with CT and MR imaging [J]. Radiographics， 1998; 18（4）: 827848.
  32. 32. Proujansky R, Vinton N. Acute hepatitis [J]. Adolesc Med， 1995; 6（3）: 437446.
  33. 33. Semelka RC, Kelekis NL, Sallah S, et al. Hepatosplenic fungal disease: diagnostic accuracy and spectrum of appearances on MR imaging [J]. AJR Am J Roentgenol， 1997; 169（5）: 13111316.
  34. 34. Sallah S, Semelka RC, Wehbie R, et al. Hepatosplenic candidiasis in patients with acute leukaemia [J]. Br J Haematol， 1999; 106（3）: 697701.
  35. 35. Thanos L, Zormpala A, Brountzos E, et al. Nodular hepatic and splenic sarcoidosis in a patient with normal chest radiograph [J]. Eur J Radiol， 2002; 41（1）: 1011.
  36. 36. Sakai T, Maeda M, Takabatake M, et al. MR imaging of hepatosplenic sarcoidosis [J]. Radiat Med， 1995; 13（1）: 3941.