ULTRASOUND EXAMINATION IN DIFFUSE LIVER-DISEASE - CLINICAL-SIGNIFICANCE OF ENLARGED LYMPH-NODES IN THE HEPATO-DUODENAL LIGAMENT
ULTRASOUND EXAMINATION IN DIFFUSE LIVER-DISEASE - CLINICAL-SIGNIFICANCE OF ENLARGED LYMPH-NODES IN THE HEPATO-DUODENAL LIGAMENT
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DOI：
10.3109/02841858709177348
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发表时间：
1987-05-01
期刊：
影响因子：
1.3
通讯作者：
PRYTZ, H
中科院分区：
文献类型：
--
作者：
FORSBERG, L;FLOREN, CH;PRYTZ, H
73例病理性肝功能检查患者在肝活检前1天行超声检查。将超声检查结果与组织学检查结果进行比较。在23例患者中发现肝十二指肠韧带淋巴结肿大，其中21例为主动免疫介导性肝病。在其余2例患者中，1例患有溃疡性结肠炎（和脂肪肝），1例患有慢性胆囊炎（和血色素沉着症）。在33例经活检证实的主动免疫介导性肝病患者中，21例在超声检查中发现肝-十二指肠韧带有病理性淋巴结。8例患者无法识别韧带，其余4例未发现病理性淋巴结。21例肝脏超声回声正常，5例回声增强，5例回声不均匀。在另外2例患者中发现回声增强和不均匀实质。因此，仅对肝实质进行超声检查，33例患者中有21例被归为正常，另外5例被归为肝脏脂肪改变。只有7例被认为有明显的肝脏病理。然而，如果超声显示肝-十二指肠韧带的病理性淋巴结与显著的肝脏病理一致，则可在这7例患者的基础上再增加15例患者，使33例患者中有22例（67%）仅用超声诊断为显著的肝脏病理。因此，积极寻找肝-十二指肠韧带淋巴结可大大提高超声诊断免疫介导性肝病的可靠性。
Seventy-three patients with pathologic liver function tests were examined using ultrasound one day prior to liver biopsy. The ultrasound findings were compared with the histologic findings. In 23 patients enlarged lymph nodes were found in the hepatoduodenal ligament and 21 of these had active immune-mediated liver disease. Of the remaining 2 patients one had ulcerative colitis (and fatty liver) and one chronic cholecystitis (and haemosiderosis). Of the 33 patients with biopsy-proven active immune-mediated liver disease 21 had pathologic lymph nodes in the hepato-duodenal ligament at ultrasound. It was not possible to identify the ligament in 8 patients and in the remaining 4 no pathologic lymph nodes could be found. Twenty-one of these patients had normal liver echoes on ultrasound, 5 exhibited increased echogenicity and 5 had heterogeneous echogenicity. In a further 2 patients both increased echogenicity and heterogeneous parenchyma were found. Ultrasound examination of the liver parenchyma alone would thus lead to 21 of the 33 patients being classified as normal and a further 5 being classified as having fatty changes of the liver. Only 7 would be regarded as having significant liver pathology. However, if demonstration at ultrasound of pathologic lymph nodes in the hepato-deuodenal ligament is regarded as being consistent with significant hepatic pathology a further 15 patients could be added to these 7 patients, giving a total of 22 out of 33 patients (67%) identified as having significant liver pathology using ultrasound alone. The reliability of ultrasound in the diagnosis of immune-mediated liver disease can thus be improved considerably by actively searching for lymph nodes in the hepato-duodenal ligament.