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标题: 请411老师及版主帮我看一下我的CT结果，我需要再做MRI吗？ [打印本页]

作者: liliya 时间: 2011-1-13 15:31 标题: 请411老师及版主帮我看一下我的CT结果，我需要再做MRI吗？

本帖最后由 liliya 于 2011-1-13 15:31 编辑

我是2008年六月开始恩替抗病毒治疗的，效果十分好，除了血小板是111b/l 外，其他一切正常。
以下是我最近的CT结果：
Indication：HepatitisB cirrhosis with small nodules in the liver at previous CT. Ultrasounds in the intervl show no masses. Normal AFP.
Triphasic scans of the liver have been performed and compared with the previous from 2008 and with reference the the ultrasound in between.
Contrast administered without adverse reaction.
There is no significant abnormality demonstrated on the nonehanced scan. The liver looks uniform in its attenuation.
On the arterial phase the vascular and hepatic opacification is slightly different from the previous scan which was somewhat more towards a portal venous phase in its opacification than the arterial phase we have today.
There are a number of focal perfusion abnormalities demonstrated in the liver at today's examination. One of these only, peripheral and somewhat poorly defined, almost wedge-shaped abnormality in segment 6 looks very similar to that seen previously and almost certainly represents a perfusion anomaly or possibly a regenerating nodule with surrounding perfusion change.
There is a further enhancing lesion demonstrated in segment 6 measuring 6x5x6mm, not clearly visible in the previous scan but becoming isodense on the portal venous phase. It dose not therefore show clearly a wash-out effect but remains somewhat suspicious and should be referred to on the next followup scan. There is a further poorly-defined 8mm maximum lesion demonstrated posteriorly in segment 6 which has more characteristics of a perfusion anomaly with a slightly low-attenuation, wedge-shaped area peripherally. Again this becomes isodense on the portal venous phase. A more peripheral, less well -defined, hypodense lesion is seen right against the margin of the liver posteriorly in segment 6 which again is almost certainly a perfusion anomaly.
In segment 7, again peripherally, there is a small , brightly enhancing area with a less well-defined zone adjacent which again becomes siodense on the portal venous phase and I think probably is again a perfusion anomaly or possibly a small haemangioma. It really is too difficult to classify. More certrally in segment 7 there is a very small. hypodense area,4mm , again becoming isodense on the portal venous phase.
In segment 4A anteriorly, again there is a small area of increased perfusion with a less well-defined area surrounding it, likely to represent a regenerating nodule or perfusion anomaly.
The spleen is similar in size and appearance to that seen previously and the portal vein has a similar dimension at around 11--12mm. There is no adenopathy demonstrated. The kidneys and pancreas are normal. There is no significant pelvic abnormality demonstrated.
There is a small, enhancing lesion demonstrated low in the pelvis between urethra and rectum on the left which was present previously but because of the timing of the scan, not so well seen and is likely to represent a small vascular anomaly. Its unlikely to be of clinical consequence. Maximum dimension is 12mm.
Summary:
A number of arterial phase perfusion changes have been demonstrated, only one of which was clearly seen on the previous scan from 2008. This is partly due to the slight difference in the timing of the sequences, with today's scan being a very arterial sequence. All of these lesion are small and therefore very difficult to characterise but some have fairly distinctive perfusion anomaly appearances. The lesions of suspicion would be that which is centred slightly more centrally in segment 6 at approximately 6mm, and seg7 at 4mm. These do not, however, show significant wash-out.
At this stage these lesions are probably too small to be further accurately characterised by MRI and ,in the absence of a rise in AFP. followup surveillance with a combination of ultrasound and CT should be continued.
请问411 老师，我需要再做MRI吗？

作者: galaxy5230 时间: 2011-1-13 15:59

全是英文，考验英语水平啊

作者: 瓶儿 时间: 2011-1-13 18:42

顶起，，只有411老师能看得懂了

作者: 三叠 时间: 2011-1-13 19:54

本帖最后由三叠于 2011-1-13 23:19 编辑

411好像最近回帖少了。
好像没有提示有异常血流信号，arterial sequence=异常的动脉血流？请411解读。最大的那个也没有大变化。最近AFP怎么样呢？
不过既然建议作MRI就做吧，有什么问题呢？经济？麻烦？上次也作过MRI？
以后为什么不直接MRI？

西方就是不一样，每一个灶都描述得很清楚。特别是我觉得西方医生的表述中敢于使用“I think probably”，这样的表述其实代表一种责任和信心。

作者: 三叠 时间: 2011-1-13 19:55

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稀客啦，有空上海来玩，世博会来看了吗？

作者: liliya 时间: 2011-1-14 05:38

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谢谢你的回复。我的AFP一直都很正常，2008年做CT的时候，也是这样的结果，那时就没要求MRI，就直接抗病毒治疗了，每三个月验血，六个月B超，情况还好，这次专家要求CT检查，我曾咨询过411老师，他说做B超就行，没必要CT，没想到CT完了，又要求MRI, 我就有点紧张，是不是有什么大的问题。
另：半年前，专家让我把恩替换成替诺福韦，我咨询411老师，411老师让我坚持恩替就行了。

作者: liver_GZ 时间: 2011-1-14 12:48

确实太长很费时间。
最后结论：At this stage these lesions are probably too small to be further accurately characterised by MRI and ,in the absence of a rise in AFP. followup surveillance with a combination of ultrasound and CT should be continued.
结合专业，大致意思是：目前病灶太小，且AFP阴性，因此CT和MRI很可能都无法准确定性。建议通过AFP、超声和CT复查密切随访观察。

作者: 三叠 时间: 2011-1-14 13:19

问题是：A number of arterial phase perfusion changes have been demonstrated
意味着什么呢？

作者: 天水间 时间: 2011-1-14 16:09

A number of arterial phase perfusion changes have been demonstrated
大量的动脉相灌注修改已被展示

作者: liliya 时间: 2011-1-14 17:09

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谢谢liver_GZ版主的回复。
At this stage these lesions are probably too small to be further accurately characterised by MRI 。
这句话的意思是：这个阶段受损的组织太小，要通过MRI来进一步确诊，　还是：这个阶段受损的组织太小，MRI 也不能确诊。请liver_GZ指教。谢谢！

作者: liliya 时间: 2011-1-14 17:14

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综合前文好像是，以前作的ＣＴ是动脉增强，这次变成了静脉增强，所以有变化。

作者: liver_GZ 时间: 2011-1-14 17:40

本帖最后由 liver_GZ 于 2011-1-14 17:52 编辑

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哈，楼上来英语考试（A或B），要让露馅了。最后Admin和411老师当裁判。

如果没有futher，我肯定倾向后者。

但有了further ，似乎有那个意思：建议进一步的MRI准确定性（但小病灶lesion除了血管瘤外，MRI准确性并不高）。
但结合整个句子，我仍然选择后者。

抱歉，露馅！

能否贴出CT片？

作者: 三叠 时间: 2011-1-14 20:06

本帖最后由三叠于 2011-1-14 20:10 编辑

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通过MRI进一步定性，所以既然有这样的建议，就应该MRI，合理吗。

作者: 三叠 时间: 2011-1-14 20:24

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A number of arterial phase perfusion changes have been demonstrated, only one of which was clearly seen on the previous scan from 2008.
一定数量的(再生结节)显示为动脉灌注阶段，而在此前2008年的扫描中仅有其中一个能够清楚显示。

我觉得这个好像进一步确诊为好。

另就是觉得该报告中都是和前一次的比较，我很想知道为什么国内的报告陈述模式完全不同？

作者: liliya 时间: 2011-1-15 10:24

本帖最后由 liliya 于 2011-1-15 17:04 编辑

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我有他们给的CT片子和DVD，但不知如何上传到论坛上来。
我真是外行，人家给我的可能是电子档，但是文件太大，不能上传。

作者: 瓶儿 时间: 2011-1-15 15:48

三叠发表于 2011-1-13 19:55
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稀客啦，有空上海来玩，世博会来看了吗？

谢谢哈，10号刚从上海回来，，早知道就来看望您了哦~~~~
世博走马观花了一下下，，同时和战友小聚了一下下，，相比世博，，我觉得战友小聚更开心哟~~~

作者: liliya 时间: 2011-1-15 17:10

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我是想做MRI，正好我马上要回国了，我对专家说，我回中国做行吗？专家说你最好回来在这里做，
唉，我也是想节省几个钱啊，所以到论坛和大家讨论。

作者: liver411 时间: 2011-1-16 14:19

第六个段图像上有几个病变（lesions)，此前没有看到除去第一个2008和期间的检查有看到过。主要是那个6毫米和第七阶段图像上4毫米的东西。因为有动脉期增强，但是门脉期间回复等密度所以很难判断。有可能是结节，血管瘤，病变（分化不好），即使你做MRI也不好分析。不如2-3个月重复CT或结合超生检查评估外加AFP。此外，7，4A阶段图像也都有增强不过门脉期间也呈现等密度。可能是灌注，结节或其它问题。
此外腹腔的靠近直肠和尿道左侧附近有个此前扫描看到过的东西可能是血管病变（比如，内痔）。
2-3个月重复CT看看。

PS：2008到目前都是CT么？还是超生交替？

作者: liliya 时间: 2011-1-17 12:45

本帖最后由 liliya 于 2011-1-17 13:28 编辑

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谢谢411老师的回复。
我是2008年6月做过一次CT，然后一直是每半年B超，只是这次专家突然要求改成CT, 以前我曾咨询过您，您说不必要做，但是我怕有问题，就勉强做了，谁想这个完了，又要求做MR，我郁闷死了，尤其是我说我最近回中国，不如我回中国做，但是他说最好还是回来这里做，我很矛盾，因为我是固定去看这位专家的，如果我不听他的，会不会对我不利呀。另：这位专家是香港人，但不会讲中文，只讲英文。以下是专家给我的report：
Problems：
1。HBeAg negative chronic hepatitis B with elevated liver enzyme tests and HBV DNA level of 30188IU/ml pre-treatment
2.Ultrasound and CT scan sugges liver cirrhosis with regenerative nodule, but no evidence or portal hypertension
Medication:
Entecavir 0.mg daily commenced 19/06/08
most recent blood tests from 18.12.10 shows : Hb 138, WCC 5.4, platelets 111,creatinine 61,bilirubin 13, ALP 44, GGT 28, ALT 21,AST 24, albumin 43, HBs Ag positive, HBV DNA <20 and AFP2.3ug/l
Repeat CT scan on 7.1.11 showed a number of arterial phase perfusion abnormality/lesions,which were similar to that of her previous scan in 2008. The maximal demension of the lesions was about 12mm. None of the lesions had characteristic changes for HCC.
Her hepatitis B is under good control. In view of the radiology one is obviously concerned that she could develop HCC in a cirrhotic liver. I have therefore arranged for her to have an MRI scan to try to characterise the liver lesions further and we can also use as a baseline as clearly ashe weill require repeated liver imaging and sequential MRI's would avoid the risk of radiation. I will get back to lily once I have the result, which is likely to have done when she returns from her trip back to China in five weeks time. She will have her next blood test in three months and formal review after that.

作者: liver411 时间: 2011-1-17 13:19

At this stage these lesions are probably too small to be further accurately characterised by MRI and ,in the absence of a rise in AFP. followup surveillance with a combination of ultrasound and CT should be continued.

在目前这个阶段，这些病变太小以至于在进一步的MRI扫描上也不好准确定性。在AFP不高的情况下，应继续超声结合电子断层扫描观察。

你目前不需要那么急做MRI因为有可能仍是继续观察不能绝对定性的结论。（影像放射科就是这样，不排除，也不能确定的时候）

主要是你2008和2011期间没有CT+显影的对照，如果期间有对照，没有变化，也不需要怎样。

过2个月再重复CT/MRI就好了。

作者: liliya 时间: 2011-1-17 13:35

本帖最后由 liliya 于 2011-1-17 13:38 编辑

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再次感谢411老师。
这是我的医疗报告：
Problems：
1。HBeAg negative chronic hepatitis B with elevated liver enzyme tests and HBV DNA level of 30188IU/ml pre-treatment
2.Ultrasound and CT scan sugges liver cirrhosis with regenerative nodule, but no evidence or portal hypertension
Medication:
Entecavir 0.mg daily commenced 19/06/08
most recent blood tests from 18.12.10 shows : Hb 138, WCC 5.4, platelets 111,creatinine 61,bilirubin 13, ALP 44, GGT 28, ALT 21,AST 24, albumin 43, HBs Ag positive, HBV DNA <20 and AFP2.3ug/l
Repeat CT scan on 7.1.11 showed a number of arterial phase perfusion abnormality/lesions,which were similar to that of her previous scan in 2008. The maximal demension of the lesions was about 12mm. None of the lesions had characteristic changes for HCC.
Her hepatitis B is under good control. In view of the radiology one is obviously concerned that she could develop HCC in a cirrhotic liver. I have therefore arranged for her to have an MRI scan to try to characterise the liver lesions further and we can also use as a baseline as clearly she will require repeated liver imaging and sequential MRI's would avoid the risk of radiation. I will get back to lily once I have the result, which is likely to have done when she returns from her trip back to China in five weeks time. She will have her next blood test in three months and formal review after that.

作者: liver411 时间: 2011-1-17 13:45

挺好的，HBV DNA<20/29? IU/ml 大约低于150copies/ml。他认为是2008看到的类似的影像不正常地方。
他已经帮你预约MRI（主要是放射科顾虑肝硬化容易癌变的建议和缘故）。之后可能也是MRI因为减少放射线因素。MRI5个星期后妳从国内回来做（时间也比较恰当）。三个月血液检查+再报告。

作者: liliya 时间: 2011-1-17 14:33

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谢谢411老师。

作者: 三叠 时间: 2011-1-17 18:22

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411借问一下，欧美医生都是这样能够写报告吗？和国内的陈述方式很不一样，特别是从没有见过报告里用“我认为”、“我建议”等等，国外是不是都是唯一一个医生负责制的？

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