What Is the Treatment for Liver Calcification?

Intrahepatic calcification refers to the presence of strong echoes or high-density images like stones in the liver on B-mode or CT images. It is more common in people aged 20-50 years old, and the incidence rate is equal for men and women. Generally, there is a single calcification, and the right liver is more common. In the left liver, left and right liver calcifications rarely occur at the same time.

Basic Information

Chinese name

Intrahepatic calcification

Foreign name

Intrahepatic calcification

Category

Liver case changes

Scope of application

Medical Terminology

Detection method

B-ultrasound

Similar condition

Intrahepatic bile duct stones

Causes of intrahepatic calcification

There are many lesions that form intrahepatic calcification, including: intrahepatic bile duct stones are the most common factors; chronic inflammation or trauma in the liver; parasitic infections; benign and malignant liver tumors and intrahepatic metastases; Development, fetuses in the uterus with intrahepatic calcification, often with congenital malformations, the detection rate is 0.057%.

Examination method of intrahepatic calcification

B-ultrasound is preferred for diagnosis and differentiation of intrahepatic calcifications;

CT has high resolution and clear calcification. It is mainly used for B-ultrasounds that are difficult to identify intrahepatic calcifications, especially patients with suspected intrahepatic metastases.

Characteristics of intrahepatic calcification

Features of intrahepatic single or multiple isolated and unfused calcifications

Most intrahepatic calcifications are found by accident during normal physical examination. For single or multiple isolated and non-fused calcifications in the liver, no conscious symptoms and signs, and abnormal liver size and morphology may be related to congenital development, malnutrition, Disturbance or damage of calcium and phosphorus metabolism is related to some factors, and it may also be some lesions, such as intrahepatic bile duct stones, liver abscesses, or changes after liver wound healing.

The B-mode images of this type of intrahepatic calcification are characterized by strong echoes scattered in the shape of "pin" or "equal sign". They travel outside the bile duct cavity, and there are mostly no sound shadows or light sound shadows at the back, and no intrahepatic bile duct dilatation . No treatment is needed for this type of intrahepatic calcification. For the sake of caution, follow-up observation of this type of calcification can be performed for 2 to 3 years, and the B-ultrasound should be reviewed every 3 to 6 months.

Features of calcification in intrahepatic bile duct stones

The strong echo group with sound and shadow in the back travels in the intrahepatic bile duct, and is usually beaded. If there is a liquid dark area around the bright light group, accompanied by proximal bile duct stenosis and distal bile duct dilatation, it can be more determined as intrahepatic bile duct stones. CT can clearly show the location, size, morphology and accompanying lesions of intrahepatic bile duct stones, and enhanced scanning can also identify localized mild bile duct dilatation and liver atrophy, which are difficult to show by B ultrasound, and exclude other lesions.

Characteristics of intrahepatic calcification

Primary benign tumors in the liver, calcification is more common in hepatic cavernous hemangioma, and fibrous septum and small blood vessels separating the tumor can be calcified, showing spots or bands. Primary liver cancer calcification is rare, with an incidence rate of only 0.36% to 1.2%. It is more common in fibrous lamellar hepatocellular carcinoma and hepatoblastoma. The former is more common in adolescents, and the latter is mostly <5 years old children. Inside the tumor, it is stellate or nodular.

Intrahepatic metastatic tumor calcifications are cancerous lesions formed by metastasis of other parts to the liver. They are more common in lesions> 3 cm in diameter, and less than 2 cm in calcification. Calcification can be distributed in the center or periphery of the mass, and some are located in In the entire lesion, the B-mode images of metastatic tumors typically show a "bull's eye" sign, that is, low echoes at the edges and high echoes at the center. CT manifestations of metastatic tumors are also multiple manifestations, showing grit-like calcification, irregular plaques, or speckled calcifications. In short, there is no obvious regularity in the distribution and morphology of calcifications in metastatic tumors.

Those with suspected intrahepatic metastatic tumor calcifications must first consider colon cancer metastasis, followed by breast cancer, gastric cancer, thyroid cancer, ovarian cancer, lung cancer, smooth muscle cancer, islet cell tumor, osteosarcoma, and melanoma. Therefore, Actively look for primary cancer. The pathogenesis of tumor calcification is still unclear, and may be related to nutritional calcification, that is, the tumor is caused by bleeding or ischemic degeneration and necrosis or the tumor itself secretes some substances such as glycoproteins and mucopolysaccharides to cause calcification. Intrahepatic metastasis calcification is often accompanied by Elevated alkaline phosphatase may cause tumor calcification to accelerate tumor cell death. Calcified tumor cells are inevitably dead cells. Therefore, tumors with calcification often indicate a good prognosis. However, calcified lesions cannot be used as a basis for the diagnosis of primary or secondary tumors, and they cannot be distinguished from benign and malignant tumors. Comprehensive data such as clinical manifestations, imaging, and auxiliary examinations should be integrated. If necessary, ultrasound biopsy or CT guided biopsy should be performed. To obtain a histological diagnosis.

Characteristics of calcifications in liver parasites

Calcification of liver parasitic disease can also occur. Hepatic hydatid disease and hepatic schistosomiasis are common. The former are more common in herders, and the latter are mostly farmers and fishermen in affected areas. Hepatic hydatid disease The liver lesions are formed by the aggregation of numerous small vesicles, which diffusely infiltrate and grow. The boundary with normal liver tissue is unclear, and calcium salts are deposited on the cyst wall. On the B-mode image, there was a strong echo of cysts accompanied by sound shadows. CT showed blurred and irregular edges of the lesion, and extensive granules or irregular calcifications were visible. Liquefaction and necrosis could occur in the center of the lesion, and the enhanced scan did not strengthen the lesion. A large amount of calcification and infiltration Cystic low-density areas of varying size in the foci are characteristic CT signs. The ultrasound and CT images of schistosomiasis of the liver show a variety of manifestations depending on the degree of infection. The characteristic images are calcification of the liver capsule and interval-like calcification of the liver parenchyma, which collectively constitute a "map liver" or "turtle-like" performance. Chronic inflammation in the liver is more common in tuberculosis and liver abscess, and rare in mycosis, brucellosis, portal vein thrombosis and nodular disease. These types of calcifications lack characteristic B-mode and CT images, and are difficult to distinguish from primary liver cancer and intrahepatic metastases. However, the plain X-ray film has a very large diagnosis. On 50% of the liver areas, calcifications are evenly distributed in the left and right lobes of the liver. 90% of the calcifications are 8-12 mm in size. Individual fusion calcifications can reach 3 to 4 cm. Furthermore, signs of tuberculosis were seen on chest radiographs in 65% of patients. Liver abscess calcification occurs frequently during the healing period, which occurs in the cyst wall or the edge of the lesion. Even after more than 10 years of liver abscess healing, B-mode or CT examination still shows a more complete calcification ring, and clearly outlines the size and shape of the original abscess.

Diagnosis and identification of intrahepatic calcification

Intrahepatic bile duct stones are stones above the confluence of the left and right hepatic ducts. Most are due to the large curvature of the intrahepatic bile duct, and the bile generated by hepatocytes flows slowly in the intrahepatic bile duct, causing the bile duct in the intrahepatic bile to be eliminated poorly and silted to form stones; the other is due to recurrent cholangitis, Bile duct stenosis and cholestasis caused the formation of stones. Intrahepatic bile duct stones are often associated with cholestasis or inflammatory infections, leading to hepatic atrophy and hepatic displacement of the liver lobe and segments above the bile duct, biliary liver abscess, and biliary cirrhosis. Causes intrahepatic bile duct cancer. Therefore, once the diagnosis of intrahepatic bile duct stones is clear, early treatment should be performed, and the current treatment of intrahepatic bile duct stones is mainly based on biliary surgery. Causes of calcification of liver parenchyma can be caused by previous trauma, hemorrhage, abscess or granulomatous calcification scars; calcification lesions formed by worm bodies or eggs of certain parasites (cysticercosis, schistosomiasis, tapeworms, etc.); tuberculosis , Mold, syphilis, sarcoidosis, etc. all cause localized calcification in the liver. These calcifications mostly indicate that the lesion has stabilized or healed, and no special treatment is required. Therefore, ultrasound doctors need to combine medical history before diagnosis, based on the location, number, shape, size of the echogenic lesions, whether the bile ducts inside and outside the liver are dilated, liver parenchyma, and liver capsule.

Sonographic features and identification points of intrahepatic bile duct stones and intrahepatic calcifications

Intrahepatic bile duct stones:

(1) There are fine dots, spots, strands, rosary, round or lumps-like strong echoes (or medium to high echoes) in the liver, irregular borders, and they often appear isolated in the liver. Scattered or fusion, often accompanied by sound and shadow; (2) The strong echoes of the above forms are distributed along the intrahepatic bile duct, often accompanied by dendritic and cystic expansion of the intrahepatic bile duct, and the stones are located in the expanded bile duct, which is reliable Diagnostic basis. If the bile duct is filled with bile around, the anterior wall of the bile duct is clear, otherwise the bile duct line is unclear; (3) due to cholestasis of the liver segment and leaf where the stone obstruction is located, resulting in damage to a segment or multiple leaves in the liver; (4) The involvement of the left lobe of the liver is more common, which is consistent with related reports (Figure 1).

Intrahepatic calcifications:

(1) Strong echogenic lesions can appear in any part of the liver parenchyma, isolated, and can be accompanied by sound shadows; (2) inconsistent with the intrahepatic bile duct movement, without intrahepatic bile duct dilatation; (3) the surrounding liver tissue is normal (hepatic parenchyma without Other lesions); (4) Mostly occurred in the right lobe of the liver, and there was no significant change in periodic review and follow-up (Figure 2).

Figure 2 Sonogram of intrahepatic calcification

Figure 1 Sonogram of intrahepatic bile duct stones

Intrahepatic calcification

Intrahepatic calcification is a pathological change after certain liver lesions are stabilized or healed. According to clinical observations, the lesions will not subside or continue to develop. Because the lesions are small, they generally do not cause significant adverse effects on the body. Therefore, other liver diseases such as intrahepatic bile duct stones are excluded. After a clear diagnosis, treatment is generally not required. Periodic B-mode ultrasound examination can be performed, and follow-up observation is sufficient. Only patients with a clear diagnosis of intrahepatic bile duct stones require treatment when cholestasis or suppurative cholangitis occurs, and local resection of the lesion should be performed at the same time as hepatic bile duct stones are treated. In particular, it is necessary to point out that in the outpatient work, clinicians should raise awareness, especially for simple intrahepatic calcifications, should pay attention to distinguishing from intrahepatic bile duct stones to avoid misdiagnosis and mistreatment and bring unnecessary psychology to patients And financial burden.

Reference source of intrahepatic calcification

[1] Liu Shijing. Identification of intrahepatic calcifications [J]. Chinese Community Physician, 2011,27 (07): 16.

[2] Lu Yangping, Li Xinxin. Ultrasound for the differential diagnosis of intrahepatic bile duct stones and intrahepatic calcifications [J]. Chinese Journal of Ultrasound Diagnosis, 2006 (02): 102-104.

[3] Chen Zhong, Ni Jialian, Liu Luyue, Yan Jianjun, Huang Liang, Yan Yiqun. Report of 12 cases of intrahepatic calcification [J]. Abdominal Surgery, 2007 (02): 92-93.