目的总结不同病因的肝脏囊性病变的超声、CT和(或)MRI影像学征象,以提高肝脏囊性病变的诊断正确率。方法复习国内外关于不同类型肝脏囊性病变的影像学研究的文献,以病因为线索,总结其超声、CT和(或)MRI平扫及增强特点。结果肝脏囊性病变种类较多,其影像学表现多样且征象间存在重叠,不典型病例的诊断及鉴别诊断困难。(1)对于单纯性肝囊肿,影像学检查呈水样回声、密度及信号的圆形或类圆形囊性肿块,边界清晰,囊内无分隔,对比增强无强化。超声和MRI诊断的敏感性和特异性均较高,CT诊断价值不及这二者。(2)胆管错构瘤和Caroli病均表现为多发、广泛分布于全肝的单纯囊性小病变,多数无强化,与胆管是否相通是鉴别的关键征象。(3)相比肝内胆管囊腺瘤,壁结节强化多见于囊腺癌,准确诊断肝内胆管囊腺瘤应结合典型超声、CT及MRI表现。(4)囊性肝转移瘤表现为肝实质内或肝周多发以囊性为主的肿瘤,CT是其诊断的主要方法,其密度低于肝实质,增强扫描病变外周环形强化;行MRI检查可与单纯性肝囊肿鉴别。(5)囊性肝细胞癌表现为多房囊实性肿瘤,门静脉内如果出现癌栓可提高本病诊断准确性。(6)未分化胚胎肉瘤的CT平扫为边界清楚的囊状低密度肿块,边缘可有钙化,增强扫描肿块内软组织成分持续强化;MRI平扫肿块内部信号无特异性,肿块周边呈缓慢渐进性强化。(7)肝脓肿的不同形成时期有其特征性表现,不难诊断,但对于症状不典型时与肝内胆管细胞癌易误诊;(8)对肝囊型包虫病主要选超声检查,影像学检查的意义在于判断包虫囊的活性,而肝泡型棘球蚴病的主要诊断方法是CT,MRI检查可于术前评估病变与胆管和血管的解剖关系及判断有无侵犯,MRCP有重要诊断价值。结论腹部超声检查可作为肝脏囊性病变检查的首选方法,CT和MRI可作为有效的补充方法,合理选择多种影像学技术进行综合分析是关键,根据肝脏囊性病变的数目、形态以及是否有实性成分是诊断和鉴别诊断的重要征象。 Objective To summarize the ultrasound, CT and / or MRI features of liver cystic lesions of different etiologies in order to improve the diagnostic accuracy of cystic lesions of the liver. Methods To review the literatures on different types of liver cystic lesions at home and abroad, summarize the features of ultrasound, CT and / or MRI plain scan and enhancement by clues. Results There were many types of cystic lesions of the liver, with various imaging manifestations and overlapping signs. The diagnosis and differential diagnosis of atypical cases were difficult. (1) For simple hepatic cysts, the imaging examination is round or round-like cystic mass with water echo, density and signal, the boundary is clear, there is no separation in the cysts, contrast enhancement is no enhancement. Sensitivity and specificity of ultrasound and MRI diagnosis are high, CT diagnosis is less than the value of both. (2) Both cholangiocarcinoma and Caroli disease are characterized by multiple, widely distributed in the simple cystic lesions of the whole liver, the majority of no enhancement, and whether the bile duct is the key sign of identification. (3) compared with intrahepatic cholangiocarcinoma, wall nodules more common in cystic adenocarcinoma, accurate diagnosis of intrahepatic biliary cystadenoma should be combined with typical ultrasound, CT and MRI findings. (4) Cystic liver metastases showed mainly cystic tumors in the liver parenchyma or in the liver. CT was the main method of diagnosis. Its density was lower than that of the liver parenchyma, which enhanced the peripheral annular enhancement of the lesion. MRI was performed Can be identified with simple liver cysts. (5) Cystic hepatocellular carcinoma showed multiple solid cystic tumors, if there is tumor embolism in the portal vein can improve the diagnostic accuracy of the disease. (6) The CT scan of undifferentiated embryonal sarcoma was a clear cystic low-density mass with marginal calcification, and the enhancement of the soft tissue components in the mass of the scan continued to be intensified. The signal inside the MRI massacre was nonspecific and the mass of the mass showed a slowly progressive Sexual strengthening. (7) Liver abscess formation at different times has its characteristic performance, not difficult to diagnose, but atypical symptoms and intrahepatic cholangiocarcinoma is often misdiagnosed; (8) The main selection of hepatic cystic echinococcosis ultrasound imaging The significance of the study is to determine the activity of hydatid cysts, and the main diagnostic method for hepatic alveolar hydatid disease is CT, MRI can preoperatively assess the anatomy of lesions and bile duct and blood vessels to determine whether there is invasion, MRCP have Important diagnostic value. Conclusion Abdominal ultrasonography can be used as the first choice for the examination of liver cystic lesions. CT and MRI can be used as effective supplementary methods. It is the key to choose a variety of imaging techniques reasonably. According to the number and shape of liver cystic lesions, Solid ingredients are important signs of diagnosis and differential diagnosis.