小肝细胞癌的影象学评价

EVALUATION OF IMAGING METHODS IN THE DIAGNOSIS OF SMALL HEPATOCELLULAR CARCINOMA

以１１８例经手术后病理证实的小肝细胞癌（ＳＨＣＣ）作计算机Ｘ线体层摄影（ＣＴ）分析。增强前（ＮＣ）的敏感性（６２．２％）低于增强后（＋Ｃ）（７８．１％），低于进床式动态团注增强ＣＴ（ＤＩＢ－ＣＴ）（８４．６％），Ｐ＜０．０１、Ｐ＜０．０５，但与４ｈ延迟ＣＴ（Ｄ－ＣＴ）（７８．５％）相比Ｐ＞０．０５。动脉造影ＣＴ（ＣＴＡ）、经动脉门脉造影ＣＴ（ＣＴＡＰ）的敏感性显著高于ＮＣ（Ｐ＜０．０５）。Ｂ超（ＵＳ）的敏感性显著低于＋Ｃ、ＣＴＡ和ＣＴＡＰ（Ｐ＜０．０５）。同位素（ＰＭＴ）检查的敏感性均低于其他各种影象学方法（Ｐ＜０．０１）。对≤１ｃｍ的ＳＨＣＣ，以ＣＴＡ（７１．４％）和ＣＴＡＰ（１００％）的敏感性为最高，与ＵＳ（３．０％）和＋Ｃ（１５．２％）相比Ｐ＜０．０１。对ＳＨＣＣ的定性诊断，以ＣＴＡ和ＤＩＢ－ＣＴ最佳。以ＣＴＡ和ＣＴＡＰ敏感性最高，ＤＩＢ－ＣＴ和Ｄ－ＣＴ次之，常规ＣＴ优于ＵＳ。

CT study were performed in 118 cases of small hepatocellular carcinoma(SHCC) confirmed by operation and pathoology. The sensitivity of non-contrast(NC) (62.2%)in detecting SHCC was lower than that of postcontrast(+C)(78.1%), and lower than that of DIB-CT (84-67%), P<0.01, P<0.05. Thesensitivity of D-CT (87.5%) was higher than that of three methods mentionedabove, but there was no significant difference, P>0.05. The sensitivity of CTAand CTAP was higher than that of NC, P<0.05. The sensitivity of US (68.4%)was lower than that of +C, CTA and CTAP, P<0.05. The sensitivity of PMTwas lower than that all other imaging methods, P<0.01. As to SHCC (≤1 cm),the sensitivity of CTA (71.4%) and CTAP (100%) was higher than that of US(3%) and +C (15 .2%) , P<0 . 01. The accuracy was high in determing the SHCCfor CTA and CTAP. It was believed that CTA and CTAP was highest insensitivity for detection of SHCC among all imaging methods, DIB-CT and D-CTwas next, NC and +C was better than US in this aspect.