肝癌螺旋CT双期增强扫描影像学特征及CT假阳性病灶的病理分析

Helical Double-phase CT Scan Imaging Features of Hepatocellular Carcinoma and Pathology of False-positive Lesions

背景与目的:肝细胞癌(简称肝癌)螺旋CT双期增强扫描“快进快出”的特点与其它病变存在交叉重叠的现象,为进一步提高螺旋CT对肝细胞癌诊断的准确性,探讨与肝癌螺旋CT双期扫描特点类似的病变,分析出现假阳性病灶的原因,并阐明它们与病理之间的关系。方法:收集自2000年12月至2002年12月中山大学肿瘤防治中心行螺旋CT双期增强扫描发现肝内病灶,并经手术切除、病理证实的病例52例(男性49例,女性3例),CT扫描共发现56个病灶。分析、总结肝癌病灶动脉期与门脉期增强特点,螺旋CT所见假阳性(falsepositive)病灶与病理结果对照分析。结果:本组52例的56个病灶中,癌灶51个,其中49个为肝细胞癌病灶,另有2例为肝细胞与胆管细胞的混合癌;假阳性灶5个。全部肝癌病灶动脉期明显不均匀强化;门脉期不均匀低密度;巨块型肝癌癌灶内可见不同程度坏死,小肝癌与结节性肝癌病灶内坏死较少见。病灶大部分边缘清楚,可见包膜。另外5个为CT扫描的假阳性病灶(8.9%),假阳性病灶病理诊断包括肝硬化结节增生、再生结节,肝硬化合并胆管增生、胆管结石合并胆管壁的炎性反应、纤维增生。假阳性病灶的螺旋CT征象与肝癌灶类似。结论:螺旋CT双期增强扫描对肝癌典型病灶可以明确诊断。假阳性病灶与典型的肝癌病灶双期螺旋扫描的CT征象差别不大,应结合临床资料进行分析,行随诊观察或病理活检证实。

BACKGROUND ＆ OBJECTIVE： The helical double-phase CT scan imaging features of hepatocellular carcinoma （HCC） overlap those of other hepatic lesions. This study was to investigate the helical double-phase CT scan imaging features of HCC to improve diagnosis accuracy. METHODS： Double-phase CT data and pathologic data of 52 HCC patients, received resection in Cancer Center of Sun Yat-sen University from Dec. 2000 to Dec. 2002, were analyzed. The double-phase CT features of HCC lesions were summarized. The pathology of false-positive lesions was analyzed. RESULTS： CT scan showed 56 lesions in the 52 patients. 51 were cancer lesions, including 49 HCC lesions and 2 mixed lesions of HCC and cholangioma, 5 were false-positive lesions. Arterial phase of these HCC lesions showed obvious heterogeneous enhancement, and the portal vein phase showed heterogeneous low dense. Necrosis was seen in all massive lesions, but was seldom seen in nodular and small lesions. Most lesions had clear borders and amicula. The pathologic diagnoses of the 5 false-positive lesions were hepatic cirrhosis with hepatocellular nodular hyperplasia, regenerative nodule, hepatic cirrhosis, bile duct calculus companied with inflammatory reaction, and fibrosis hyperplasia. CONCLUSIONS： Helical double-phase CT scan can be used to diagnose typical HCC lesions. There are no obvious differences in helical double-phase CT scan between HCC lesions and false-positive lesions. The diagnosis of HCC must be based on clinical information, follow-up or biopsy.