肝硬化合并肝癌与肝硬化再生结节螺旋CT双期扫描影像分析

Study of Dual Phased SCT Imaging in the Diagnostic Analysis of Liver Cirrhosis Complicated with Hepatoma or Regenerative Nodules

目的：分析肝硬化合并肝癌与肝硬化再生结节螺旋CT双期扫描的影像表现并评价其诊断价值。方法：回顾性分析30例肝硬化合并小肝癌,28例肝硬化再生结节螺旋CT平扫、动脉期、门脉期的CT征象。扫描层厚5-10mm,对比剂为60%的有机碘水溶液,用高压注射器静脉团注,注射流率3ml/s,总量80-100ml。动脉期扫描为注射开始后25-30s,门静脉期为60-70s。结果：小肝癌平扫多数为低密度,少数为等密度,动脉期全瘤范围强化,其强化密度高于肝但低于同层主动脉,门脉期肿瘤密度从高于肝迅速降至低于肝,同时也低于同层主动脉密度。肝硬化再生结节表现为平扫一般为等密度或稍高密度,动脉期大多数再生结节不强化或呈低密度,极少有轻度强化,门静脉期再生结节多数为均匀强化,少数为低密度。结论：螺旋CT增强双期扫描对肝硬化合并小肝癌具有诊断意义,特别是与肝硬化再生结节的鉴别诊断具有重要意义。

Objective：To evaluate the CT manifestations and the diagnostic value of dynamic dual phased spiral CT scans in the cases of hepatic cirrhosis complicated with hepatoma or regenerative nodules. Methods： The scans of 30 cases of liver cirrhosis complicated with liver cancer and 28 cases of cirrhotic liver with regenerative nodules scanned with dynamic dual phased spiral CT techniques were retrospectively studied. The technical details were as follows ： The slice thickness of the scans was 5-10mm;a volume of 80-100ml of 60% non-ionic contrast media was injected;the contrast media administration was accomplished with a bolus mode by a high power injector at an injection rate of 3ml/s, the arterial phased and portal vein phased scans were initiated 25 - 30s and 60 - 70s respectively after the initiation of the injection, Results： The majority lesions of the hepatocellular carcinoma （HCC） on CT plain scans were hypodense, while a few of them showed isodense, On arterial phased images, HCC revealed an enhancing mode of whole tumor extent enhancement, the attenuation of which was higher than that of the liver parenchyma,yet lower than that of the abdominal aorta on the same slice. In the cirrhotic liver with regenerative nodules, most of the lesions appeared generally as isodense or mildly hyperdense nodules on plain scans,and,non-enhanced or even hypodense as well as only a very few of them showed mildly enhanced on arterial phased scans, On portal vein phased scans, the regenerative nodules in most of the cases demonstrated homogeneous enhancement, while the minority of them still appeared as hypodense nodules, Conclusion：Spiral CT scan using dynamic dual （arterial and venous） phased scanning techniques played an important role in the diagnosis and differential diagnosis of HCC, especially in case that differential diagnosis between HCC and regenerating nodules was needed to make in the clinical cases of nodular lesions found in cirrhotic livers.