肝细胞癌累及肝后下腔静脉前间隙的CT表现及其解剖学基础

Involvement of retrohepatic tunnel by hepatocellular carcinoma:CT features and the anatomic basis

目的:探讨肝细胞癌累及肝后下腔静脉前间隙的CT表现及其解剖学基础,为临床提供全面的影像学信息。方法:回顾性分析27例CT扫描资料和临床资料完整的肝细胞癌累及肝后下腔静脉前间隙的病例,均经手术病理或经临床综合指标诊断。另选择临床诊断为肝细胞癌,但肝后下腔静脉前间隙无异常者5例作为对照组。着重观察病灶部位、大小、密度,肝后腔静脉前间隙是否受侵犯,肝后腔静脉前间隙内肿块强化特征。结果:(1)27例肝内病灶直接和/或经肝裸区累及肝后下腔静脉前间隙;其中3例肝内病灶经肝裸区累及肝后下腔静脉前间隙;20例为肝内病灶直接累及肝后下腔静脉前间隙;4例为肝内病灶直接累及和经肝裸区累及肝后下腔静脉前间隙两种途径;(2)肝内病灶直接累及肝后下腔静脉前间隙表现为肝内肿块侵出肝脏,肝后下腔静脉前间隙消失,下腔静脉与肝脏交界处边缘不齐。肝内病灶经肝裸区累及肝后下腔静脉前间隙表现为肝内肿块经肝裸区长入肝后下腔静脉前间隙内形成软组织肿块,且其强化特点与肝内病灶一致。结论:肝细胞癌可直接和/或经肝裸区累及肝后下腔静脉前间隙。根据CT表现,可判断肝细胞癌是否累及肝后下腔静脉前间隙。

Objective： To analyze the CT features and its anatomic bases of hepatocellular carcinoma （HCC） involving the retrohepatic tunnel（RT）, providing comprehensive iconography information on clinical application. Methods： The CT scanning data and detailed clinical information of 27 cases who inflicted by HCC involving the RT were analyzed. All of cases had been confirmed by surgical pathology and clinical comprehensive index diagnosis. Five cases with HCC involvement but normal RT were selected as normal group .The location, size and density of focus ,the condition of RT and its mass＇ feathers after being invaded by HCC were emphasizely put under observation. Results： （1）Among 27 cases, the focus of liver have three ways to invade the RT, one through the bare area （3 cases） and one invade directly （20 cases） and one with compound channels above（4 cases ）.（2） the identity of directly invading RT form the focus was the jagged mass in the liver, the disappearance of the RT and irregularity of the anterior edge of the inferior vena cava. Conclusions; The HCC can invade the retrohepatic tunnel directly or though bare area of liver or with both ways above, and it can be accurately diagnosed by CT.