快速填充型肝血管瘤与肝细胞癌的CT鉴别诊断

Differential Diagnosis of Rapidly Filling Hemangioma and Hepatocellular Carcinoma by CT

目的:通过动态CT扫描鉴别快速填充型肝血管瘤(HCH)与肝细胞癌(HCC)。方法:回顾性分析并比较动脉期呈均匀强化的11例HCH(13个病灶)和38例HCC(45个病灶)的动态CT表现,包括病灶大小、平扫密度值(AV)、动脉期密度增加值(EV)、动脉-门静脉(A-P)分流及假包膜出现率、门静脉期及延迟期的强化特点。结果:HCH病灶的动脉期EV、A-P分流及假包膜出现率分别为(112.31±25.17)HU、30.8%和0%,HCC的分别为(50.76±14.62)HU、2.2%和24.4%,两者差异均有显著性意义(P<0.05);门静脉期,13个HCH病灶有8个呈高密度、5个呈等密度,45个HCC病灶4个呈高密度、12个呈等密度、29个呈低密度,两者差异有显著性意义;延迟期,13个HCH病灶2个呈高密度、11个呈等密度,35个HCC病灶3个呈等密度、32个呈低密度,两者差异亦有显著性意义(P<0.05);而HCH和HCC的病灶大小、平扫AV的差异均无显著性(P>0.05)。结论:综合病灶的动脉期EV、A-P分流及假包膜出现率、门静脉期及延迟期的病灶强化特点,CT动态扫描可以对动脉期呈均匀强化的HCH和HCC进行有效的鉴别诊断。

Objictive： To differentiate early homogeneouMy enhancing hepatic cavenous hemangioma （HCHs） from hepatoeellular carcinoma （HCCs） by dynamic CT. Methods：The CT findings, including size of the lesions, attenuation values （AV） on non-enhanced images, enhancement values （EV） of arterial phase, prevalence of arterio-portal （A-P） shunting and pseudocapsule, and enhancement characteristics of potal venous phase and delayed phase, were analyzed retrospectively and compared in 11 patients with 13 HCHs and 38 patients with 45 HCCs. Results：Of the HCHs, the EV of arterial phase, prevalence of A-P shunting and pseudocapsule were （112.31±25. 17）HU,30.8% and 0,respectively,and those of HCCs were （50.76±14.62） HU, 2.2% and 24.4%, respectively, with the difference being significant between two groups. At portal venous phase,of the 13 HCHs,8 lesions showed hyper-attenuation and 5 lesions iso attenuation;of the 45 HCCs,4 lesions showed hyper-attenuation, 12 lesions iso-attenuation and 29 lesions hypo-attenuation. At delayed phase, of the 13 HCHs, 2 lesions displayed hyper attenuation and 11 lesions iso-attenuation;of the 35 HCCs,3 lesions displayed iso attenution and 32 lesions hypo-attenuation. The enhancement characteristics of HCHs in both portal veneous phase and delayed phase were significantly different from those of HCCs. The differences in size and AVs of non enhanced phase between HCHs and HCCs were not significant. Conclusion：Based on the EV of arterial phase, prevalence of A P shunting and pseudocapsule and enhancement characteristics of potal venous phase and delayed phase, dynamic CT could differentiate effectively early homogenously enhancing HCHs from HCCs.