原发性肝细胞癌少见CT征象及误漏诊分析

Analysis on rare CT manifestations and missed or misdiagnosis of HCC

目的探讨原发性肝细胞癌(HCC)少见CT征象,减少误漏诊,进一步提高肝癌CT诊断的准确性。方法回顾性分析8例经病理证实的HCC的临床资料。所有患者均经GE Lightspeed16螺旋CT常规平扫、增强后肝动脉期和门脉期及延迟期扫描,观察瘤灶多期动态扫描的CT征象。结果平扫时多数病灶境界模糊,增强后逐渐变清晰。病灶内部密度及强化特点分为4种类型:①病灶大面积脂肪变1例,平扫以略低密度为主,内见大量脂肪成分,动脉期呈轻度强化,密度整体略低于周围正常肝实质,门脉期密度明显低于周围正常肝实质,即低-低-低型伴大面积脂肪变。②病灶大面积囊性变1例,平扫呈低密度伴大面积囊变液化区及散在小片状高密度出血区,动脉期轻度强化,呈略低密度,门脉期以低密度为主,囊变区密度均匀,即低-低等混杂-低型;③延迟强化型2例,平扫呈略低密度,动脉期呈低密度,门脉期病灶呈环形强化,密度高于周围正常肝实质,内见片状不定形强化程度较轻的低密度区,即低-低-高型。④其它类型4例,平扫呈等或略低密度,病灶与正常肝实质境界不清,动脉期轻度不均匀强化,低于周围正常肝实质,门脉期呈更低密度,即等-低-低型或低-低-低型。结论动脉期无强化或强化较轻,或静脉期持续强化的肝癌结节,容易被忽视甚至误诊为其它病变,综合分析各期强化特点方可减少误漏诊。

Objective To determine the rare CT manifestations and missed or misdiagnosis of primary hepatoceller carcinoma （ HCC ） so as to improve the accuracy of CT diagnosis. Methods Eight cases with HCC confirmed by pathologic tests were reviewed. All the patients received GE Lightspeed 16 CT routine scan and dynamically contrast enhanced scan on hepatic artery, portal vein and delayed scan. The focus of tumors of dynamically CT manifestations were observed. Results The routine scan demonstrated blurred focus border, which gradually became clearer after contrast enhancement. The intratumor density and characteristics of enhancement could he divided into four types：①a fatty mass in one case.The routine scan demonstrated hypodensity With a lot fat inside the focus.The contrast enhanced scan demonstrated mild enhancement and the intratumor density was a little lower than the normal liver parenchyma at hepatic artery phase with much lower density at portal phase,i.e.low-low-low with a fatty mass.②Cystic changes in one case.The routine scan demonstrated low-density areas with a mass of cystic changes and fluids and the high-density small patches with hemorrhage areas. A little lower density was showed at hepatic rtery phase and low density at portal phase. The density is even in cystic change areas i i. e.low-low mixed-high-density type. ③Delayed enhancement in two cases.The routine scan demonstrated a little lower density.Low density was showed at hepatic artery phase and circle like enhancement with density higher than normal liver parenchyma was showed＇at portal phase. Inside the focus were patches with irregularly light enhancement with low-density i. e. low-low-high type. ④Other types in four cases. The routine scan demonstrated equal or a little lower density. The focus shared blurred borders with normal liver parenchyma. Uneven enhancement was showed at hepatic artery phase and the density was lower than normal liver parenchyma with much lower density at portal phase,i, e. equal-low-low or low-low-low type. Conclusion No enhancement or mild enhancement is showed at hepatic artery phase and continuously enhanced liver cancer nodular at portal phase is easy to be ignored or misdiagnosed as other pathological changes. Missed or misdiagnosis can be reduced through comprehensive analysis of the enhancement characteristics of each phase.