外生性肝癌的螺旋CT诊断

Helical CT for Diagnosis of Pedunculated Hepatocellular Carcinoma

目的探讨螺旋CT肝脏双期扫描对外生性肝癌的诊断价值,提高对该病的诊断能力。方法回顾性分析12例经病理证实的外生性肝癌螺旋CT肝脏双期扫描的临床和影像学表现。结果 12例中主诉有上腹疼痛或隐痛7例,其中6例可触及巨大包块,消瘦伴乏力3例,2例B健康体检发现;8例HbsAg(+),甲胎蛋白(AFP)增高9例,3例≥500ng/ml;12例外生性肝癌均与肝脏相连,呈向肝外生长的肿块,4例有明显蒂部,11例病灶内见"更低密度区",11例增强后表现为典型"快进快出"表现,CT多平面重建(MPR)能更好地显示肿块与肝脏的关系。结论外生性肝癌有明显的CT征象特点,螺旋CT肝脏双期扫描对外生性肝癌的诊断有较高的临床价值。

Objective To discuss the helical CT signs in the hepatocellular carcinoma and improve the diagnosis of this disease. Methods The clinical features of 12 cases of pedunculated hepatocellular carcinoma conformed by pathological examination and imaging finding of hepatic dual phase CT scanning were reviewed retrospectively. Results Of the 12 patients,7 cases complained of epigastric pain or vague pain ,6 cases visited for palpable mass ,3 cases were with emaciation and weakness, and 2 cases were detected by health examination. 8 cases were with HbsAg（ ＋ ） ,9 cases with elevated AFP, in which 3 cases with AFP≥500 ng/ml. The pedunculated hepatocellular carcinoma was connected with liver and presented a large epiphytic mass to the liver in 12 cases,4 cases were with a well defined peduncle;11 cases were showed hypodense areas within the tumor,and another 11 cases showed the typical enhancement change characteristic of ＂rising and lowering rapidly＂ by density. CT muhiplanar reconstruction（MPR） demonstrated the relationship between tumor and liver preferably. Conclusion Hepatic dual phase helical CT scanning is of great value in diagnosing the pedunculated hepatocellular carcinoma.