螺旋CT及血管造影在肝癌破裂诊断中的价值

The value of spiral CT and angiography in diagnosis of ruptured hepatocellular carcinoma

目的评价螺旋CT及血管造影在肝癌(HCC)破裂诊断中的价值。方法对临床确诊HCC破裂的108例患者的影像资料进行回顾性分析,其中螺旋CT检查42例,血管造影检查94例次,21例患者先后行螺旋CT及血管造影检查。94例次血管造影病例均行选择性肝动脉造影及超选择性肝动脉造影。由两位主治医师以上职称的放射科医师共同诊断,对其阳性征象进行分类、总结,比较两种检查方法对HCC破裂诊断的检出率以及不同肝动脉水平血管造影的检出率。结果螺旋CT诊断HCC破裂的阳性征象包括被膜下及腹腔内积血、肿瘤包膜中断伴瘤周血肿、活动性对比剂外溢及"去核征",共检出40例HCC破裂(40/42),诊断阳性率为95.2%。血管造影诊断HCC破裂的阳性征象包括小动脉喷血、微动脉洒血及毛细血管渗血,共检出37例(37/94),诊断阳性率为39.4%。螺旋CT检出率高于血管造影,二者差异有统计学意义(P<0.05)。21例同时行螺旋CT及血管造影检查,CT检出全部病例(100%),血管造影检出6例(28.6%),二者差异有统计学意义(P<0.01)。94例血管造影检查行选择性肝动脉造影检出15例(16.0%),行超选择性肝动脉造影检出35例(37.2%),二者检出率差异有统计学意义(P<0.05)。结论螺旋CT对肝癌破裂出血的检出率明显高于数字减影血管造影;超选择性肝动脉造影较选择性肝动脉造影的检出率高。

Objective To discuss the value of spiral CT and digital subtraction angiography（DSA）in the diagnosis of ruptured hepatocellular carcinoma（HCC）.Methods The images including 42 spiral CT and 94 DSA examinations of 108 patients with ruptured HCC were retrospectively analyzed.21 patients underwent both spiral CT and DSA examinations.94 patients underwent selective and superselective hepatic artery angiography.The imaging diagnosis of ruptured HCC were common confirmed by two radiologists.The positive signs of the two methods in detecting the rupture of HCC were summarized and the detection rates of the two methods were compared.The detection rates of selective and superselective hepatic angiography were also compared.Results 40 patients with ruptured HCC were confirmed by spiral CT examinations（40/42）with the positive signs including hemoperitoneum,surrounding hematoma,active extravasation of contrast materials,discontinuity of the hepatic surface and the enucleation sign.The positive rate was 95.2%.37 cases were confirmed by DSA（37/94）with the positive signs including spurting arteries,sprinkling arterioles and capillaries.The positive rate was 39.4%.The two methods were significantly different（P0.05）.The two methods were also significantly different in 21 patients who underwent both spiral CT and DSA examinations（P0.05）.All of the 21 patients were confirmed by spiral CT（100%）,while 6 cases by DSA（28.6%）.The selective hepatic angiography detected 15 cases（16.0%）and the superselective hepatic angiography detected 35 cases（37.2%）in the 94 patients who underwent both.There was a significant difference between selective and superselective hepatic angiography（P0.05）.Conclusions Spiral CT demonstrates a higher positive rate than DSA in diagnosis of the rupture of HCC.The superselective hepatic angiography has a higher positive rate than selective hepatic angiography.