螺旋CT多期连续扫描在诊断肝多发性血管瘤及合并肝癌、肝转移瘤中的作用

The usefulness of hepatic spiral multi phase CT scanning in diagnosis of multiple hemangioma and coincident with hepatocellular carcinoma or metastatic tumor of the liver

目的 :分析肝多发性血管瘤及合并肝癌或肝转移瘤的CT表现 ,探讨螺旋CT多期连续扫描在诊断上的优越性。方法 :2 1例患者 ( 16例多发性血管瘤 ,2例肝血管瘤合并原发性肝癌 ,3例肝血管瘤合并肝转移瘤 )。按常规先对全肝进行平扫 ,然后于注射造影剂后 3 0秒、60秒、2分钟、5分钟、10分钟、15分钟后进行肝脏螺旋扫描。结果 :2 1例患者肝脏内病灶数共 75个。血管瘤病灶 66个 ,其中 2 1/ 66小血管瘤病灶平扫时表现为均匀低密度区 ,增强扫描 3 0秒、60秒 ,表现均匀强化 ,或边缘不规则强化 ,2分钟、5分钟、表现高密度或等密度灶 ;10分钟、15分钟 ,表现为等密度灶或低密度灶。 4 4/ 66例大血管瘤 ,增强扫描表现为强化渐向中心扩展 ;1/ 66例大血管瘤 ,5～ 15分钟 ,表现为边缘轻度强化。 2例肝血管瘤合并肝癌 ,肝癌病灶共 2个 ,平扫时为低密度灶 ,增强扫描 3 0秒表现为不均匀强化。 3例肝血管瘤合并转移瘤 ,转移病灶 7个 ,平扫表现低密度。增强扫描 5 / 7个病灶在 3 0秒、60秒表现为周边强化 ,2 / 7个病灶各期呈均匀低密度。结论 :螺旋CT多期动态扫描 ,不仅同时对肝多发性血管瘤做出诊断 。

Objective:The CT appearances of multiple hemangiomas and coincident with hepatocellular carcinoma or metastatic tumor of the liver with hepatic spiral multi phase CT scanning were analyzed,to investigate it's advantage in diagnosis. Metheods:At first,the precontrast CT scanning of the liver in 21 cases (16 multiple hemangiomas,2 multiple hemangiomas coincident with hepatocellular carcinomas,3 multiple hemangiomas combined with metastatic tumors of the liver) were carried out. The liver was scanned at 30sec,60sec,2min,5min,10min,15min seperately after injection of contrast medium. The characterization of all lesions were observed. Results:There were 75 lesions in 21 cases altogether.Twenty one of 66 little hemangiomas appeared homogeneous hypodense in precontrast images.After injection of contrast at 30 sec to 60 sec,the lesions appeared homogeneous attenuation or appeared peripheral area attenuation;all lesions appeared hyperdense or isodense at 2 min to 5 min,then appearing isodense or hypodense at 10 min to 15 min. The 44/66 large hemangiomas appeared gradual progressive opacification from the periphery to the center. One large hemangioma appeared peripheral slight attenuation of the lesion at 5 min～15 min.Two cases were multiple hemangiomas coincident with hepatocellular carcinomas. Two lesions of hepatocellular carcinomas appeared hypodense in precontrast.Then appeared heterogenous attenuation at 30 sec after injection of contrast medium.Three cases were multiple hemangiomas coincident with metastatic tumors of the liver,7 lesions of metastatic tumor appeared hypodense in precontrast. Five of 7 lesions appeared attenuation of the peripheral areas at 30 sec to 60 sec after injection of contrast medium. Two of 7 lesions continuously appeared hypodense. Conclusions:According to the results of hepatic spiral multiphase dynamic CT scanning, not only the hepatic multiple hemangiomas were diagnosed,but also hepatical hemangioma coincident with hepatocellular carcinoma or metastatic tumor of the liver can be diagnosed and differential diagnosed.