肝细胞癌螺旋CT表现特征与时间窗的相关性研究

Correlative Study of Spiral CT Features of HCC with Temporary Window Optimization

目的 探讨肝细胞癌螺旋CT增强表现及其随时间延迟所致的CT征象的变化过程。材料与方法 41例肝细胞癌患者 ,其中 13例经手术病理标本证实 ,其余患者由临床表现和实验室检查诊断。采用SiemensSomatomPlus 4A螺旋CT设备 ,先作平扫 ,然后在肿瘤靶平面进行动脉期同层面动态扫描 (延迟 14～ 2 1s)、全肝门静脉期扫描 (延迟 80～ 85s)及病变靶平面平衡期扫描 (延迟 170～ 2 85s)。着重观察、分析不同CT扫描时相肝细胞癌CT表现特征的动态变化过程及其病理学基础。结果 在CT扫描时间窗优化条件下 ,肝细胞癌可显示以下CT表现特征 :肿瘤供血血管及瘤区异常血管增强 (35 /41,85 .37% ,包括供血血管增多、僵直 ,瘤区异常血管、动静脉瘘等 ) ;大血管癌栓 (2 2 /41,5 3 .6 6 % ) ;肿瘤实质强化 (4 1/41,10 0 % ) ;肿瘤与肝实质界面改变 (境界清楚 2 6 /41,6 3 .40 % ;境界不清 15 /41,36 .6 0 % ) ;肿瘤相关肝段改变 (17/41,41.46 % )等。肿瘤供血动脉及瘤内血管显示最早、最佳及消退时间分别为18.37s、31.5 2s、5 2 .2 5s。肿瘤实质和包膜强化在不同时相也有一定规律。结论 不同CT征象随时间延迟有一定的演变过程 。

Objective To investigate the enhanced spiral CT features of HCC and the changing of these features with time.Materials and Methods Of 41 cases with HCC, 13 were surgically and pathologically proved, and 28 were clinically diagnosed. Plain scanning, singlelevel dynamic scanning of the target section during hepatic arterial phase (delaying 14～21 sec.), portal venous phase scanning (delaying 80～85 sec.) of the whole liver, and equilibrium scanning of the rarget section were performed. The dynamic changes of CT features and their pathological basis were observed and analyzed.Results The CT features of HCC under optimized timing window were as follows: (1) abnormal enhancement of tumorfeeding vessels and neoplastic vasculature (35/41, 85.3%), such as dilatation, stiffness of tumorfeeding vessels, neoplastic vasculature, and arterialvenous fistulas; (2) cancerous emboli in larger vessels (22/41, 53.66%); (3) enhancement of tumor mass (41/41, 100%); (4) clear (26/41, 63.4%) or unclear (15/41, 36.6%) interface between tumor and liver parenchyma; (5) abnormality of liver segment related to the tumor (17/41, 41.46%). For demonstrating the tumorfeeding vessels and neoplastic vasculature within the tumor, the appearing, optimal and fading away time was 18.37, 31.52 and 52.25 seconds, respectively.Conclusion With different delay time, the CT features of HCC change following a certain way, reflecting the hemodynamics and pathology of HCC.