多排螺旋CT对早期小肝癌的诊断价值

Value of multi-slice CT in the diagnosis of small hepatocellular carcinoma

目的探讨早期小肝癌(SHCC)的CT表现,提高对该病的诊断水平。方法回顾性分析30例经手术病理、定期随访观察确诊的SHCC患者CT图像及临床资料。所有病例均行多排螺旋CT(MSCT)平扫、动态增强扫描;5例行CT灌注成像(CTA)进一步检查,其中3例行肝动脉造影CT(CTHA)检查,2例行肝动脉门静脉造影CT(CTAP)检查;2例较小病灶行碘油CT扫描。结果 30例中共检出36个病灶,直径0.45～3.2cm,平均2.6cm,其中1.5cm以上24个病灶,有6例病灶周围分别见0.5～0.8cm的子灶;CT平扫:26例病灶呈低密度,密度较均匀,5例病灶呈等密度;8例较大病灶周围可见环形低密度影;2例合并有脂肪肝,平扫病灶呈高或等密度;增强扫描:动脉期29个病灶明显均匀、不均匀强化,呈高密度结节状,强化峰值高;门静脉期病灶呈均匀、不均匀低密度,平衡期呈低密度;7例病灶周边有环形强化;CT灌注成像:在CTHA中表现为多血供。在CTAP检查中,表现为灌注缺损;2例见有少许碘剂沉积影。结论早期肝细胞癌有一定的CT特征,尤其多排螺旋CT动态增强扫描,结合CTA及碘油CT,对早期SHCC定位、定性诊断具有较高的价值。

Objective To explore the CT findings of small hepatocellular carcinoma （SHCC）, in order to im- prove the diagnosis and treatment of the disease. Methods CT images and clinical data of 30 patients with SHCC confirmed by pathology and follow-up were retrospectively analyzed. All the patients were performed multi-slice CT （MSCT） and dynamic enhanced CT. Among them, CT perfusion imaging were done in 5 cases （3 for CTHA and 2 for CTAP）, and iodized oil CT scan were performed in 2 cases. Results A total of 36 lesions were detected, ranging from 0.45 to 3.2 cm in diameter （2.6 cm in average）, of which 24 were larger than 1.5 cm in diameter. Satellite nodules of 0.5-0.8 cm in diameter were found in 6 cases. Conventional CT showed low density in 26 cases and equal density in 5 cases. Larger lesions were surrounded with ring-like low density in 8 cases. Dynamic enhanced CT showed homo- geneous and inhomogeneous enhance in 29 cases in arterial phase, homogeneous and inhomogeneous low density in portal phase, and low density in balanced phase. Ring-like enhances were found in 7 cases. CTHA showed rich blood supply and CTAP showed perfusion defect. Conclusion CT findings of SHCC are relatively specific. MSCT and dy- namic enhanced CT combined with CTA and iodized oil CT has significantly high value in the locating and qualitative diagnosis of SHCC.