螺旋CT多时相扫描对小和微小肝癌诊断价值的探讨

Diagnostic Role of Small Hepatic Cellular Carcinoma and/or Microhepatic Cellular Carcinoma with Multiple-phase Spiral Computed Tomography Scanning

目的 探讨螺旋 CT(SCT)多时相扫描对小肝癌 (SHCC)和微小肝癌 (MHCC)的 CT表现和诊断价值。方法 分析螺旋 CT多时相扫描检查肝脏 5 89例 ,其中经组织学证实 SHCC16例 ,MHCC7例。所有病例先做平扫、对兴趣区再做增强后动脉期和门静脉期及全肝平衡期扫描。层厚 6 .5～ 8m m,进床 5～ 6 .5 m m,图像重建间隔是 3mm或 5 mm;所用造影剂为 6 0 %泛影葡胺或非离子型造影剂 ,用量 80～ 12 0 ml,注射速率为 2 .5～ 3m l/s;扫描时间窗 :动脉期于注射造影剂后 2 0 s进行 ,门静脉期 5 5～ 6 0 s。结果 CT平扫 :低密度 SHCC17例 ,MH CC2例 (82 % ) ,等密度 MHCC4例 (13% )。动脉期 :不均匀的高密度强化 SHCC 16例 ,MH CC 2例 (78% ) ;低密度无强化 SHCC 4例 ,MH CC 1例 (2 1% ) ;供血动脉增多、增粗、僵直13例 (5 6 % ) ,动脉血管迂曲、血管呈斑点状 6例 ,动静脉瘘伴有邻近肝实质异常高灌注区 6例 (高灌注区呈三角形、楔形或不规则形 ,强化程度高于周围肝实质 )。肿瘤内有液化坏死 7例。门静脉期 :低密度 SH CC18例 ,MH CC3例 (91% ) ,稍高密度SHCC 1例 ;肿瘤边缘清楚 SH CC 6例 ,MHCC 2例 ,肿瘤边缘模糊 SHCC 14例 ,MH CC 2例。结论 螺旋 CT增强后动静脉双期或多时相扫描能显著增加 SHCC和 MHCC的检出率 ,提高?

Objective To evaluate diagnostic value of small hepatic cellular carcinoma (SHCC) and/or micro-hepatic cellular carcinoma (MHCC) with multiple-phase spiral computed tomography.Method During the period from 1998.6 to 2000.6,of 589 cases with multiple-phase scanning of spiral computed tomography of,23 patients with SHCC and/or MHCC (19 males and 4 females,aged 36～74 years,mean 52 years) were surgically and pathologically proved.Plain scanning,arterial phase scanning (delaying 20s),portal venous phase scanning (delaying 55～60s) and equilibrium phase scanning of liver.Result 23 case of SHCC and MHCC on plain CT images included hypodensitiy of 18 cases (78%),iodensity of 4 cases (17%),mixed density of 1 case.Uniformity enhancement of arterial phase scanning,and hypodensity of portal venous phase scanning were mainly characteristics of SHCC and MHCC of 19 cases (82%).Without enhancement finding on arterial phase scanning and portal venous phase scanning,it was 4 cases (17%) of 23 cases.Other manifestations were arterial-venous fistulas,thicked-arteries,stiffness of tumor-feeding vessels,neoplastic vasculature,cancerous emboli in large vessels,enhancement of tumor mass and so on.Conclusion Spiral CT multiple-phase scanning exhibits highly detection rate for SHCC or MHCC and is one of the very useful method and imaging technique for diagnosing and differentiating of intrahepatic small or microlesions,for example:SHCC or MHCC. [