螺旋CT三期增强扫描对肝细胞腺瘤的诊断价值(附五例报告)

Evaluation of triphasic contrast enhanced spiral CT for diagnosing hepatocellular adenoma (report of 5 cases)

目的 评价螺旋CT三期增强扫描对肝细胞腺瘤的诊断及鉴别诊断的价值 ,重点探讨动脉期扫描的意义 ,以进一步提高CT诊断的准确性。方法 5例肝腺瘤均行平扫及三期增强扫描 ,10 0ml对比剂 ,3ml/s单相注射 ,延迟 2 0～ 30s行动脉期扫描 ,6 0～ 70s行门脉期扫描 ,3min后行延迟期扫描。测量腺瘤及正常肝组织的强化CT值 ,观察腺瘤的三期强化特征 ,并对结果进行统计学分析。结果 5例肝腺瘤平扫表现为等密度或略低密度 ,与正常肝组织无法区分 ;动脉期均表现为高密度 ,其平均CT值与正常肝组织相差 38HU ,定量比较有显著性差异 (t=18 94,P <0 0 1) ;在门脉及延迟期 ,4例腺瘤表现为等密度 ,1例为略低密度 ,分别与正常肝组织平均CT值相差 (3 7± 7 1)HU和(- 4 3± 3 6 )HU ,定量比较差异无显著性意义 (t =1 10 ,t=0 75 ;P值均 >0 0 5 ) ;肝腺瘤动脉期平均CT值明显高于门脉及延迟期 ,定量比较有显著性差异 (F =18 39,P <0 0 1)。结论 螺旋CT三期增强扫描对肝腺瘤的诊断与鉴别诊断有重要价值 ,尤其是动脉期扫描。

Objective To evaluate the diagnostic and differential value of triphasic, especially the arterial phase, contrast enhanced CT scans for the hepatocellular adenoma, and to improve CT diagnostic accuracy. Methods Spiral CT scanning of pre and post contrast arterial phase, portal venous phase and delayed phase was performed in 5 patients with hepatocellular adenomas proved surgically and pathologically. The enhancement was administrated with venous injection of 3 ml/sec, totally 100 ml angiografin. Arterial phase of contrast enhanced scanning started 20～30 sec, portal venous phase 60～70 sec and delay scanning 3 min after the injection of contrast medium. The degrees of the enhancement of adnoma and normal tissues of liver in the three contrast enhanced phases were calculated and compared statistically. Results In plain CT, the lesions were iso density in 4 cases and slight hypodensity in 1 case, which was hardly distinguished from the normal tissue. In all 5 cases, the lesions showed marked enhancement in the arterial phase compared with normal tissue of liver (38 HU high), and there were markedly statistical difference ( t =18 94, P <0 01). In the portal venous and delay phase, the lesions showed iso density in 4 cases and slight hypodensity in 1 case, the differences of average CT values were (3 7±7 1) HU and (-4 3±3 6) HU compared with normal tissue of liver, there were no statistic differences ( t =1.10, t =0 75; P >0.05). The mean CT value of hepatocellular adenoma in the arterial phase was much higher than that in portal venous and delay phase, there were statistical differences between them ( F =18.39, P < 0.01). Conclusion Triphasic contrast enhanced spiral CT scan, especially the arterial phase scan, is valuable in detecting and differentiating hepatocellular adenoma.