小肝癌动态CT不强化的病理基础研究

Study of the Pathological Basis of Non-enhanced Small HCCs on Dynamic CT Scan

目的 回顾性分析螺旋CT增强动脉期扫描对小肝癌 (HCCs)诊断的作用 ,探讨部分小HCCs不强化的病理基础。材料与方法 搜集 15 8例共 186个病灶。临床记录初诊主诉、肝炎、肝硬化史和AFP。手术病理记录肝脏有无肝硬化、病灶的包膜和边缘、出血坏死囊变及透明细胞变等。CT扫描记录病灶平扫的密度和均匀性及动脉期和门脉期有无强化、均匀性和轮廓等改变。结果 80 .4%的病例有肝炎、肝硬化病史。 66.5 %的患者AFP阳性。术中见肝硬化者占 83 .9%。 2 8%的病灶有完整包膜 ,2 9%的病灶包膜不完整。 2 0 .4%的病灶内见出血坏死 ,16.7%的病灶内出现透明细胞变或全灶为透明细胞癌。CT平扫发现不到 71.7%的病灶。动脉期强化呈高密度者占 78.3 % ,等密度 8.5 % ,低密度 13 .2 %。低密度主要由坏死造成 ,透明细胞变可能是原因之一。结论 动脉期大部分小HCCs病灶出现强化 ,不强化者占 13 .2 %。其动脉期不强化的常见原因是坏死 ,透明细胞变可能为另一原因。

Objective To evaluate enhanced spiral CT scan in the diagnosis of small HCCs, and to study the pathology of non enhanced small HCCs. Materials and Methods 186 lesions found in 158 patients were collected. Clinical complains, history of cirrhosis due to hepatitis and AFP were recorded. Present or absent of cirrhosis, capsule and margin of the lesion, necrosis and cellular hyaline degeneration founded on surgery and pathologic examination were also documented. The attenuation, homogeneity and edge of the non enhanced lesions on CT in arterial and portal phase were observed and analyzed. Results Up to 80.4% of patients had a history of hepatitis and cirrhosis. AFP was elevated in 66.5% of patients. Cirrhosis in 83.9% cases was found in surgery. On CT, the lesions were well defined (72.6%) with complete (28%) or incomplete (29%) capsule. On pathological examination, necrosis (20.4%) and hyaline degeneration (16.7%) within the lesions were seen. Less than 71.7% of the lesions could be demonstrated with plain CT scans. During arterial phase, the lesions displayed hyper (78.3%), iso (8.5%) or hypo density (13.2%). Low density area was mainly due to the necrosis, and, perhaps, hyaline degeneration was another cause. Conclusion During arterial phase most small HCCs show enhancement, only 13.2% of lesions are not enhanced. The reasons for non enhancement are mainly due to necrosis and, probably, hyaline degeneration.