肝细胞癌门静脉癌栓致肝脏灌注异常CT表现

Abnormal Liver Perfusion in Hepatocellular Carcinoma during Dual-phase Spiral CT Scan:Correlation with Carcinomatous Embolus in Portal Veins

目的 探讨肝细胞癌合并门静脉癌栓致肝脏灌注异常螺旋CT动、门脉双期增强表现特征 ,以利于准确判断癌灶的范围、肝脏血流动力学异常等。材料与方法 1998年 4月至 2 0 0 0年 7月因肝细胞癌行肝脏螺旋CT动、门脉双期增强扫描的连续性病例2 45例 ,随机选择其中门静脉左支、右支或 /和主干癌栓的病例共 3 6例作为研究组 ,并随机选择同期无门静脉癌栓的肝细胞癌 3 6例作为对照组。全肝平扫后 ,分别于开始注射对比剂后 2 0s、60s行全肝螺旋CT双期扫描。观察平扫、动脉期、门脉期非癌变肝组织、癌灶、门静脉的密度变化。结果 门静脉癌栓发生部位 :右支 16例 ,左支 4例 ,右支及主干 10例 ,左、右支及主干 6例。动脉期扫描非癌变肝组织高灌注 15例 ,表现为不规则斑片状或三角形均匀性高密度区 ,门脉期扫描该区域密度与其他部位非癌变肝组织密度一致或略低。门脉期扫描发现异常灌注 9例 ,表现为不规则斑片状或三角形低密度区。结论 门静脉癌栓是引发肝实质灌注异常的重要原因之一 ,由乙肝病毒感染所致肝硬化较少引起肝实质局灶性灌注异常。螺旋CT动、门脉双期增强扫描 ,有利于发现肝实质灌注异常、准确判断癌灶的范围。

Objective To investigate the correlation of abnormal perfusion of liver in hepatocellular carcinoma (HCC) during dual-phase spiral CT scan with the carcinomatous embolus in the portal veins.Materials and Methods During April 1999～July 2000, dual-phase spiral CT scan was performed in 245 consecutive patients with HCC, of which 36 with and another 36 without portal carcinomatous embolus were randomly selected. Following plain spiral CT scan of the liver, dual-phase scanning was started at 20 s and 60 s, respectively, after contrast injection. CT findings were observed and the relationship between the abnormal liver perfusion of HCC and portal carcinomatous embolus was analyzed.Results Of 36 cases with portal embolus, 21 presented abnormal liver perfusion in portal venous phase, which was in conformity with the involved portal veins. High liver perfusion in arterial phase was seen in 15 cases, presenting as irregular patchy or pyramid-shaped homogeneous high density in arterial phase and homogeneous iso-density in portal venous phase. Low liver perfusion in portal venous phase was seen in 9 cases, presenting as irregular low attenuation in portal venous phase and iso-density in arterial phase as well as on plain scans. Of 36 cases without carcinomatous embolus in portal veins, only 2 demonstrated high liver perfusion in arterial phase. Conclusion An obvious correlation exists between abnormal liver perfusion and portal tumor embolus in HCC, dual-phase spiral CT scanning is helpful in detecting the abnormal liver perfusion and precisely judging the extent of the tumor.