原发性结节型肝癌CT征象研究

Study of Appearance of Nodulous Primary Hepatic Carcinoma in CT Scanning

目的：对原发性结节型肝癌常见与少见计算机断层扫描图像(computed tomography,CT)特征进行对比分析，归纳出肝癌的少见征象类型，以提高对此类疾病的诊断与鉴别诊断水平。材料与方法：选取61例病理诊断为肝细胞肝癌的病例，分析其常规CT检查结果、经动脉造影CT（CT hepatic arteriography, CTA）及动门脉造影CT (CT hepatic arterial portography, CTAP)检查结果。结果：肝内共发现病灶61个。30例结节型肝癌呈典型表现，CT平扫呈低密度，动脉期见不均匀强化，门脉期呈低密度表现。另31例呈结节型肝癌的少见表现，其中7例动脉期、门脉期扫描密度均高于肝实质；3例CT平扫病灶为低密度，周围可见“包膜样”结构，动脉期病灶强化不均匀，门脉期呈等密度；8例CT平扫呈低密度，其中5例动脉期中央部结节性强化，另3例动脉期肿瘤周边见不规则环形强化，门脉期密度均降低；10例平扫、动脉期及门脉期均表现为低密度病灶；3例患者常规CT检查肝内未发现病变，CTA检查见病变呈高密度，CTAP检查呈低密度。结论：结节型肝癌存在常见表现和多种少见CT表现类型，应结合其临床资料、CTA、CTAP检查，并与肝内其他常见占位性病变加以区别。

Objective：This study was designed to compare the common CT （computed tomography）appearance infrequent CT appearance of nodulous primary hepatic carcinoma (NPHC) in CT scanning, and discuss the infrequent characteristics of NPHC, so as to improve the diagnosis and differential diagnosis of this disease. Methods：Sixty-one cases approved to be hepatocellular carcinoma pathologically were involved in this study. The authors retrospectively summarized the characteristics of these patients with NHPC according to CT imaging or CT hepatical arteriography (CTA) combined with CT hepatical arterial portography (CTAP). Results：Sixty-one lesions were found in all 61 cases. Thirty patients with NHPC appeared hypodensity in precontrast CT scanning, heterogenuous attenuation in arterial phase, hypodensity in portal phase. Thirty-one patients appeared infrequent, the density of lesion in 7 cases were higher than parenchyma of the liver in arterial and portal phase. Three appeared low density and membranoid characteristics were found in the periphery of the lesions in plain CT scanning, its appearing heterogeneous attenuation in arterial phase and isodensity in portal phase. Eight cases appeared low density in plain CT scanning,5 of which nodules attenuation were found in the center of the lesions, 3 cases appearing irregular attenuation rim in the peripheral area of the lesions during arterial phase, the density decreasing in portal phase. Ten appeared hypodensity in plain CT scanning and arterial and portal phase. No lesions were found in 3 cases applied normal CT scanning, but the lesions were found hyperattenuation in CT hepatic arteriography and hypodensity in CT hepatical arterial portography. Conclusion：There existed common and several kinds of infrequent appearance in the patients with NPHC. In order to exclude the other occupied lesion, clinic materials should be considered and CT hepatic arteriography and CT hepatic arterial portography should also be applied in those patients in necessary.