CT检查对肝硬化患者肝脏良恶性结节的诊断价值

Diagnostic value of CT for benign and malignant liver nodules in patients with liver cirrhosis

目的探讨CT对肝硬化背景下肝脏良恶性结节的诊断价值。方法选择2015年4月至2018年4月在山西省煤炭中心医院诊治的存在肝脏孤立性结节的肝硬化患者135例为研究对象,均接受上腹部CT检查。观察病灶CT表现及诊断准确率,并以肝细胞癌为阳性,其他类型结节为阴性,分析CT对其诊断价值。结果肝硬化背景下肝脏良恶性结节CT平扫均表现为略低或低密度病灶;动态增强扫描,肝细胞癌特征为动脉期明显强化,门脉期迅速廓清,延迟期假包膜强化;局灶性结节性增生特征为中心瘢痕延迟强化;血管瘤特征为动脉期-延迟期持续性强化;肝腺瘤特征表现为动脉期明显强化,门脉期及延迟期廓清较慢;肝硬化再生结节各期强化特征同肝实质。CT对肝硬化背景下肝脏良恶性结节诊断准确率达90.4%(122/135),其中对血管瘤诊断准确率最高,为100.0%(30/30);对肝硬化再生结节诊断准确率最低,为81.1%(30/37)。CT对肝硬化背景下肝脏良恶性结节诊断敏感性、特异性、阳性预测值、阴性预测值及准确度分别为92.1%、89.7%、77.8%、96.7%和90.4%。结论在肝硬化背景下良恶性结节的诊断中,螺旋CT具有很高的诊断价值,通过动态增强扫描能够对绝大多数病变进行准确的鉴别诊断。

Objective To analyze the diagnostic value of CT for benign and malignant liver nodules in patients with cirrhosis. Methods From April 2015 to April 2018, 135 cases of liver cirrhosis with solitary liver nodules in Shanxi Coal Central Hospital were selected, and all patients received the upper abdominal CT examination.The CT manifestations and diagnostic accuracy of the lesions were observed, and positive for hepatocellular carcinoma and negative for other benign nodules.The diagnostic efficacy of CT was analyzed. Results The CT scan of benign and malignant nodules of liver in the background of liver cirrhosis all showed a slight or low density focus, dynamic enhanced scan, the characteristics of hepatocellular carcinoma were obviously strengthened in the arterial phase, the portal phase was relatively low density, the delayed phase of the capsule was strengthened.The focal nodular hyperplasia was characterized by the enhancement of the middle heart scar in the delay period;the angioma was special.The characteristics of the hepatic adenoma were obvious enhancement of the arterial phase, the slow clearance of the portal phase and the delay period, and the enhancement of the liver parenchyma in the stages of the regenerative nodules of the liver cirrhosis.The accuracy of CT in the diagnosis of benign and malignant liver nodules under the background of liver cirrhosis was 90.4%(122/135), of which the accuracy of diagnosis of hemangioma was the highest[100.0%(30/30)], and the lowest rate for the diagnosis of regenerative nodules of liver cirrhosis was 81.1%(30/37). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT for the diagnosis of benign and malignant liver nodules under the background of liver cirrhosis were 92.1%, 89.7%, 77.8%, 96.7% and 90.4%, respectively. Conclusion In the diagnosis of benign and malignant nodules under the background of liver cirrhosis, spiral CT has high diagnostic effect.Dynamic enhanced scan can accurately differentiate most of the lesions.