肝脏局灶性结节增生的CT多期扫描表现及病理对照研究

Multiphase CT findings and pathologic correlation of hepatic focal nodular hyperplasia

目的：评价多层螺旋CT（MSCT）多期扫描对肝脏局灶性结节增生的临床诊断价值。方法回顾性分析12例经病理确诊为肝脏局灶性结节增生的患者，对其MSCT的平扫、动脉期、门脉期及延迟期共4期扫描图像进行分析，并与病理结果进行对照研究。结果本组12例病例男女比例为7∶5，年龄20~65岁，平均年龄34岁。12例患者均进行CT四期扫描，共观察到病灶12个，病灶位于肝脏左外叶2个，左内叶3个，右前叶4个，右后叶3个，最大平面直径范围为1．7~4．8 cm，平均（3．1±1．3）cm。病灶CT平扫呈等密度5个，低密度7个，等密度者无法显示病灶边缘，低密度者2例病灶边界清楚，5例病灶边界显示模糊，其中可见更低密度瘢痕组织3例。CT增强动脉期显示12例病灶均呈明显强化，其中5例可见中央瘢痕或条索状低密度影，中间瘢痕组织无强化，11例病灶边界显示清晰，均未见包膜；门脉期病灶较动脉期密度降低，但仍较肝脏组织密度高，中间瘢痕组织无明显强化，仍呈低密度；延迟期病灶呈等密度为主，瘢痕组织可见强化，与病灶呈等密度分辨不清。结论MSCT多期扫描在肝脏局灶性结节增生的影像表现方面有一定的特征性，在诊断及鉴别诊断中有很好的作用，但确诊还需要病理诊断。

Objective To observe hepatic focal nodular hyperplasia by multiphase helical CT scan and to im-prove its diagnostic accuracy. Methods Retrospectively analyze 12 cases with hepatic focal nodular hyperplasia con-firmed pathologically, and observe the imagings of plain CT scan, arterial phase, portal venous phase and delayed phase,then the results were compared with the pathological manifestation. Results Of Twelve cases,the ratio of male and female is 7：5,aging from 20 to 65 years,with the mean age of 34 years. Twelve lesions were observed,while 2 lesions located in left lateral lobe, 3 in left inner lobe, 4 in right anterior lobe, 3 in right posterior lobe. The average diameter was 3.1 ± 1.3 cm,ranging from 1.7 cm to 4.8 cm. Plain CT scan showed that 7 of 12 lesions were with hy-podense while 5 lesions were with isodense, 2 lesions had smooth edge, while 5 lesions had slightly blurred bound-aries,3 lesions had central scar area. By the arterial phase scans, all lesions were markedly and homogeneously en-hanced, except for 5 lesions of the central scar area. By portal venous phase , all of the lesions turned to slightly hy-perdense,the central scar area were still with hypodense. By delayed phase the lesions turned to isodense ,and the central scar area demonstrated late enhancement. Conclusion Multiphase helical CT scan have some characteristic manifestations for hepatic focal nodular hyperplasia. And it is of great value in diagnosing and differential diagnosis .