多层螺旋CT血管成像对肝脏局灶性结节增生、原发性肝细胞癌及肝血管瘤的鉴别诊断价值

Differential value of multislice CT angiography in hepatic focal nodular hyperplasia, hepatocellular carcinoma and liver hemangioma

目的 探讨MSCT血管成像在肝脏局灶性结节增生（FNH）、原发性肝细胞癌（HCC）及肝血管瘤（HA）鉴别诊断中的应用价值。方法对2008年3月-2014年3月在北大深圳医院做MSCT血管成像的肝脏肿瘤患者的临床资料进行回顾性分析，其中FNH19例（21个病灶）、HCC19例（21个病灶）和HA17例（22个病灶），采用MSCT血管成像技术对肿瘤血管进行3D重建，观察肿瘤供血动脉、动静脉瘘、门脉癌栓、引流静脉、供血动脉进入中心低密度及包膜影等影像学特征，并用X2检验进行统计学分析。结果FNH、HCC和HA均多有供血动脉增粗表现，显示率分别为95．2％（20／21）、100．0％（21／21）、77．3％（17／22），3者间比较差异均无统计学意义（P值均〉0．05）。HA除了供血动脉增粗外，均未见包膜影、门脉癌栓及动静脉瘘影等特征性表现，包膜影多见于FNH（66．7％，14／21）和HC（71．4％，15／21）。FNH引流静脉、供血动脉进入中心低密度及低密度分隔影的显示率分别为61．9％（13／21）、38．1％（8／21）、61．9％（13／21），均明显高于HCC的9．5％（2／21）、0（0／21）、0（0／21），差异均有统计学意义（）（。=12．548、7．560、18．828，P值均〈0．05）；FNH中未见动静脉瘘和门脉癌栓，而HCC常见动静脉瘘（19．0％，4／21）和门脉癌栓（28．6％，6／21）。结论MSCT血管成像对于FNH、HCC和HA的鉴别诊断有重要的临床指导意义，有助于指导外科医生选择治疗方式。

Objective To evaluate the differential diagnostic value of MSCT angiography in hepatic focal nodular hyperplasia （ FNH ） , hepatoeellular carcinoma （ HCC ） and hepatic hemangiomas （ HA ）. Methods The clinical data of patients with liver tumor who underwent MSCT angiography in Peking University Shenzhen Hospital from March 2008 to March 2014 were analyzed retrospectively, including 19 patients with FNH, 19 patients with HCC and 17 patients with HA. MSCT angiography was used in threedimensional reconstruction of tumor vessels. The image characteristics of tumors, such as tumor feeding arteries, arteriovenous fistula, portal vein tumor emboli, draining vein, feeding arteries into the center of the low density, low density separator film, and pseudocapsule, were observed and analyzed statistically by chi-square test. Results Feeding artery thickening was found in all of the patients with FNH, HCC and HA. The display rate were 95.2% （20/21） ,100.0% （21/21） ,and 77.3% （ 17/22）, respectively. There were no statistical differences among the three groups （ all P values 〉 0.05 ）. Except for feeding artery thickening, pseudocapsule, portal vein tumor emboli and arteriovenous fistula were found in patients with FNH and HCC but not in patients with HA, especially pseudocapsule which was higher than those in patients with FNH （66.7% , 14/21 ） and HCC（71.4% , 15/21 ）. So the emergence of pseudocapsule could exclude HA, which could differentiate HA from FNH and HCC. Draining vein,feeding arteries into the center of the low density and low density separator film in patients with FNH were 61.9% （ 13/21 ）, 38.1% （8/21） , and 61.9% （ 13/21 ）, respectively, which were significantly higher than those in patients with HCC [ 9.5%（2/21）, 0（0/21 ）, 0（0/21 ） ] , there were statistically differences（ X2 = 12. 548, 7. 560, 18. 828, all P values 〈 0.05 ）. Portal vein tumor emboli and arteriovenous fistula were not found in patients with FNH but found in patients with HCC[ （ 19.0% ,4/21 ）, （28.6% ,6/21 ） ] , especially the emergence of portal vein tumor emboli supported HCC diagnosis, which could differentiate HCC from FNH. Conclusions MSCT angiography has great values in the differential diagnosis and important clinical significance for FNH, HCC and HA. It can help guide surgeons to choose the best way of treatment.