CT灌注值分析及CT灌注成像鉴别肝细胞癌和肝局灶性结节增生的诊断价值

Evaluation of CT perfusion imaging and the relative value analysis in differential diagnosis between hepatocellular carcinoma and hepatic focal nodular hyperplasia

目的对肝细胞癌和肝局灶性结节增生的CT灌注值进行分析,以研究CT灌注成像对二者的鉴别作用,探讨其临床诊断价值。方法将张家港市第一人民医院在2015年3月至2015年11月期间收治的肝细胞癌患者24例作为实验组,肝局灶性结节增生患者17例作为对照组。应用CT扫描仪对所有研究对象进行平扫及全肝灌注扫描,对两组的实性部分的CT灌注值(肝动脉灌注量、门静脉灌注量、总肝灌注量、肝动脉灌注指数)进行分析比较;对肝细胞癌的实性成分、灶周组织及远处肝组织的CT灌注值进行分析比较;对肝局灶性结节增生的实性部分与远处肝组织的CT灌注值进行分析比较。结果与对照组相比,实验组的实性成分肝动脉灌注量为(43.32±19.56)mL/(min·100 mg)、肝动脉灌注指数为(67.86±11.62)%均较低,但门静脉灌注量较高(22.30±13.44)mL/(min·100 mg),差异均具有统计学意义。在实验组中,与灶周、远处肝组织相比,病灶的肝动脉灌注量(43.321±19.66)mL/(min·100 mg)、肝动脉灌注指数(67.86±11.62)%较高,但门静脉灌注量较低(22.30±13.44)mL/(min·100 mg),差异均具有统计学意义。在对照组中,与远处肝组织相比,病灶的肝动脉灌注量(67.69±23.54)mL/(min·100 mg)、肝动脉灌注指数(88.46±5.62)%较高,而门静脉灌注量较低(9.30±7.44)mL/(min·100 mg),差异均具有统计学意义。但上述情况的总肝灌注量的差异均无统计学意义。结论通过对肝细胞癌和肝局灶性结节增生CT灌注值的分析与比较,可知CT灌注成像对于二者的鉴别诊断具有重要的临床价值。

Objective To investigate computed tomography （CT）perfusion imaging of hepatocellular carcinoma （HCC）and hepatic focal nodular hyperplasia （FNH）,and its role in differential diagnosis.Methods 24 HCC patients and 17 FNH patients in our hospital from March 2015 to November 2015 were enrolled.CT routine scan and liver perfusion scan were carried out in all those patients.Comparison of CT perfusion values,including hepatic arterial perfusion,portal perfusion,hepatic perfusion,hepatic arterial perfusion index,between HCC and FNH group,as well as carcinoma,peri-carcinoma and distant liver in HCC,and lesions and distant liver in FNH group,respectively.Results Comparing with FNH group,HCC group showed lower hepatic arterial perfusion and hepatic arterial perfusion index,but higher portal venous perfusion,which were statistically significant differences.Among cases with HCC,carcinoma tissue showed higher hepatic artery perfusion and hepatic arterial perfusion index than peri-carcinoma and distant liver,but lower portal perfusion,which were statistically significant differences.Similarly,focal tissue in FNH group showed higher hepatic arterial perfusion lesion,hepatic arterial perfusion index and lower portal venous perfusion than distant liver tissue with statistically significant differences.However,the total liver perfusion in all comparisons had no statistically significant differences.Conclusion CT perfusion imaging and relative value analysis might play important roles in differential diagnosis between HCC and FNH.