不典型小肝癌的多排螺旋CT灌注成像与病理对照分析

The comparison between pathology and multi-slice spiral computed tomography perfusion imaging for atypical small hepatocellular carcinoma

目的探讨小肝癌在多排螺旋CT灌注成像中的不典型表现及其病理基础。方法本研究经手术病理证实为小肝癌的45例45个病灶,筛选出多排螺旋CT灌注成像中不典型表现的小肝癌15例共15个病灶,并分析其灌注参数及病理特点。结果 45例小肝癌中有30例为典型表现,肝细胞癌组病灶中心肝动脉灌注量(HAP)、血流量(HBF)、血容量(HBV)、肝动脉灌注指数(HPI)高于病灶边缘,门静脉灌注量(PVP)、门静脉灌注指数(PPI)低于病灶边缘,平均通过时间(MTT)较长,表面通透性(PS)略低;病灶边缘HAP、HBF、HPI高于正常肝组织,PVP、PPI低于正常肝组织,MTT缩短,PS略高。15例不典型表现的病灶中,第1组11例病灶中心HAP、HBF、HBV、HPI明显高于病灶边缘及正常肝组织,PVP稍高于或等于病灶边缘及正常肝组织,MTT较病灶边缘长、较正常肝组织短,PS较病灶边缘略低、较正常肝组织高;第2组4例病灶中心HAP、HBF、HBV、PVP低于病灶边缘及正常肝组织,HPI低于正常肝组织、高于病灶边缘,MTT较正常肝组织短、较病灶边缘长,PS较正常肝组织高、较病灶边缘低。结论病灶的血供变化、病理学基础等是小肝癌多排螺旋CT灌注成像产生不典型表现的主要原因。

Objective To Investigate the atypical pathological basis and atypical presentation in multi-slice spiral computed tomography（MSCT） perfusion imaging of small hepatocellular carcinoma（SHCC）. Methods A total of 15 lesions in 15 patients with atypical presentation were screened out from 45 patients with 45 lesions of small hepatocellular carcinomas confirmed by surgery and pathology. Then we carried out Analysis of the perfusion parameters and pathological features. Results Thirty cases in 45 patients of SHCC were typical performance,hepatic arterial perfusion（HAP）,hand blood flow（HBF）,hand blood volume（HBV）,hepatic perfusion index（HPI）of lesion center was higher than that of the edge of lesions. Portal venous perfusion（PVP）,portal perfusion index（PPI）of lesion center was lower than that of the edge of lesions. Mean transit time（MTT）was longer,permeability surface（PS）was slightly lower. A total of 15 lesions in15 patients were atypical performance,group 1 had 11 patients,a total of 11 lesions whose HAP,HBF,HBV,HPI in center were higher than that in edge of lesion,however,PVP in center was slightly higher than them in the edge of lesions. MTT was longer,PS was slightly lower. Group 2 had 4 patients,a total of 4 lessons whose HAP,HBF,HBV,HPI,PVP in center were higher than them in edge of lesions,MTT was longer,PS was slightly. Conclusion The change of blood supply for lesion and the pathological basis result in atypical performance of SHCC in multi-slice spiral CT perfusion imaging.