动脉期轻度强化或不强化肝脏病灶的CT表现分析

Analysis of CT manifestations of mild or non-enhanced hepatic lesions during arterial phase

目的探讨在螺旋CT增强扫描动脉期轻度强化或不强化的各类肝脏病灶CT表现,分析并总结出各自病灶的CT特征性。方法回顾性分析158例CT增强扫描动脉期轻度强化或不强化肝脏病灶的CT表现;114例收集的病例均经过手术或穿刺病理检查证实,其余患者由于病史具有特征性(如外伤等)或病灶特征性(脂肪瘤、囊肿等)而证实。结果CT增强扫描动脉期轻度强化或不强化肝脏病灶常见的恶性病变有:肝内胆管细胞癌、肝转移瘤、乏血供肝细胞癌、肝淋巴瘤,良性病变有:错构瘤、脂肪瘤、肝结核、肝脓肿、炎性假瘤、囊肿或多囊肝、脂肪肝、血肿或挫伤;胆管细胞癌呈渐进性强化伴有其内及周围胆管扩张为特征性改变,肝转移瘤呈典型"牛眼征"及原发病变为其特征性,肝淋巴瘤各期均呈轻度均匀强化为其特征,错构瘤的特征为其内脂肪及血管影,脂肪瘤的特征为病灶为脂肪密度无强化,肝结核形态不规则呈斑片状同时有肺等其他部位结核的表现,肝脓肿呈多层环形、部分病灶伴有积气,囊肿/多囊肝呈无强化均匀液性密度影,脂肪肝各期强化程度基本与正常肝脏一致,肝脏血肿或挫伤有外伤史。结论结合其他各期CT表现可以对动脉期轻度强化或不强化肝脏病灶进行诊断及鉴别诊断。

Objective To investigate the CT findings of various types of hepatic lesions with enhanced,non-enhanced or mildly enhanced spiral CT at arterial phase. The CT features of each lesion were analyzed and summarized. Methods CT findings on liver lesions of 158 patients,who underwent the enhanced,mild or non-enhanced CT scan,were retrospectively analyzed. The114 patients were confirmed by operation or biopsy,and the rest were confirmed by the characteristic of the history（ such as trauma） or the characteristics of the lesion（ lipoma,cyst,etc）. Results The common malignant liver lesions,which were shown by the enhanced,mild or nom-enhanced CT scan at the arterial phase,were intrahepatic cholangiocarcinoma,liver metastasis,blood supply of hepatocellular carcinoma,liver lymphoma; whereas,the benign lesions were hamartoma,lipoma,liver tuberculosis,liver abscess,inflammatory pseudotumor,cyst or polycystic liver,fatty liver,hematoma or contusion. Cholangiocarcinoma was progressive enhancement accompanied by the internal and surrounding bile duct dilatation,which was characterized by changes in liver metastases,exhibiting typical ＂ Cow Eye Sign ＂ and the primary lesion as its characteristics. Liver lymphoma showed mild uniform enhancement at all stages as its characteristic. Hamartoma was characterized by its internal fat and blood vessels. Lipoma was characterized by the density of the lesion as fat strengthening. Irregular hepatic tuberculosis was patchy and,at the same time,there are pulmonary tuberculosis and the performance of other parts. Liver abscess was multi-layer ring,with some lesions associated with gas. Cysts/polycystic liver had no enhanced homogeneous liquid density. The enhanced degree of the fatter liver at all the stages was basically the same to that of normal liver. Liver hematoma or contusion had a history of trauma. Conclusion Combined CT manifestations with other stages at the arterial phase can make the diagnosis and differential diagnosis of liver lesions underwent mild or non-enhancement CT scan.