64排螺旋CT肝脏增强扫描对乙型肝炎肝硬化再生结节的诊断价值

The value of 64 slice spiral CT enhanced liver scan in the diagnosis of regenerative nodules in liver cirrhosis

目的:观察64排螺旋CT肝脏增强扫描对诊断乙型肝炎肝硬化再生结节的应用价值。方法:乙型肝炎肝硬化占位性病变患者72例,根据结节性质分为再生结节组(46例)和癌变结节组(26例),均采用64排螺旋CT均对肝实质、主动脉、门静脉进行动脉期、门脉期和延迟期的三期扫描,测量增强肝实质、主动脉、门静脉的动脉期、门脉期和延迟期的CT值,并分析动脉期、门脉期和延迟期CT值差异和检出结节的敏感性。结果:再生结节组患者的CT多表现为低密度影,病灶强化不均匀,且边界较为清晰;癌变结节组患者的CT表现为低密度液体灌注状,增强期扫描表现为典型的动态强化信号,肝动脉期可表现高密度信号病灶。肝实质的动脉期、门脉期、延迟期扫描CT值,主动脉的动脉期、门脉期扫描CT值,门静脉的动脉期、延迟期扫描CT值对比显示:再生结节组均高于癌变结节组(P<0.05)。再生结节组动脉期检出66个(敏感性68.75%),门脉期检出80个(敏感性83.33%),延迟期检出43个(敏感性44.79%);癌变结节组相应为14个(敏感性68.75%),20个(敏感性83.33%),13个(敏感性44.79%)。门脉期的再生结节和癌变结节检出敏感性均高于动脉期和延迟期(P<0.05)。结论:相对于乙型肝炎肝硬化癌变结节,乙型肝炎肝硬化再生结节的64排螺旋CT扫描中,在肝实质、主动脉、门静脉的动脉期、门脉期、延迟期均具有较高CT值,这利于乙型肝炎肝硬化再生结节与癌变结节的检出,尤其是门脉期增强扫描具有较高的敏感性,有利于乙型肝炎肝硬化再生结节与癌变结节的鉴别。

Objective:To observe the application value of 64 slice spiral CT in the diagnosis of regenerative nodules of hepatitis B cirrhosis.Methods:A total of 72 cases of liver cirrhosis(treatment time:from June 2017 to June 2019)were studied.According to the nature of the nodules,they were divided into two groups:regenerative nodule group(46 cases)and cancerous nodule group(26 cases).64-MDCT was used to scan the liver parenchyma,aorta and portal vein in arterial phase,portal phase and delayed phase,and to measure the enhancement of liver parenchyma,aorta and portal vein The CT value of arterial phase,portal phase and delayed phase were analyzed.The difference of CT value of arterial phase,portal phase and delayed phase and the sensitivity of nodule detection were analyzed.Results:In the regenerative nodule group,low-density shadow and heterogeneous enhancement were found,and the boundary was clear;in the cancerous nodule group,low-density liquid perfusion was found,typical dynamic enhancement signal was found in the enhancement phase,and high-density signal was found in the hepatic artery phase.The comparison of CT value of hepatic parenchyma in arterial phase,portal phase,delayed phase,aortic phase,portal phase,portal vein phase and delayed phase showed that the regenerating nodule group was higher than the cancerous nodule group(P<0.05).In the regenerative nodule group,66 were detected in arterial phase(sensitivity 68.75%),80 in portal phase(sensitivity 83.33%),43 in delayed phase(sensitivity 44.79%).In the cancerous nodule group,14 were detected in arterial phase(sensitivity 68.75%),20 in portal phase(sensitivity 83.33%),and 13 in delayed phase(sensitivity 44.79%).The sensitivity of detecting regenerated and cancerous nodules in portal phase was higher than that in arterial phase and delayed phase(P<0.05).Conclusion:Compared with the cancerous nodule of hepatitis B cirrhosis,64 MDCT scan of regenerative nodule of hepatitis B cirrhosis has higher CT value in the arterial phase,portal phase and delayed phase of liver parenchyma,aorta and portal vein,which is beneficial to the detection of regenerative nodule of hepatitis B cirrhosis,especially the detection rate of regenerative nodule of portal phase.