多层螺旋CT在外生性肝癌诊断中的应用

Application of multislice spiral CT in diagnosis of extrahepatic growing hepatocellular carcinoma

目的:探讨外生性肝癌的多层螺旋CT(multislice spiral CT,MSCT)表现及其诊断价值。方法:回顾性分析26例经临床及手术后病理学检查证实的外生性肝癌患者的MSCT资料,患者均行MSCT平扫及增强扫描,其中12例行CT后处理重建,主要重建方法为多平面重建(multiplanar reformation,MPR)。结果:26例患者26个外生性肝癌病灶中,最大径为2.8～16.5 cm,平均6.7cm。位于肝右叶14个、肝左叶9个、尾叶3个;位于脏面21个、膈面5个。5个与肝脏以蒂带连接,21个与邻近肝叶分界不清但无明确瘤蒂。CT平扫呈类圆形或不规则形与肝脏边缘相连、向肝外生长的实质性肿块,22个瘤内见不规则更低密度坏死区,7个瘤内见斑片状高密度出血影,3个瘤内见弧线状钙化影。增强扫描动脉期26个肿瘤明显不均匀强化,瘤内可见不规则强化血管影,25个门静脉期及延迟期扫描肿瘤呈低密度。23个瘤灶增强后可见包膜。12例MPR重建后均显示肿瘤与肝脏在解剖学上相连。结论:外生性肝癌的MSCT表现有一定特点,MSCT多期扫描及MPR对外生性肝癌的诊断有重要临床价值。

Objective:To study the multislice spiral CT(MSCT)findings of extrahepatic growing hepatocellular carcinoma(E-HCC)and evaluate its diagnostic value.Methods:The MSCT findings of 26 cases of E-HCC proved by surgery and pathology were analyzed retrospectively.Plain CT and enhanced CT scans were performed in all cases.The main reconstruction technique was multiplanar reformation(MPR).Results:The 26 cases with 26 E-HCC ranged from 2.8 cm to 16.5 cm(mean 6.7 cm)in the maximum diameter.There were 5 cases with pedicel attachment to the liver and the other 21 had indefinite borderline with corresponding hepatic lobes.The lesions originated from the right lobe of the liver in 14 cases,from the left lobe in 9 cases and from the caudate lobe in 3 cases.The masses were located in diaphragmatic surface of the liver in 21 cases and in visceral surface in 5 cases.Plain CT image showed round-like or irregular extrahepatic growing solid masses,of which 22 showed hypodense necrosis area,7 displayed plaque-like hyperdense hemorrhagic shadow and 3 presented arc calcification within the tumor.Contrastenhancement CT displayed heterogeneous enhancement in the tumor.Enlarged tumor vessels were demonstrated in hepatic arterial phase in all cases.The portal venous phase and delayed phase scanning showed hypoattenuation and hypodense in 25 cases.In 23 lesions envelope was observed.MPR performed in 12 cases well-demonstrated that the tumors originated from the liver.Conclusion:The MSCT features of E-HCC are some specific.MSCT scanning and reconstructions have important values in the diagnosis of E-HCC.