多层螺旋CT肝脏多期扫描对肝细胞癌检出的初步评价

Evaluation in the detection of hepatocellular carcinoma with multiphase hepatic CT scan by using a multidetector row helical CT scanner

目的 应用多层螺旋CT(MDCT)行肝脏增强后多期扫描 ,评价对肝细胞癌 (HCC)的检出。方法 回顾性分析明确诊断为HCC的患者 40例 ,共 61个HCC病灶 ;其中男 3 4例 ,女 6例 ;年龄3 3～ 76岁 ,平均 49岁。采用MarconiMX80 0 0CT扫描机行增强后多期扫描 ,动脉早期的延迟时间为 2 0s ,动脉晚期延迟时间为 3 4s左右 ,门脉期为 80s ,统计各期的病灶检出数 ,并对瘤径≥ 1cm的病灶行肿瘤及其邻近肝实质的密度值测量 ,计算其差值并行统计学分析。结果 本组 61个病灶中 ,瘤径≥ 1cm的病灶 47个 ,在增强后的动脉早期、动脉晚期及门脉期 ,肿瘤与肝脏密度差值各期间差异有显著性意义 (秩和检验 :χ2 =12 .0 7,P <0 .0 5)。在病灶检出率方面 ,61个病灶动脉早期检出率为 3 2 % ,动脉晚期检出率为 87% ,双动脉期检出率为 94% ,门脉期检出率为 82 %。经统计学分析 ,动脉早、晚期之间差异有非常显著性意义 (P <0 .0 0 1) ;动脉晚期加门脉期与动脉早期加门脉期之间对病灶检出的差异有显著性意义 (P <0 .0 5) ,双动脉期加门脉期与动脉晚期加门脉期的差异无显著性意义 (P >0 .0 5)。结论 采用MDCT行肝脏扫描 ,优化了动脉期的扫描方案 ,使全肝扫描落在真正的动脉期内 。

Objective To evaluate the mult iphase hepatic CT scan for detecting the hypervascular hepatocellular carcinoma (HCC) by using multidetector row helical CT (MDCT). Methods Multiphase hepatic CT scan of the liver in 40 patients with HCC was carried out with Marconi 8000 multidetector row helical CT scanner .The early arterial phase scan, late arterial phase scan, and portal venous phase scan were started at 20 s, 34 s, and 80 s after the injection of contrast medium, respectively. The numbers of the detected lesions were calculated in each phase. The density values of the liver and tumor were measured for HCC ≥1 cm, and the density difference values of the liver and tumor in each phase were statistically calculated and analyzed. Results The study showed that a total of 61 lesions was found in 40 cases, and the lesions ≥ 1 cm were 47. The density difference values between hepatic parenchyma and HCC in the 47 lesions were significantly different at the early arterial phase, the late arterial phase, and the portal venous phase ( P <0.05). In the 61 lesions, the detectability of the early arterial phase, the late arterial phase, the double arterial phases, and the portal venous phase was 32%, 87%, 94%, and 82%, respectively. The detective rate of the late arterial phase was much higher than that of the early arterial phase, the significant difference was found between the late arterial phase plus the portal venous phase and the early arterial phase plus the portal venous phase, and no significant statistical difference was revealed between the double arterial phase plus the portal venous phase and the late arterial phase plus the portal venous phase. Conclusion The utility of MSCT scan of the liver has optimized the arterial phase scan protocol. It is possible to scan the entire liver in a real arterial phase and it is very valuable clinically for the detection of HCC.