老年人原发性肝癌螺旋CT肝双期扫描的表现特点

CT features of primary liver cancer in elderly patients with hepatic helical dual-phase CT scanning

目的 探讨老年人原发性肝癌螺旋CT肝双期扫描表现特点。 方法 回顾性对比分析 5 0例老年人 ( 6 0～ 93岁 )及 2 7例青年人 ( 15～ 35岁 )原发性肝癌螺旋CT肝双期扫描表现。 结果 老年人原发性肝癌多见于肝右叶 ( 36例 ,占 72 0 % ) ,巨块型 ( 4 1例 ,占 80 0 % ) ,边界清楚 ( 35例 ,占 70 0 % ) ,肿瘤内多发斑点状CT“密度更低区” ( 12例 ,占 2 4 0 % ) ,门静脉癌栓 ( 9例 ,占18 0 % ) ,动 静脉瘘 ( 7例 ,占 14 0 % ) ,肝总管内癌栓并肝内胆管扩张 ( 7例 ,占 14 0 % ) ,侵犯邻近周围结构 ( 11例 ,占 2 2 0 % ) ,肝内广泛转移 ( 12例 ,占 2 4 0 % ) ;肝动脉期呈多血供型 ( 13例 ,占2 6 0 % ) ,少血供型 ( 33例 ,占 6 6 0 % ) ,无强化 ( 4例 ,占 8 0 % ) ,门静脉期强化 ( 8例 ,占 16 0 % )。与青年人原发性肝癌比较 ,老年人原发性肝癌边界多清楚 ,胆管内癌栓多见 ,肝动脉期强化多为少血供 ;肝内转移、侵犯周围器官结构及门静脉期强化相对较少见 ;发病部位、形态类型、门静脉癌栓、动静脉瘘、肿瘤内CT“密度更低区”、腹水及肿瘤内出血等与青年人原发性肝癌差异性无显著性。 结论 螺旋CT肝双期扫描是诊断与评价老年人原发性肝癌的有效方法。

Objective To analyse features of primary liver cancer in old patients by hepatic helical dual phase CT scanning. Methods The hepatic helical dual phase CT scanning data were reviewed retrospectively in 50 elderly patients(60 93 years old) and 27 young patients(15 35 years old) with primary liver cancer, and their CT appearance was compared. Results The CT appearance of primary liver cancer in elderly was as follows: right lobe location(n=36, 72 0%), huge tumor(n=41, 80 0%), clear margin(n=35, 70 0%), multiple spots on CT 'more hypodense areas'(n=12, 24 0%), tumor embolus in portal vein(n=9, 18 0%), arteriovenous shunting(n=7, 14 0%), tumor embolus in common hepatic duct(n=7, 14 0%), intrahepatic metastasis(n=12, 24 0%), invaded into adjacent tissue and structures(n=11, 22 0%), poor blood supply (n=33, 66 0%), rich blood supply (n=13, 26 0%) and without enhancement(n=4, 8 0%) in arterial phase, enhancement of portal vein phase(n=8, 16 0%). Compared with that of the young group, the primary liver cancer of elderly patients was more frequently seen as well margined, tumor embolus in common hepatic duct and poor blood supply of hepatic artery, seldom intrahepatic metastasis, invading into adjacent structures and tissues, and enhancement of portal vein phase. There were no differences between two groups in types, location, tumor embolus of portal vein, arteriovenous shunting, CT 'more hypodense areas', edema of abdominal cavity and intratumor hemorrhage. Conclusions Hepatic helical dual phase CT scanning is an effective method in diagnosing and evaluating the elderly primary liver cancer .