原发性肝癌的螺旋CT双期增强特征及其诊断价值

【摘 要】 目的：探讨原发性肝癌的螺旋CT双期增强特征及其诊断价值。材料和方法：回顾性分析56例经临床及手术病理证实的原发性肝癌双期增强表现。结果：56例共发现82个病灶。平扫呈低密度或等密度；肝动脉期91％强化，9％无明显强化；门脉期76％呈低密度或稍低密度，病灶密度呈“速升速降”的变化特点。结论：螺旋CT双期扫描可充分反映原发性肝癌的特征，对肝癌的检出和定性准确率的提高有重要价值。

【关键词】 肝肿瘤；螺旋CT； 诊断

【Abstract】Objective: Evaluation the characteristic and diagnoses value with dual phase spiral CT in primary hepatocellular Carcinoma. Material and methods : We review analyse 56 examples hepatocellular Carcinoma that had approved by pathology verify or surgical operation dual-phase spiral CT scanning characteristic. Results: 56 examples find 82 focuses altogether. They were reveal the low density or the low density slightly in plain scanning; 91% of Primary liver cancer were enhanced in arterial phase. 9% were not enhanced obviously; 76% were reveal the low density or the low density slightly in portal venous phase, focus presents the change characteristic of" rising and lower rapidly " by density. conclusion: Dual phase spiral CT is a important value in the detection and charaterization of primary hepatocellular Carcinoma , it can improve rate of accuracy examine and determine the nature .

【Key Words】 Liver neoplasm, Spiral CT, Diagnoses

以往常规CT扫描时间较长，很难抓住全肝的动脉期，定性诊断有一定困难。近年来出现的螺旋CT，扫描速度快，一次注射造影剂可获得全肝动脉期、门脉期和延迟期像，提高了肝癌的检出率和诊断的准确率。现对56例原发性肝癌的螺旋CT双期增强扫描表现进行分析，旨在探讨原发性肝癌的螺旋CT双期增强特征及其诊断价值。

1 资料和方法

1.1 资料 56例原发性肝癌，男42例，女14例，年龄36~78岁，平均58岁。其中24例经手术病理证实，32例经临床实验室超声及DSA证实。

1.2 方法 CT为德国西门子Esprit螺旋CT，扫描方式选择为肝脏双期连续容积扫描，层厚8mm，1.5螺距行肝脏平扫，然后用高压注射器经前臂静脉注入80~100ml欧乃派克，注射速率2.5~3ml/s。肝动脉期20~25s，门静脉期45~60s，有3例延迟至平衡期300s扫描。动脉期腹主动脉显著增强，肝动脉显影，门静脉无明显造影剂充填；门静脉期门静脉增强明显，肝脏显著增强，肝内门静脉分支清晰可见。

56例共发现病灶82个，肿瘤大小0.5~18cm，平均4.3cm。≤3cm的结节34个，3~5cm结节17个，≥5.0cm巨块31个。

2.1 平扫：发现病灶55个，39个表现为低密度，密度均匀者12个，27个密度不均匀者病灶中可见到更低密度的坏死区或脂肪变性。有6个病灶因伴有脂肪肝而呈高密度有肝硬化表现者12例。

2.2 肝动脉期扫描：发现病灶82个。强化表现为病灶均匀性高密度强化28个；不均匀性强化，中心低密度区强化不明显45个；有9个病灶无明显强化，仍为低密度；病灶边缘及中心见到不规则条状、网状或放射状的血管影9个。

2.3 门静脉期扫描：发现病灶71个，表现为低密度者63个，等密度灶5个，高密度灶3个。有6例可见到门静脉侵犯及癌栓，表现为门静脉增粗，充盈缺损或不显影；3个病灶见到肿瘤包膜环形增强。2例有肝动脉门静脉瘘，表现为门静脉早显，同时有门静脉腔内充盈缺损。