螺旋CT增强三期扫描对原发性小肝癌血供的影像学观察

目的　观察原发性小肝细胞癌(SHCC)的血供特点,提高螺旋CT对SHCC的定性诊断能力。方法　盲法下观察34例经手术病理证实的原发性SHCC患者,术前采用单层动态肝动脉、门静脉及静脉期螺旋CT分别于注入造影剂后2 8～30秒、6 5～70秒及180秒行靶区动态增强扫描,造影剂注射速率为3.0 m/ s,用量90～10 0 ml。结果　共发现37个结节病灶,平扫、动脉期、门静脉期、静脉期的检出率分别为75 .6 %、94 .6 %、97.3%、81.1% ,动脉期和门静脉双期的检出率较平扫和静脉期高(P<0 .0 5 ) ,动脉期与门静脉期、平扫与静脉期检出率无显著性差异(P均>0 .0 5 )。34例中,2 8例肝癌组织为单纯肝动脉供血,其中动脉期强化密度明显高于正常肝脏2 2例,边缘轻度高密度6例;6例为肝动脉和门静脉双重供血,其中4例在三期扫描过程表现为“向心性”强化。结论　原发性SHCC由肝动脉供血者占绝对优势;部分可见肝动脉和门静脉双重供血,并呈现“向心性”强化征象,此征象在与肝脏海绵状血管瘤的鉴别中起重要作用。

The radiographic observation of thi-phase spiral CT of the blood supply in primary small hepatic carcinoma

Objective To observe the blood supply of the small hepatic carcinoma(SHCC).Methods 34 cases with SHCC diagnosed by pathological examination were observed by single dynamic spiral CT scan in arterial-phase,portal vein-phase and vein-phase.Scanning at twenty-eight to thirty seconds,sixty-five to seventy seconds and one hundred and eighty seconds after injection(at 3.0ml/s,90~100ml).The radiogrephic features were analysed.Results 34 cases of SHCC were detected,including 37 lesions.The detecting ratio in routine scan at arterial-phase,portal vein-phase and vein-phase were 75.6%,94.6%,97.3%,81.1% respectively. The lesion was easier to be found in arterial-phase and portal vein-phase than in routine scan and vein-phase(P<0.05).There was no significanty diffrence between rterial-phase and portal vein-phase and routine scan and vein-phase( P>0.05).In 34 cases,SHCC of 28 cases were supplied by artery only;6 cases by artery and portal vein. Conclusions Blood of primary SHCC was mainly supplied by liver artery, partly both liver artery and portal vein.