螺旋CT对结节型肝细胞癌的多期扫描表现分析

目的：描述结节型肝细胞癌的螺旋CT动脉期、门静脉期和延迟期增强特点,比较各期的病灶的检出率,重点评价动脉期、延迟期的价值。方法：36例结节型肝细胞癌患者行螺旋CT双期、三期动态扫描后,观察病灶的强化方式,统计各期病灶的检出率。结果：36例55个病灶,螺旋CT多期扫描共发现52个,平扫、肝动脉期、门脉期、延迟期及三期合计的检出率分别为70．9％,87．2％、72．7％,68．7％、94．5％。动脉期检出敏感性明显高于其它各期,三期结合可明显提高对结节型肝癌的检出率。结论：螺旋CT多期扫描能显示肝细胞癌的增强特点,明显提高结节型肝细胞癌的检出敏感性。     

螺旋CT三期增强扫描对小肝癌的诊断

目的　研究小肝癌 (SHCC)在螺旋CT三期 (动脉期、门脉期和延迟期 )增强扫描的表现 ,比较各期的病灶检出率 ,提高诊断水平。方法　 70例SHCC患者行平扫及增强扫描 ,造影剂注射速率为 3ml/s ,然后开始动脉期、门脉期和延迟期的扫描。统计各期的病灶检出数 ,观察病灶在不同时期的特征。结果　共发现 82个病灶 ,动脉期、门脉期和延迟期的检出率分别为 92 .68% ,70 .73 %和 73 .17%。动脉期的敏感性高于延迟期和门脉期。三期联合检出率明显增加达 95 %。结论　SHCC增强扫描表现形式复杂 ,螺旋CT三期扫描可以充分显示SHCC各期的增强表现 ,正确评价其血流变化 ,提高了病灶的检出率和诊断的准确率     

螺旋CT双期动态扫描对小肝癌及微小肝癌检出敏感性的研究

目的：对９７例ＳＨＣＣ患者进行螺旋ＣＴ双期全肝动态扫描，比较肝动脉期和门脉期扫描的病灶检出率，探讨螺旋ＣＴ双期动态扫描在ＳＨＣＣ及ＭＨＣＣ检出中的价值。材料和方法：９７例患者采用ＧＥ—Ｈｉｓｐｅｅｄ螺旋扫描机行全肝平扫和增强扫描。注射造影剂后３０ｓ开始肝动脉期扫描而６０～７０ｓ开始门脉期扫描。统计各期的病灶检出率并行统计学检验。结果：９７例共发现病灶１５０个，其中ＭＨＣＣ４１个。对直径≤３ｃｍ和直径≤１ｃｍ的病灶，肝动脉期、门脉期和双期合计的检出率分别为：８６％、６７．３３％、９２％及６８．２９％、２９．２７％、７５．６１％，肝动脉期的检出率明显高于门脉期，两者有非常显著的统计学差异。结论：螺旋ＣＴ能充分反映ＳＨＣＣ和ＭＨＣＣ的血供特点，对ＳＨＣＣ尤其是ＭＨＣＣ的检出具有十分重要的临床应用价值。     

螺旋CT在肝脏富血供转移灶诊断中的价值和限度

目的 分析２１例共６３个富血供肝转移灶在螺旋ＣＴ双期扫描中的表现，探讨螺旋ＣＴ在该病诊断中的价值和限度。材料与方法 ２１例均作平扫和增强扫描，注射对比剂后２０～２５ｓ行动脉期扫描，７０ｓ行门脉期扫描，有７例加作延迟期扫描，延迟时间为４ｍｉｎ，统计动脉期和门脉期扫描的病灶检出数目，观察病灶的强化类型，结果 ２１例共发现病灶６３个，动脉期４检出率为９２．０６％（５８／６３），门脉期检出率为８２．５４％     

螺旋CT双期动态扫描在小肝癌诊断中的价值

目的：应用螺旋ＣＴ行肝动脉期和门静脉期双期全肝动态扫描，比较二期的病灶检出率并和超声进行检出敏感性和定性准确性的比较研究。材料和方法：４９例小肝癌患者行螺旋ＣＴ双期全肝动态扫描后，统计各期病灶的检出数，观察病灶强化方式，计算检出敏感性并行统计学处理。结果：４９例共发现病灶５３个，肝动脉期、门静脉期及双期合计的检出敏感性分别为：８８．６８％、７１．７０％、９０．５７％，双期扫描和超声（６７．９２％）比较有显著性差异，其定性准确性（９５．８３％）也明显高于超声（８０．５６％）。结论：螺旋ＣＴ双期动态扫描可充分反映小肝癌的血供特点，明显提高小肝癌的检出敏感性，无论检出还是定性均优于超声     

三期螺旋CT扫描对肝转移瘤的诊断价值

目的：分析肝转移瘤三期螺旋CT扫描的影像表现，并评价其诊断价值。方法：回顾性分析63例患者365个肝转移瘤病灶的三期螺旋CT扫描图像。统计各期病灶的检出数，观察病灶增强方式。结果：肝转移瘤在动脉期、门脉期和平衡期的检出数分别为86％、95％和88％。强化方式呈多样性，以边缘环形强化、内部低密度强化为主要特征，门脉期病灶显示更清楚，更易发现病灶。结论：三期螺旋CT扫描可提高肝转移瘤的检出率，有利于肝转移瘤特征的显示，可反映病灶的血供，有利于诊断和鉴别诊断。     

硬化型肝癌的螺旋CT多期扫描表现

目的：分析总结硬化型肝癌的螺旋CT多期扫描表现，以进一步提高对该病的诊断准确性。材料和方法：经手术证实的7例硬化型肝癌患者行螺旋CT平扫和多期增强扫描。注射造影剂后30s开始动脉期扫描，70s开始门脉期扫描，另有4例加做3—4min的延迟期扫描，观察病灶的强化方式。结果：平扫7个病灶均为低密度。动脉期6个病灶有轻度的不规则环形、点状或结节状强化，1例无强化。门脉期7个病灶均有不同程度的强化，如不规则环形强化、边缘结节状强化或中心强化等，强化范围较动脉期增大。延迟期4个病灶仍有各种各样的强化表现。结论：硬化型肝癌的螺旋CT多期扫描表现特殊，以早期轻度强化、门脉期和(或)延迟期仍有持续强化为主，需认真与血管瘤及炎性假瘤鉴别，了解其CT表现有助于临床正确诊断和治疗方案的选择。     

螺旋CT双期肝脏增强扫描对肝癌和肝转移瘤的诊断

目的：比较螺旋CT肝脏双期增强扫描的动脉期和门脉期对肝癌和肝转移瘤的检出率。材料和方法：对97例肝癌和47例肝转移瘤病人行螺旋CT双期增强扫描，造影剂注射速度为3ml／S，扫描延迟时间动脉期为30秒，门脉期为65秒。比较动脉期和门脉期对病灶的检出率。结果：207个肝癌病灶，动脉期和门豚期检出率分别为92％和83％，其中对于直径≤3cm病灶的检出率分别为83％和54％（P＜0．005）。482个转移瘤病灶，动脉期和门脉期的检出率分别为70％和96％，动脉期在7例病人中多检出17个病灶。结论：动脉期与门脉期相比，可以显著提高对肝癌和其它多血管肿瘤的检出率，对小的肝癌病灶检出的意义更大。     

肝脏局灶性结节增生（FNH）：螺旋CT多期扫描表现

探讨肝脏局灶性结节增生在螺旋ＣＴ多期扫描中的表现,以进一步提高ＣＴ诊断的准确性。材料与方法：１３例经手术证实的ＦＮＨ,均做平扫,动脉期,门脉期及延迟期扫描。结果：１３个病灶平扫低密度者１１个,均匀或不均匀,２个为等密度,增强动脉期扫描所有病灶均有明显强化且除中心疤痕外病灶强化均匀一致,     

螺旋CT三期增强扫描诊断原发性小肝细胞癌的价值

目的:评价螺旋CT三期增强扫描诊断原发性小肝癌(SHCC)的价值。材料和方法:分析21例经病理证实的小肝细胞癌,螺旋CT平扫及三期增强扫描的CT征象。结果:21例SHCC中,检出26个病灶,其中20个病灶在三期扫描中为典型表现,即动脉期为高密度,门脉期为等密度或低密度,平衡期为低密度,动脉期检出率为92.3%。结论:螺旋CT三期增强扫描能明确肿瘤的血供特点和门脉受累情况,明显提高病灶的检出率,为明确诊断和指导治疗提供了可靠依据     

螺旋CT双期或三期扫描对肝脏占位性病变的诊断

目的：分析肝脏螺旋CT双期或三期扫描表现，探讨其对原发性肝癌、肝转移瘤、肝血管瘤的诊断及鉴别诊断的意义。方法：经临床证实25例，均作螺旋CT平扫、动脉期、门脉期及部分平衡期和延迟期扫描，并分析螺旋CT多期扫描表现。结果：原发性肝癌动脉期明显强化而肝脏无强化，形成鲜明的对比，门脉期呈相对低密度或恢复到平扫时表现。肝血管瘤CT特征为动脉期呈边缘性环状、结节样强化，门脉期病灶边缘强化向中心强化并充满病灶呈高密度，平衡期呈等密度或低密度肝转移瘤表现多样化，周边强化或不均匀强化或不强化。结论：螺旋CT双期或三期扫描已作为对肝脏占位性病变的主要检查方法，并作为常规。     

Neoangiogenesis and sinusoidal capillarization in hepatocellular carcinoma: correlation between dynamic CT and density of tumor microvessels

PURPOSE: To retrospectively evaluate the correlation between the degree of contrast enhancement on dynamic computed tomographic (CT) scans and the degree of neoangiogenesis and sinusoidal capillarization in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The institutional review board did not require approval or informed patient's consent for the review of medical records or images. Dynamic CT scans of 97 nodular HCCs in 97 patients (79 men, 18 women; age range, 29-73 years; mean age, 54 years) were evaluated in terms of the attenuation change in the arterial, portal venous, and delayed phases, and the results were correlated with the number of unpaired arteries and the degree of sinusoidal capillarization at histopathologic examination. The mean attenuation value of the nodular HCCs on triple-phase helical CT scans was correlated with the number of unpaired arteries and the degree of sinusoidal capillarization. Statistical analysis was performed with the Spearman rank correlation test. RESULTS: The number of unpaired arteries in the nodular HCCs was found to correlate with the degree of contrast enhancement in the arterial phase (r = 0.225, P = .027), but did not correlate with the degree of contrast enhancement in the portal and delayed phases. The degree of sinusoidal capillarization did not correlate linearly with the mean attenuation of the nodular HCCs in any phase of contrast enhancement. CONCLUSION: The degree of contrast enhancement of the nodular HCCs in the arterial phase tended to correlate with the number of unpaired arteries, but no correlation was evident between the degree of contrast enhancement and sinusoidal capillarization in any phase of CT imaging.     

肝脏双期螺旋CT扫描的临床应用价值

目的:研究双期螺旋CT最佳扫描技术及其在肝肿瘤或肝癌探测中的应用。材料与方法:35例无肝肿瘤和17例肝肿瘤患者均经双期螺旋CT行肝脏扫描,于动脉期和门静脉期观察了正常肝脏和肝细胞癌病灶中的CT表现。结果:正常肝脏与肝细胞癌的CT表现有明显不同。在12例肝细胞癌患者中确切看到了14个肝细胞癌病灶,其中13个病灶在动脉期呈高密度,12个病灶在门静脉期呈低密度,动脉期和门静脉期肝细胞癌的检出率分别为92.8％和85.7％。结论:选择最优化扫描参数,可清晰显示肝细胞癌的增强特点,并显著提高其病变的检出率,因此,双期螺旋CT扫描可当作探测肝肿瘤或肝细胞癌的常规方法。     

Detection of hepatocellular carcinoma: comparison of dynamic three-phase computed tomography images and four-phase computed tomography images using multidetector row helical computed tomography

PURPOSE: The purpose of our study was to assess the value of additional early arterial phase computed tomography (CT) imaging in the detection of hepatocellular carcinoma (HCC) by comparing three-phase and four-phase imaging by using multidetector row helical CT. METHODS: Twenty-five patients with 33 HCCs underwent four-phase helical CT imaging. The diagnosis was established by pathologic examination after surgical resection in 19 patients and by biopsy in six. Four-phase CT imaging comprises early arterial, late arterial, portal venous, and delayed phase imaging obtained 25 seconds, 45 seconds, 75 seconds, and 180 seconds after the start of contrast material injection using multidetector row helical CT. Three-phase CT images (late arterial, portal venous, and delayed phase) and four-phase CT images (early arterial, late arterial, portal venous, and delayed phase) were interpreted independently for the detection of HCC by three blinded observers on a segment-by-segment basis. Sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (Az) for three-phase CT images and four-phase CT images were calculated. The enhancement pattern of HCC was analyzed on early arterial and late arterial phase imaging. RESULTS: The mean sensitivity of three- and four-phase CT images was 94% and 93%, respectively. The differences between sensitivities were not statistically significant (all p > 0.05). The mean specificities of three- and four-phase CT images were 99% and 98%, respectively. The differences between the specificities were not statistically significantly (all p > 0.05). Neither were the mean areas under the ROC curve for four-phase CT images (Az = 0.976) and three-phase CT images (Az = 0.971) statistically significant (p > 0.05). On early arterial phase imaging, 16 HCCs were hyperattenuating and 17 HCCs were isoattenuating. On late arterial phase imaging, 24 HCCs were hyperattenuating and nine HCCs were isoattenuating. CONCLUSIONS: Additional early arterial phase imaging did not improve the detection of HCC compared with three-phase CT images, including late arterial, portal venous, and delayed phase imaging.     

螺旋CT多期扫描在肝门胆管癌术前评估中的价值

目的　探讨螺旋CT多期扫描在肝门胆管癌术前评估中的价值。方法　经病理证实的26例肝门胆管癌行常规上腹部平扫和增强扫描。增强扫描在注入造影剂后30s、70s时分别行动脉期和门脉期扫描。另有15例加做了3~4min的延迟期扫描。肝门区采用3~5mm的薄层扫描。观察肿块的部位、大小、强化的特征和累及的范围。评价手术可切除性。结果　多期相扫描能发现所有病灶。动脉期16个病灶有强化。门脉期26个病灶均有强化,其中19个病灶明显强化。15个做延迟期扫描的病灶均有持续强化。可切除性评估的准确性为84. 62%。结论　螺旋CT多期增强扫描结合薄层扫描技术可清晰显示病灶的部位和强化特征,明显提高了肝门胆管癌的可切除性估价的准确性,有助于术前治疗方案的选择和预后的估计。     

螺旋CT三期增强扫描误诊漏诊肝细胞癌20例分析

目的：探讨螺旋CT三期增强扫描误诊或漏诊的20例肝细胞性肝癌（HCC）的原因,以进一步提高HCC的诊断准确性。方法：20例HCC患者行平扫及三期增强扫描,对比剂注射流率为3.0ml/s,然后开始动脉期、门脉期和延迟期的扫描,观察病灶的强化方式和部位。结果：漏诊的5个病灶均〈1cm,其中2个病灶在三期扫描中均未能发现,其余3个病灶因观察分析不仔细而漏诊。16个病灶误诊为其它肝脏病变,肝血管瘤（5个）,肝脓肿（4个）,肝硬化结节（3个）,局灶性结节增生（2个）,肝炎性假瘤（2个）。结论：HCC在三期增强扫描中强化方式不典型是误诊的主要原因,而这种不典型强化方式是HCC的病理基础和生长方式所造成的。了解HCC的病理基础和生长方式及仔细阅片和分析可进一步提高HCC的诊断准确性。     

Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis

PURPOSE: To determine, by using multi-detector row helical computed tomography (CT), the added value of obtaining unenhanced and delayed phase scans in addition to biphasic (hepatic arterial and portal venous phases) scans in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. MATERIALS AND METHODS: Local ethical committee approval and patient consent were obtained. One hundred ninety-five patients (129 men, 66 women; mean age, 61 years; age range, 39-78 years) with 250 HCCs underwent multi-detector row helical CT of the liver. A quadruple-phase protocol that included unenhanced, hepatic arterial, portal venous, and delayed phases was performed. Analysis of images from hepatic arterial and portal venous phases combined, hepatic arterial and portal venous phases with the unenhanced phase, hepatic arterial and portal venous phases with the delayed phase, and all phases combined was performed separately by three independent radiologists. Relative sensitivity, positive predictive value, and area under the receiver operating characteristic curve (A(z)) were calculated for each reading session. RESULTS: Mean sensitivity and positive predictive values, respectively, for HCC detection were 88.8% (666 of 750 readings) and 97.8% (666 of 681 readings) for the combined hepatic arterial and portal venous phases, 89.2% (669 of 750 readings) and 97.8% (669 of 684 readings) for hepatic arterial and portal venous phases with the unenhanced phase, 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for hepatic arterial and portal venous phases with the delayed phase, and 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for all four phases combined. The reading sessions in which delayed phase images were available for interpretation showed significantly (P < .05) superior sensitivity and A(z) values. CONCLUSION: Unenhanced phase images are not effective for HCC detection. Because of the significant increase in HCC detection, a delayed phase can be a useful adjunct to biphasic CT in patients at risk for developing HCC.     

肝癌多期动态CT强化特点与PTEN表达的相关性研究

目的:探讨肝癌多期动态CT强化特点及其与抑癌基因PTEN表达的相关性。方法:选择肝细胞癌患者99例行CT扫描,增强扫描包括动脉期早期、动脉晚期、静脉期及延迟期。于后处理工作站分析CT数据,并通过多平面重组、容积再现及最大密度投影观察病变特点,分析肝癌包膜及门静脉癌栓与肝癌内PTEN表达的关系。结果:①动脉晚期对<3cm肝癌病灶的显示率明显高于其他2期(P<0.05)。各期对≥3cm肝癌病灶显示率差异无统计学意义(P>0.05)。②有完整包膜的肝癌患者中PTEN阳性28例(75.68%),明显高于包膜不完整及无包膜的肝癌患者(P<0.05),PTEN蛋白的表达与肝癌完整包膜间呈正相关。不伴有门静脉癌栓的肝癌患者中PTEN阳性25例(75.76%),明显高于伴有门静脉癌栓的肝癌患者(P<0.05),PTEN蛋白的表达与门静脉癌栓呈负相关。结论:多期动态螺旋CT扫描对肝细胞癌具有很高的检出率,且肝癌包膜的完整性及门静脉癌栓的有无与PTEN表达存在相关性。     

Multiple-phase spiral computerized tomography of small hepatocellular carcinoma: technique optimization and diagnostic yield

PURPOSE: Spiral imaging has dramatically increased the diagnostic capabilities of Computed Tomography (CT) in the evaluation of small hepatocellular carcinomas (HCCs, O < 3 cm). We report our experience with multiple-phase CT of small HCC relative to both examination technique and lesion patterns. We compared the yield of biphasic (arterial-dominant + portal-dominant phases) and triphasic (arterial-dominant + portal-dominant + delayed phases) and also reviewed the literature for a meta-analysis of the techniques used. MATERIAL AND METHODS: December 1996 to July 1998, forty-eight patients with small nodular HCCs were examined--98 nodules in all (range 1-9, mean 2 per patient). After baseline CT, a nonionic contrast agent (350 mgI/mL, 130-140 mL, 4 mL/s) was administered through a power injector and a 16-gauge needle. Biphasic volume images were acquired in 19 subjects (early-phase delay 24 s, venous-phase delay 75 s) and triphasic images in 29 (early-phase delay 24 s, venous-phase delay 60 s, delayed-phase delay 100 s). Retrospectively we assessed the number of nodules detected with each protocol in every phase, nodule conspicuity (graded I-IV) relative to surrounding parenchyma, and nodule patterns in the various phases. Nodule patterns were distinguished into homogeneous, peripheral, central and mixed hyperdensity, and homogeneous hypodensity. RESULTS: Thirty-seven lesions were found in the patients examined with the biphasic technique: baseline images showed 35% of the nodules, arterial images 92%, portal images 76% and combined arterial and portal acquisitions 95%. Sixty-one lesions were found in the patients examined with the triphasic technique: baseline images showed 43% of the nodules, arterial images 93%, portal images 70%, and delayed images 77%; combined arterial and portal acquisitions detected 93% of the nodules, combined arterial and delayed images 95%, combined arterial and delayed images 80%. Finally, 95% of lesions were demonstrated when the three phases were combined. Overall conspicuity grades were I in 44% of cases, II in 28%, III in 18% and IV in 10% of cases at baseline scanning; I in 9%, II in 24%, III in 34% and IV in 33% in the arterial phase; I in 28%, II in 41%, III in 18% and IV in 13% in the portal phase; I in 23%, II in 30%, III in 26% and IV in 21% of cases in the delayed phase. At baseline, 10% of lesions were hyperdense (homogeneously and peripherally in 5% each); mixed density was seen in 8%, and hypodensity in 82%. In the arterial phase, 93% of lesions were hyperdense (homogeneously in 80%, peripherally in 10% and centrally in 3%); mixed density was seen in 5%, and hypodensity in 1%. In the portal phase, 4% of lesions were hyperdense (homogeneously in 1% and centrally in 3%); mixed density was seen in 11%, and hypodensity in 85%. In the delayed phase, the lesions appeared mixed in 11% of cases and hypodense in 89%. CONCLUSIONS: Spiral CT scanning of small HCCs requires dedicated and meticulous technique. Multipassage assessment is mandatory, with 2 or 3 dynamic acquisitions of the whole liver. No major difference in nodule detection was demonstrated between these two options and thus the choice rests with the radiologist's preference. Early CT images proved best for lesion detection, followed by delayed, venous, and baseline studies; lesion recognition depends largely on nodular diameter. The same applies to conspicuity, which however depends on tumor volume less. Lesion patterns are quite typical and constant in all phases and are independent of lesion diameter.