实时超声造影与增强螺旋CT检出恶性肿瘤肝转移灶的临床研究

目的 比较常规超声、超声造影及增强CT对恶性肿瘤肝转移灶的检出能力。方法 应用超声造影剂SonoVue及反向脉冲谐波造影成像技术,对73例已确诊为恶性肿瘤并疑有肝转移的患者进行超声造影检查,与常规超声及增强CT结果进行比较。结果 常规超声在67例患者中检出176个转移灶,6例未显示病灶的患者超声造影后检出肝内转移灶,46例患者（63、0％）超声造影较常规超声多检出119个转移灶（P〈0、01）,89、9％的新检出病灶〈2cm,最小者0．3cm。13例患者超声造影较增强CT多检出44个亚厘米转移灶（P〈0．01）,2例患者增强CT较超声造影多检出3个转移灶。结论 超声造影能够明显提高恶性肿瘤肝内小转移灶的检出能力,对亚厘米转移灶的检出优于增强CT,超声造影对恶性肿瘤临床分期及治疗方案的选择有较高的应用价值。     

Spiral CT for the detection of hepatocellular carcinomas: relative value of arterial- and late-phase scanning

Background: Spiral computed tomography (CT) can image the liver during arterial and late phases of contrast and optimize the evaluation of hypervascular tumor. The objective of this study was to evaluate the relative value of arterial- and late-phase spiral CT in the detection of hepatocellular carcinomas. Methods: Fifty-eight patients with hepatocellular carcinomas underwent two-phase spiral CT examination with 10-mm collimation at 10 mm/s table speed (Siemens Somatom Plus S), and 120 mL of contrast material (36 g iodine) was injected at the rate of 3 mL/s. CT images of hepatic arterial and late phases were obtained with a 35-s and 180-s delay, respectively. Results: In 58 patients, 111 hepatocellular carcinoma lesions were seen. The arterial phase detected 93 (84%) and the late phase 75 (68%) lesions (p < 0.01). The arterial phase detected more lesions in 11 patients, and the late phase dected more in two patients and an equal number in 45 patients. If lesions larger than 2 cm are excluded, the arterial phase detected 40 (74%) and the late phase 21 (39%) of 54 lesions (p < 0.001). Conclusion: The arterial phase of spiral CT greatly improves the detection of hepatocellular carcinoma when compared with the late phase. Received: 13 April 1995/Accepted: 22 May 1995     

Peritoneal Coccidioidomycosis: a potential CT mimic of peritoneal malignancy

Peritoneal involvement is a rare extrapulmonary manifestation of coccidioidomycosis. We report a patient with meningeal coccidioidomycosis who was found to have multiple, globular, peripherally enhancing deposits in the peritoneal cavity at abdominal computed tomography, raising the consideration of peritoneal malignancy. Aspiration biopsy demonstrated peritoneal coccidioidomycosis. The particular computed tomographic findings of peritoneal coccidioidomycosis seen in this patient have not been previously described.     

Arteriovenous malformation of the pancreas in a patient with gastrointestinal bleeding: helical CT findings

Dynamic computed tomographic (CT) findings of arteriovenous malformation (AVM) of the pancreas include strong enhancement or conglomeration of small hypervascular spots in the pancreas and early contrast filling of the portal vein during the arterial phase. We describe a case with pancreatic AVM in which we identified enlarged arterial feeders and draining veins as supportive findings of the diagnosis and ulceration into the pancreatic duct as a possible cause of gastrointestinal bleeding at contrast-enhanced CT.     

应用64层螺旋CT智能触发技术优化肝脏双动脉期扫描

目的 探讨64层螺旋CT对比剂追踪智能触发技术(ABT)在肝脏双动脉期扫描中的技术优化.方法 将200例接受64层螺旋CT肝脏平扫加增强扫描的患者随机分为四组各50例;其中三组患者采用ABT技术启动动脉早期扫描,触发监测点设为腹腔干层面的降主动脉,CT触发阀值分别采用110、140、170 HU,触发后延时5 s开始动脉早期扫描,延时20 s开始动脉晚期扫描;另一组患者动脉早期扫描用固定延时(注射对比剂后)20 s,动脉晚期延时35 s.测量肝实质的强化CT值及腹腔干层面的降主动脉、肝固有动脉的CT值作为评判动脉早期成像质量的指标.结果 ABT三组中,140 HU触发组符合优化的动脉早期成像(43/50,86.00%)高于110 HU触发组(35/50,70.00%)及170 HU触发组(32/50,64.00%);固定延时扫描组符合率最低(28/50,56.00%),四组之间优化的动脉早期成像的符合率差异有显著统计学意义(P<0.01).结论 在触发阀值为140 HU时,64层螺旋CT肝脏智能触发增强扫描技术可获取最佳双动脉期增强效果.     

CT of agenesis and atrophy of the right hepatic lobe

Background: To identify and differentiate agenesis and severe atrophy of the right hepatic lobe on computed tomography (CT). Methods: The CT examinations of three cases of agenesis and 11 cases of severe atrophy of the right hepatic lobe were reviewed. We evaluated visibility of the three hepatic veins, the two main portal veins (including their branches if necessary), the dilated intrahepatic ducts, enlargement of the medial and lateral segments of the left lobe and caudate lobe of the liver, presence of a retrohepatic gallbladder, hyperattenuation of the atrophic liver parenchyma, posterolateral interposition of the hepatic flexure of the colon, and upward migration of the right kidney. Results: In the three cases of agenesis, no structure can be recognized as the right hepatic vein, right portal vein, or dilated right intrahepatic ducts. In the 11 cases of severe lobar atrophy, the right portal vein (or its branches) was recognized in eight cases, the right hepatic vein in four cases, and the dilated right intrahepatic ducts in 11 cases. The degree of enlargement of the lateral segment does not necessarily change inversely with the size of the medial segment and the caudate lobe. The retrohepatic gallbladder is present in eight cases (two in agenesis and six in atrophy). The phenomenon of hyperattenuation of the atrophic liver parenchyma was noted in six cases. Conclusion: Even though a retrohepatic gallbladder and a severely distorted hepatic morphology due to compensatory hypertrophy of the left and caudate lobes may raise a suspicion of agenesis of the right lobe of the liver, absence of visualization of all of the right hepatic vein, right portal vein and its branches, and dilated right intrahepatic ducts is a prerequisite of the diagnosis of agenesis of the right hepatic lobe on CT. In severe lobar atrophy, at least one of these structures is recognizable. Received: 1 March 1997/Accepted after revision: 25 June 1997     

超声造影和增强CT诊断肝脏局灶性病变的Meta分析

目的 通过Meta分析比较超声造影(CEUS)和增强CT(CECT)对肝脏局灶性病变的诊断价值. 方法 检索PubMed和中国期刊网CNKI数据库关于CEUS及CECT诊断肝脏局灶性病变的中英文文献,并对文献进行评价和筛选.应用Metadisc软件对纳入的试验结果 进行分析. 结果 CEUS诊断肝脏局灶性病变共纳入2041例,合并敏感度为89.00%,合并特异度为88.00%,加权SROC曲线下面积(AUC)为0.9666.CECT诊断肝脏局灶性病变共纳入686例,合并敏感度为93.00%,合并特异度为84.00%,加权SROC曲线下面积(AUC)为0.9610. 结论 CEUS与CECT对肝脏局灶性病变诊断准确性差异无统计学意义.     

运用正交试验法研究肝脏动态CT增强扫描最佳参数

目的 研究肝脏动态CT增强扫描的最佳参数。方法 选择3因素2水平正交试验表(L_82~7),安排40例病人造影检查,分析不同造影剂注射速度(2ml/秒、4ml/秒)、注射时相(单、双相)及延迟时间(15秒、30秒)对造影观察指标的影响。结果 造影剂注射速度为4ml/秒及延迟30秒扫描可获得较高的肝脏增强峰值(p<0.05);采用2ml/秒的注射速度及双相注射可获得较长的到达肝脏增强峰值的时间;采用2ml/秒的注射速度可获得较长的平衡期及最佳扫描间隙。结论 2ml秒注射速度、双相注射及延迟30秒扫描可作为肝脏动态CT增强扫描的最佳参数组合。     

Epithelioid hemangioendothelioma of the liver

Epithelioid hemangioendothelioma of the liver is a rare vascular tumor with intermediate malignant potential. On imaging studies, the lesion has a solid appearance and may mimic metastatic disease. We present a case in which the morphologic features (multifocal aspect, peripheral location, and capsular retraction) and the clinical history aided in including this entity in the differential diagnosis.     

延迟相全肝扫查联合再次造影对肝脏恶性肿瘤检出的价值

目的评价超声造影延迟相全肝扫查联合再次造影对肝脏恶性肿瘤检出的价值。方法对行肝脏超声造影检查的22例肝脏恶性肿瘤患者采用低机械指数实时连续成像技术(造影剂SonoVue),延迟相进行全肝快速扫查寻找异常低增强区。并再次注射造影剂对延迟相发现的异常低增强区进行观察,超声造影诊断结果以增强CT/MRI、穿刺或手术病理诊断、临床及超声随访结果为参照,计算B型超声、超声造影发现病灶个数,计算并对比两种方法对疾病诊断的漏诊率。结果采用延迟相全肝扫查联合再次注射SonoVue后,22例患者中,超声造影诊断肝转移瘤4例,B型超声仅诊断2例、漏诊2例;超声造影诊断肝癌或肝癌复发18例,B型超声拟诊14例,漏诊4例。超声造影对22例患者疾病漏诊率为0(0/22),B型超声漏诊率27%(6/22),二者差异有统计学意义(P<0.05)。B型超声发现病灶18个,超声造影检出病变47个,超声造影延迟相新发现病灶29个。结论延迟相全肝扫查联合再次注射造影剂可提高肝脏恶性病变的检出率,减少疾病漏诊率,值得在临床工作中推广。     

Hepatocellular carcinoma: Spectrum of contrast-enhanced gray-scale harmonic sonography findings

Sonography (US) is the most commonly used tool in the assessment of patients with chronic liver disease. Nevertheless, small nodules can be overlooked. Moreover, even if the lesion is readily recognizable, difficulty persists in differentiating hepatocellular carcinoma (HCC) from pre-tumoral, dysplastic stages of nodule evolution. In addition, US is the main tool in guiding percutaneous ablation therapies for HCC and in evaluating patients after treatment, but changes are not specific and difficulties persist in recognizing residual tumor during and after the ablation procedure. Contrast-enhanced, gray-scale, harmonic US offers new possibilities in the imaging of liver tumors. The real-time, low-mechanical index technique employed in our institution allows a true dynamic assessment of the tumor during the various phases of contrast medium circulation. This pictorial essay focuses on typical and atypical appearances of HCC when imaged with contrast-specific, real-time US. Findings useful for lesion detection, differential diagnosis, posttreatment assessment, and follow-up especially are illustrated. The potential role of contrast-enhanced US in various clinical settings is emphasized.     

Use of thin-section,multidetector row helical CT images for coronal oblique reformations for optimal visualization of structures in the hepatoduodenal ligament

Multidetector row computed tomography (CT) can acquire abdominal images of unprecedented thinness in a single breath-hold. This study investigated whether acquiring source axial images at 1.25 mm as opposed to 2.5 mm would result in a perceptible difference in image quality for coronal oblique reformations. Similarly, the hypothesis that a slice pitch of 3:1 would be superior to 6:1 was evaluated. Twenty-nine CT studies were retrospectively evaluated. The images were divided into four groups: 1.25-mm axial images, pitch 3:1; 2.5-mm axial images, pitch 3:1; 1.25-mm axial images, pitch 6:1; and 2.5-mm axial images, pitch 6:1. Three radiologists evaluated by consensus the coronal oblique reformations for overall image quality and image quality of structures in the hepatoduodenal ligament and of nodal groups. Use of 1.25-mm rather than of 2.5-mm source axial images resulted in statistically significant better scores for overall image quality and visualization of the hepatic artery, portal vein, pancreatic duct, and nodal groups. However, a pitch of 3:1 rather than of 6:1 did not result in significant differences in ratings of image quality. Use of 1.25-mm rather than of 2.5-mm source axial images improves image quality when creating coronal oblique reformations for abdominal anatomy.     

16层螺旋CT双动脉期与门脉期诊断原发性肝癌的临床应用

目的分析原发性肝癌多层面CT(multi-slicesCT,MSCT)双动脉期与门静脉期增强扫描各期强化特征,评价三期增强扫描对癌灶的检出率。方法101例原发性肝癌治疗前行MSCT的平扫,以3ml/s肘静脉注射100ml对比剂后,行动脉早期20~22s,动脉晚期34~37s,门静脉期60s扫描。测病灶平扫及各增强期CT值,观察病灶的强化情况及检出情况,以增强各期检出的肿瘤为癌灶总数。结果三期增强扫描一共显示445个病灶,<3cm癌灶199个,动脉早期检出108(54.27%),动脉晚期检出162(81.40%),门静脉期检出131(65.83%);>3cm的癌灶246个,动脉早期检出228(92.68%),动脉晚期检出236(95.93%),门静脉期检出224(91.06%)。49个仅在三期增强扫描的一期显示,动脉早期5个,动脉晚期21个,门静脉期23个。结论动脉晚期的检出率明显高于门静脉期与动脉早期。双动脉期与门静脉期增强扫描可提高肝癌检出率。     

Localized cystic disease of the kidney: CT findings

Background: We assessed the clinical and computed tomographic (CT) features of localized cystic disease of the kidney and how these features differentiate this disease from other renal cystic diseases. Methods: Medical records and CT scans of seven patients with localized cystic disease were reviewed retrospectively. Pathologic confirmation in five patients was done by surgery. The subjects consisted of four males and three females, with an age range of 29–74 years. Results: Localized cystic disease in five patients was an incidental finding. Clinical presentations in the other two patients included dark urine color, palpable flank mass, and generalized weakness. There was no patient with impairment of renal function associated with renal cystic disease. Six patients had cystic renal lesions in the left kidneys, and one patient had lesions in the right kidney. Six patients had cysts in a localized area in the affected kidney, and the remaining patient had diffuse involvement of the entire kidney. The upper pole was most frequently involved. CT appearance was characterized by multiple, variable size cysts conglomerated to islets of cysts that were separated by the normal renal parenchymal band. Conclusion: Localized cystic disease of the kidney has characteristic CT findings that distinguish it from other renal cystic diseases, making follow-up without surgical intervention possible.     

超声造影评价肝恶性肿瘤射频治疗疗效--与常规超声及增强CT比较

目的评价造影增强超声（CEUS）对判断肝恶性肿瘤射频消融疗效的应用价值。方法53例肝恶性肿瘤共71个病灶经射频消融治疗后行CEUS检查，其中原发性肝癌44例59个病灶、转移癌9例12个病灶。全部病灶采用超声造影剂SonoVue团注法行CEUS检查，并与同期常规超声及彩色超声、增强CT检查结果比较。超声仪为Technos DU8并使用CnTI实时超声造影匹配成像技术。结果CEUS观察71个病灶中，54个（76．1％）病灶在造影各时相均未强化，提示肿瘤完全灭活；13个（18．3％）病灶边缘局部动脉期增强，判断有肿瘤残存；4个（5．6％）病灶判断不清。最终诊断依据两种以上影像学检查并结合肿瘤标志物水平、穿刺活检、3个月以上随访进行综合判断。以最终诊断为金标准，CEUS诊断准确性91．5％（65／71），增强CT为93．9％（62／66），常规超声及彩色超声为67．6％（48／71）。CEUS与增强CT在评价肿瘤复发或残留方面的灵敏性、特异性、准确性差异均无显著性意义。结论CEUS可较准确地判断射频消融后肿瘤灭活程度，是评价射频消融疗效的有效方法，可成为肝癌局部治疗随访的重要手段，有较高临床应用价值。     

肝脏磁共振对比剂的过去、现在和未来

MR对比剂已广泛应用于肝脏疾病的诊断及相关研究。本文对不同种类对比剂在肝脏应用方面的过去、目前临床应用及研究现状、存在问题、未来发展趋势等进行简单介绍,旨在提高肝脏MR磁共振对比剂在临床应用及研究等方面的认识。     

Transdiaphragmatic liver scanning: a new intraoperative imaging technique for examination of the liver from the thoracic cavity

In order to examine the liver during thoracotomy, a new intraoperative imaging technique called "transdiaphragmatic liver scanning" was developed. Transdiaphragmatic scanning performed with high-frequency transducers provided clear visualization of the entire liver from the thoracic cavity through the diaphragm. In our study, transdiaphragmatic scanning was used in 27 thoracotomy operations performed for the treatment of malignant diseases, including lung and esophageal cancers. One 5-mm liver cyst, one 3-mm x 4-mm hemangioma, and one 5-mm x 6-mm ill-defined lesion (possible metastasis), all of which were unrecognized preoperatively, were detected. In 3 operations, preoperatively suspected liver metastases were excluded by transdiaphragmatic scanning. Because transdiaphragmatic scanning provides high-resolution images of the liver and is the only method capable of examining the liver during thoracotomy, this intraoperative scanning technique may become a useful tool in the evaluation of liver metastases from thoracic or mediastinal malignancies.     

Anomalous right lobe of the liver: CT appearance

We report five cases of anomalous right lobe of the liver diagnosed by computed tomography (CT). There were three men and two women, with an average age of 67 years. The right lobe was deformed and decreased in size in all patients. Hypertrophy of the left lobe was present in all patients.     

肝脏炎性假瘤的超声造影表现

目的 观察肝脏炎性假瘤超声造影的表现，探讨超声造影对肝炎性假瘤的诊断价值。方法 经外周静脉团注声诺维，使用对比脉冲序列（CPS）技术对2例经超声引导下活检证实的肝脏炎性假瘤行超声造影检查，观察注射造影剂后病灶的增强情况。结果 2例炎性假瘤均表现为动脉期迅速增强并快速廓清，门脉期与实质期回声显著低于周边肝实质。结论 肝脏炎性假瘤的超声造影灌注特征可以与肝脏恶性肿瘤相类似，造影诊断为恶性的病灶并不能完全除外炎性假瘤的可能，应行超声引导下活检以明确病理诊断。     

Parenchymal changes of the liver in cholangiocarcinoma: CT evaluation

We evaluated parenchymal changes of the liver in 92 patients (41 peripheral types and 51 hilar types) with cholangiocarcinomas studied by bolusenhanced computed tomography (CT). In 39% of patients with the peripheral type, a wedge-shaped increased enhancement of the liver was observed peripheral to the tumor on bolus-enhanced CT. Tumor was observed in all cases. In 58.8% of patients with the hilar type, a segmental or lobar increased degree of enhancement of the liver was observed, but the tumor was demonstrated in only 58.8%. Atrophy was accompanied by areas of increased enhancement in 80% of hilar type and 25% of peripheral type. Areas of increased degree of enhancement corresponded to a wedged-shaped perfusion defect on CT during arterial portography. On magnetic resonance imaging (MRI), those lesions showed hyperintensity on T2-weighted images. Most of these changes were considered to be due to reversible hepatic parenchymal ischemia secondary to portal vein invasion by the tumor.