Hepatocellular carcinoma: Findings on spiral CT during arterial portography

Background To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC.Methods SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts.Results Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p <.001).Conclusion The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.     

Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma: CT evaluation

We retrospectively reviewed computed tomographic (CT) findings of 118 patients with hepatoma who received sequential follow-up CT after transcatheter arterial embolization (TAE). Thirty-five patients received TAE using Gelfoam particles with cisplatin, 37 patients using Gelfoam particles and iodized oil (Lipiodol) with cisplatin, and 46 patients using iodized oil with cisplatin. Liver atrophy was observed in 33 patients, lobarly or focally, depending on the embolized area. It was frequently associated with portal vein occlusion by the tumor, usage of iodized oil, and repeated embolization therapy. The lobar atrophy was seen in patients who had portal vein occlusion and/or received repeated embolization therapy. The focal atrophy was observed in patients who were administered iodized oil. Infarction developed in four patients who had a thrombus in the portal vein and received peripheral embolization therapy using iodized oil. We conclude that liver parenchymal changes occur frequently in patients who have portal vein occlusion and/or receive peripheral embolization using iodized oil.     

兔肝VX2肿瘤超声造影时相划分:与多排螺旋CT增强扫描对照实验研究

目的 探讨灰阶实时超声造影(CEUS)和多排螺旋CT(MDCT)增强扫描兔肝VX2肿瘤的增强显像特征及兔肝超声造影时相的划分标准.方法 运用超声造影剂SonoVue对33只荷肝VX2瘤兔行CEUS和64排螺旋CT增强扫描,以团注造影剂后肝动脉开始增强作为动脉期的起始时间,以VX2肿瘤增强达峰时间作为门脉期的起始时间,以肝实质增强达峰值强度时间作为实质期的起始时间,观察其增强特征,比较CEUS中肿瘤和瘤周同水平肝实质的时间强度曲线和MDCT中腹主动脉、门静脉、肝实质和肿瘤的时间密度曲线形态特征,制定划分各期时相的标准.结果 CEUS和MDCT对VX2肿瘤动脉期、门脉期、实质期起始时间的划定分别为(6.82±1.36)s、(11.64±2.03)s、(20.24±4.17)s和(9.43±2.23)s、(13.77±2.01)s、(22.71±4.58)s,CEUS较MDCT各相起始时间均提早(P<0.01),二者对兔肝VX2肿瘤增强显像特征一致,均表现为"快进快退".结论 CEUS可以对兔肝VX2肿瘤的灌注情况进行实时高分辨率显像,CEUS和MDCT时相标准可为相关的影像学评估研究提供基本的理论依据.     

60例小细胞肺癌的CT表现

目的：分析小细胞肺癌（small cell lung cancer,SCLC）的CT表现特点,以提高对该病的认识。方法：收集有CT和临床资料并经病理证实的SCLC 60例,回顾性总结分析CT影像特征。结果：中央型肺癌47例,CT表现为肺门分叶状结节或肿块,伴阻塞性肺炎11例（23.4%）,阻塞性肺不张5例（10.6%）,42例（89.4%）伴有纵隔淋巴结肿大,36例行CT增强,其中32例肿块和淋巴结均匀强化。13周围型SCLC中,9例肿大的肺门、纵隔淋巴结较肺内肿瘤大。结论：SCLC CT主要征象以肺门区实性肿块为主,多伴有肺门、纵隔淋巴结转移,支气管阻塞征象出现较晚。     

周围型肺癌CT征象与Ki-67、p53表达的关系

目的 探讨周围型肺癌（PLC）CT征象与Ki-67、p53表达的关系。方法 选取2016年1月～2022年2月在本院就诊的108例PLC患者为研究对象,采用飞利浦256层螺旋CT检查患者的CT征象,并检测PLC组织中Ki-67、p53的表达水平,分析PLC患者的病理组织类型、分化程度以及CT征象与Ki-67和p53表达的关系。结果 PLC组织中,Ki-67和p53阳性表达率分别为69.44%(75/108)、51.85%(56/108);CT主要表现为瘤体直径≥3.0 cm、分叶征、棘状突起征、毛刺征、磨玻璃征、增强值≥20 Hu和肺门、纵隔淋巴结肿大,而胸膜凹陷征、空气支气管征、空洞征、空泡征、钙化征相对较少;腺癌的Ki-67阳性表达率低于鳞癌（P<0.05）,腺癌和鳞癌的p53阳性表达率差异无统计学意义（P>0.05）;PLC的分化程度越低,Ki-67和p53阳性表达率越高（P<0.05）;瘤体直径≥3.0 cm、有分叶征、棘状突起征、毛刺征、增强值≥20 Hu和肺门、纵隔淋巴结肿大的PLC,Ki-67阳性表达率较高,且有磨玻璃征和空泡征的PLC,Ki-67阳性表...     

多层螺旋CT诊断肝移植术后肝静脉流出道梗阻

目的 探讨多层螺旋CT(MSCT)在诊断肝移植术后肝静脉流出道梗阻(HVO)中的价值. 方法 回顾性分析5例在肝移植术后4～102天接受肝脏MSCT动态增强扫描并经血管造影证实为HVO患者的MSCT增强特征. 结果 5例患者中,肝左静脉吻合口狭窄1例,肝中静脉吻合口狭窄(闭塞)2例,肝右静脉吻合口狭窄1例,合并肝中静脉及下腔静脉吻合口狭窄1例.5例患者CT动态增强扫描显示为典型的肝脏淤血征象.CT平扫见梗阻的肝静脉引流区肝实质密度降低(1例因有出血而呈高、低混杂密度);增强扫描动脉期病变区均未见明显强化,静脉期病变区可见轻中度强化,并可见病变区内门静脉分支显影,延迟期病变区强化程度进一步增强.静脉期或延迟期可见梗阻的肝静脉显影,显示肝静脉吻合口狭窄.5例患者均接受介入治疗,术后临床症状改善,其中2例CT复查显示肝淤血缓解、肝静脉血流通畅. 结论 MSCT动态增强扫描可明确诊断肝移植术后HVO的部位及肝脏淤血范围.     

肝癌16层螺旋CT肝动脉三期强化特点分析

目的：探讨肝癌在动脉三期的强化特点及临床应用价值。方法：肝癌27例，分别行动脉三期扫描，动脉早期、中期和晚期的扫描时间是在注射造影剂后的18s、24s、30s。结果：动脉早期无强化13例，强化14例，其中血管样强化9例，肿瘤实质样强化5例。动脉中期无强化3例，强化24例，其中血管样强化16例，肿瘤实质样强化8例。动脉晚期均有不同程度强化，其中血管样强化4例，肿瘤实质样强化23例。结论：动脉三期均能很好反应肝癌的强化特点，动脉中期肿瘤血管显影较佳，动脉晚期肿瘤整体强化较佳。     

低机械指数灰阶造影对肝VX2瘤动态期相性变化的研究

目的应用低机械指数灰阶超声造影研究肝恶性肿瘤的动态期相性增强变化规律及其诊断价值。方法分别经耳缘静脉对8只荷VX2瘤新西兰大白兔团注超声造影剂SonoVue（0．1ml／kg），应用CnTI低机械指数实时造影匹配成像技术，动态观察兔VX2瘤及其周围肝实质造影增强效应。结果在所有造影过程中，肝肿瘤及肝实质内造影剂随时间呈动态增强。VX2瘤动脉期明显强化，呈“灯泡征”，与周围肝组织灰阶对比明显；随后造影剂逐渐退出，肿瘤回声强度从与周围肝实质持平，到低于周围肝实质，最后造影剂完全退出瘤组织，在肝实质增强的背景下呈极低回声。肿瘤强化呈“快进快出”型。结论VX2瘤主要为肝动脉供血，具有恶性肿瘤“快进快出”典型的超声造影增强特点；低机械指数灰阶超声造影能完全反映肝恶性肿瘤血流动力学变化；观察肿瘤的动脉期是超声造影的关键，对诊断及鉴别诊断具有重要意义。     

Hepatic vein occlusion: Morphologic features on computed tomography and ultrasonography

Hepatic vein occlusion causes morphologic changes that can be demonstrated by computed tomography (CT) and ultrasound. In this study the imaging findings of acute, subacute, and chronic occlusion of the hepatic veins were analyzed retrospectively in 9 patients and correlated with the histopathologic changes. The CT findings were focal or scattered hypodense parenchymal lesions of the liver before and a patchy enhancement after intravenous bolus injection of contrast material. In none of the cases could the hepatic veins be identified. Hepatomegaly with relative enlargement of the caudate lobe was almost always observed. Ultrasonography demonstrated solid material within the major hepatic veins, intrahepatic venous collaterals, and focal parenchymal lesions, which varied with the stage of the disease: a hypoechogenic area was observed in acute hepatic vein thombosis with subsequent hemorrhagic infarction; hyperechogenic lesions corresponded with fibrotic zones in chronic disease. Ascites was shown by both methods in all patients.     

常见肝脏肿瘤三期动态增强的CT研究

目的：探寻常见肝脏肿瘤动脉增强ＣＴ的最佳扫描间期。材料与方法；经手术病理或临床随访证实５的肝细胞癌３８例，血管瘤４９例，转移瘤２６例。以２．５－３ｍｌ／秒的注射速度从前臂静脉注入６０％泛影葡胺９０ｍｌ后２０秒开始以动态程序扫描病变。以兴趣区测量肿瘤及背景肝实质的ＣＴ值。     

原发性支气管肺类癌MSCT诊断(附7例报告)

目的回顾性分析原发性支气管肺类癌的CT征象,并结合病理分型,提高对该病诊断水平。方法收集我院经手术病理确诊的7例支气管肺类癌患者的临床及影像检查资料,分析病灶部位、与邻近支气管关系、形态、大小、密度、边界、动态增强后表现等,并结合文献复习。结果本组病例包括4例典型类癌,3例不典型类癌。中央型4例,周围型3例。病灶均为单发,类圆形、椭圆形5例,1例呈分支管状、1例呈不规则团块状伴晕征。其中2例中央型病灶主要位于支气管腔内并向腔外生长,形成"冰山征"、"平行征"。肿瘤平均直径     

肝门部胆管癌合并胆管结石的影像学特征分析

目的探讨肝门部胆管癌合并胆管结石的影像学特点。材料与方法收集经手术或活检病理证实的54例肝门部胆管癌,年龄28~86岁,中位年龄61岁,男34例,女20例,以MRI或CT上有无合并胆管结石分为两组,合并胆管结石11例(A组),无胆管结石43例(B组)。回顾性分析并对比两组肿瘤大体分型、Bismuth-Corlette分型、肝叶萎缩及手术后复发情况。结果 54例肝门部胆管癌患者中,大体分型:A组浸润型3例(27.3%)、肿块型5例(45.4%)、息肉型3例(27.3%);B组浸润型32例(74.4%)、肿块型8例(18.6%)、息肉型3例(7.0%),两组肿瘤大体分型的差异有显著统计学意义(P0.05)。Bismuth-Corlette分型:A组I型2例(18.2%)、II型1例(9.1%)、IIIa型4例(36.3%)、IIIb型2例(18.2%)、IV型2例(18.2%);B组I型3例(7.0%)、II型14例(32.6%)、IIIa型6例(14.0%)、IIIb型10例(23.2%)、IV型10例(23.2%),两组Bismuth-Corlette分型无统计学意义(P0.05)。术后复发:A组2例(18.2%),B组8例(18.6%);肝叶萎缩:A组4例(36.3%),B组15例(34.9%),两组术后复发及肝叶萎缩的差异均无统计学意义(P0.05)。结论肝门部胆管癌合并胆管结石更多表现为肿块型和息肉型,肝门部胆管癌有无合并胆管结石在Bismuth-Corlette分型、肝叶萎缩及手术后复发情况上表现相似。     

Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients

Background: The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Methods: Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. Results: After chemotherapy, tumor volume decreased by 50–90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. Conclusions: These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.     

可切除胰腺导管腺癌CT强化程度与病理的相关性

目的 分析胰腺导管癌（PDAC）增强CT强化程度与病理的关系，观察其对评估PDAC患者预后的价值。方法 回顾性分析150例经术后病理证实的PDAC患者，术前均接受胰腺CT平扫及双期（实质期和门静脉期）增强扫描，测量增强CT双期肿瘤与周围胰腺实质的CT值差（实质期和门静脉期CT_{胰腺-肿瘤}）及肿瘤强化后与平扫期CT值差（CT_{实质期-平扫期}和CT_{门静脉期-平扫期}），观察其与肿瘤分化程度及其内纤维间质含量的关系，分析PDAC患者生存时间的独立影响因素。结果 实质期CT_{胰腺-肿瘤}与肿瘤分化程度呈中度负相关（P<0.05），余各CT值差与分化呈低度相关（P均<0.05）；实质期CT_{胰腺-肿瘤}与肿瘤内纤维间质含量呈负相关（r=-0.51，P<0.05）。肿瘤分化程度、淋巴结转移、手术切缘状态为PDAC患者生存时间的独立危险因素（P均<0.05）。结论 PDAC实质期CT_{胰腺-肿瘤}与其病理级别及其内纤维间质含量均呈负相关；值差越小，病理级别越低，患者存活时间越长。     

Computed tomographic findings of ruptured hepatic malignancy

Massive hemorrhage from ruptured hepatocellular carcinoma is uncommon. We report our experience in three cases of ruptured hepatocellular carcinoma diagnosed by computed tomography (CT). CT was useful in detecting ruptured hepatocelluar carcinoma showing the parenchymal tumor per se, defining the extent of the hematoma, and showing serial density changes with the age of the hematomas.     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

原发性肺肉瘤样癌的CT表现

目的 探讨原发性肺肉瘤样癌的CT表现特征。 方法 回顾性分析经手术病理证实的13例原发性肺肉瘤样癌的CT表现特点。所有病例术前均接受胸部CT平扫,其中10例接受增强扫描。 结果 13例均表现为肺内单发肿块;右肺7例,左肺6例;中心型4例,周围型9例;2例肿瘤形态规则,边界尚清,11例形态欠规则,边界不光整;病灶最大径3.0~8.3 cm,平均4.9 cm;肿块密度不均匀,10例增强后肿块均呈周边厚薄不均的环形强化,中央强化不明显或不均匀斑片状强化。3例侵及胸膜或胸壁组织,5例可见肺门和(或)纵隔淋巴结肿大,1例伴有单侧胸腔少量积液。 结论 原发性肺肉瘤样癌的CT表现具有一定的影像学特征,确诊仍需依靠组织病理学检查。     

人体肝脏巨片形吸虫感染影像学表现

目的探讨人体肝巨片形吸虫病的影像学表现特点及其诊断价值。方法回顾分析经临床确诊26例肝巨片形吸虫病患者的临床、病理及影像学表现。26例行CT平扫检查,其中24例行CT增强。9例行MRI平扫检查,其中7例行MRI增强。2例行肝穿刺病理学检查。结果 26例CT平扫示肝肿大并实质内弥漫斑片状密度减低影,边界欠清,15例病灶相互融合呈簇状或隧道样病灶,以包膜下肝实质内为主,其中24例CT增强病灶不均匀轻度强化;19例脾轻度增大。9例MRI平扫示为肝肿大并实质弥漫性病变,病变呈稍长T1、稍长T2,DWI上呈稍高或高信号改变;7例增强扫描呈蜂窝状稍强化;5例MRCP示肝内胆管及胆总管未见扩张或梗阻。2例穿刺病理活检表现为寄生虫性肉芽肿与坏死,周围大量单核细胞和嗜酸性粒细胞浸润。结论人体肝巨片形吸虫感染的CT、MRI表现为肝包膜下多发微小脓肿,部分呈簇状或隧道样特点,结合血清学检查,有助于早期诊断。     

超声造影时间-强度曲线在肝脏恶性肿瘤射频消融中的应用价值

目的探讨超声造影时间-强度曲线(TIC)在肝脏恶性肿瘤射频消融(RFA)中的应用价值。 方法选取2014年1月至2016年1月在湖北省肿瘤医院超声科治疗的肝脏恶性肿瘤患者61例,均经影像学手段、肝穿刺行组织学病理活检或手术病理证实为肝脏恶性肿瘤,共81个病灶。根据随机数字表法将患者分为对照组及观察组,其中观察组患者30例,共46个病灶,利用超声造影检查后行RFA,做出TIC;对照组患者31例,共35个病灶,常规超声检查后行RFA。比较观察组肝脏恶性肿瘤患者RFA前后正常肝实质与肿瘤组织超声造影定量分析结果的差异,同时比较肝脏恶性肿瘤患者RFA治疗后1个月肝脏肿瘤残留病灶与正常肝实质的超声造影定量分析结果,并比较观察组与对照组患者射频消融疗效的差异,采用Kappa一致性检验分析超声造影与增强CT/磁共振(MRI)检查结果的一致性。 结果RFA治疗前,运用超声造影对观察组46个肝脏病灶和肝脏肿瘤周边区的正常肝实质进行量化分析,术前肿瘤病灶造影剂灌注初始时间(IT)、最大峰值到达时间(PT)、灌注加速时间(AT)[(13.21±3.47)s,(17.56±7.12)s,(19.02±3.35)s]低于术前正常肝实质IT、PT、AT值[(18.75±3.68)s,(31.20±6.13)s,(34.50±3.12)s],灌注加速斜率(AS)(2.89±0.94)高于术前正常肝实质AS值(1.28±0.58),组间比较均差异有统计学意义(t＝7.43,9.85,22.93,9.89;均P<0.01)。RFA治疗1个月后,81个病灶中,有67个病灶未出现造影剂增强情况,8个病灶周边出现高增强,另外4个病灶出现内部不均匀高增强,2个病灶均匀性高增强;TIC分析显示肿瘤完全消融部分动脉相、门脉相及延迟相均无造影剂充填,肿瘤残留部位的IT、PT、AT值[(15.11±2.57)s,(20.97±3.33)s,(18.32±0.27)s]小于正常肝实质[(19.90±3.96)s,(35.68±2.92)s,(31.28±0.16)s],组间比较均差异有统计学意义(t＝9.13,29.89,37.17;均P<0.01)。随访3～6个月,以增强CT/MRI为判断肿瘤消融程度的对照指标,两组患者在经过治疗后,观察组患者的肿瘤完全消除率为91.30%(42/46),对照组患者的肿瘤完全消除率为71.43%(25/35),观察组患者的治疗效果明显优于对照组患者的治疗效果,组间比较差异有统计学意义(χ²＝5.49,P<0.05)。RFA术前超声造影与增强CT/MRI检出率具有较高一致性(Kappa＝0.87,P<0.05),RFA术后超声造影与增强CT/MRI检出率具有较高一致性(Kappa＝0.93,P<0.05)。 结论超声造影时间-强度曲线能有效识别肝脏恶性肿瘤组织,与增强CT/MRI检查具有较高一致性,在指导肝脏恶性肿瘤患者RFA治疗中具有较高的应用价值,值得在临床推广应用。     

兔VX2肝癌模型的影像学表现和栓塞技术的实验研究

目的建立兔VX2肝癌模型,探讨其影像学表现和介入栓塞技术。方法将VX2瘤组织块种植于30只新西兰大白兔肝左叶,建立兔肝癌模型。行DSA前,将种植成功的兔子进行CT、MR检查,不同剂量碘油栓塞术后CT复查并观察各组生存情况。结果经剖腹探查证实肝脏种植成功24只(成功率80%,24/30);肝种植两周后CT平扫肿瘤多呈等或低密度区,增强扫描动脉期表现为边缘环状强化;MRI上肿瘤实质部分T1WI与T2WI分别表现为均匀低信号和稍高信号,DWI上瘤灶呈明显高信号,境界清晰,坏死部分呈长T1长T2信号影。DSA肝实质期可见肿瘤染色,栓塞时可见碘油在肿瘤部位充填、沉积,术后CT均能见瘤区有高密度碘油沉积,大部分为瘤周沉积。根据体重和超选择情况确定栓塞碘油剂量效果较好。结论兔肝VX2肿瘤模型的建立与复制成功率高。CT、MR和DSA有利于荷瘤兔的监测和筛选。暴露股动脉穿刺和用微导管超选择,可对肝脏荷瘤兔进行有效的选择性肝动脉造影和栓塞。