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。     

多层螺旋CT多期增强扫描对肝转移瘤诊断价值

目的：分析肝转移瘤多层螺旋CT(MSCT)多期扫描的影像表现，并评价其诊断价值。方法：回顾性分析长征医院2002年l～6月82例患者458个肝转移瘤灶的多期扫描图像。检查机型MarconiMx8000多层螺旋盯，有效层厚5mm，螺距为1．25，常规平扫后动态三期扫描，高压注射器团注法，采用非离子型对比剂(300mgI／m1)，用量80～100m1。结果：肝转移瘤CT表现绝大多数为多发病灶，少数为单发；呈圆形或类圆形低密度结节，少数为等密度，边缘模糊或清楚，直径l～3cm。强化模式呈多样性，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，因而更易发现病灶。部分瘤灶内可见奈状、结节或团决状强化影。结论：多层螺旋CT扫描速度快，分辫率高，能获得料功的多期肝脏扫描图像，有利肝转移瘤的检出及病灶特征的显示，可反映病灶的血供，门脉期可提高病灶的检出率。     

肝转移瘤螺旋CT诊断

目的：探讨肝转移瘤的螺旋CT表现特征，着重讨论双期扫描表现。方法：回顾性分析78例已证实的肝转移瘤的螺旋CT扫描资料。检查机型采用西门子Somatom Plus 4螺旋CT机扫描。结果：肝转移瘤CT表现大多数为多发性低密度结节病灶，少数为孤立性低密度结节病灶，双期扫描显示大多数病灶为少血供，少部分病灶为多血管，各具有不同的影像学特征。结论：螺旋CT双期扫描可提高肝转移瘤的检出率，并有利于病灶特征的显示。     

螺旋CT增强双期扫描诊断肝转移瘤的价值

目的：应用多层螺旋CT进行平扫、动脉期、门脉期全肝动态增强扫描,评价其诊断转移瘤的价值。材料和方法：30例肝转移瘤患者均行多层螺旋CT平扫及双期全肝动态增强扫描,统计各期检出率,观察各期病灶的CT表现。结果：30例患者共发现病灶218个,平扫、动脉期及门脉期的病灶检出率分别为148/218(67．9%)、142/218(65．1%)、212/218(97．3%)。结论：双期螺旋CT在一定程度上利于肝转移瘤的检出和显示其特征,反映病灶的血供,有利于诊断和鉴别诊断。     

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。     

结节型肝细胞癌的螺旋CT多期扫描

目的：描述结节型肝细胞癌的螺旋ＣＴ动脉期、门脉期和延迟期增强特点,比较各期的病灶检出率,重点评价动脉期、延迟期的价值。方法：２６例结节型肝细胞癌病人行螺旋ＣＴ双期、三期动态扫描后,观察病灶的强化方式,统计各期病灶检出数。结果：２６例基于手术病理和影像方法共发现４５ 个病灶,螺旋ＣＴ多期扫描共发现４２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６６．７％ 、８６．７％ 、７１．１％ 、６５．２％ 、９３．３％ 。动脉期检出敏感性明显高于其他各期,三期结合可明显提高对结节型肝癌的检出率。结论：螺旋ＣＴ多期动态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。     

肝转移瘤高场MRI诊断

目的:探讨高场MRI在肝转移瘤(HMs)中的检出、诊断与鉴别诊断价值。方法:收集经临床、影像证实的HMs 43例,所有病例均进行高场MRI平扫和动脉期、门脉期、延迟期扫描,其中23例尚做螺旋CT平扫、动脉期、门脉期扫描,分析记录HMs螺旋CT、高场MRI平扫及多期增强扫描特征。结果:共计174枚瘤灶在MRI平扫上呈长T2长T1信号,动脉期122枚瘤灶不强化,门脉期174枚瘤灶均呈环状强化,延迟期108枚瘤灶呈向心性充填;23例79枚瘤灶螺旋CT平扫均呈低密度,动脉期49枚瘤灶不强化,30枚呈环状强化,门脉期73枚呈环状强化,4枚呈向心性充填;43例HMs高场MRI均准确诊断,螺旋CT漏检2例,误诊7例。结论:高场MRI对HMs的检出、诊断与鉴别诊断具重要价值,可作为HMs的首选检查方法。     

螺旋CT多期增强扫描对诊断肝细胞癌和肝转移瘤的评价

目的：评估螺旋CT多期增强扫描对肝细胞癌与肝转移瘤的诊断价值。方法：回顾分析经手术病理证实的35例肝细胞癌与肝转移瘤螺旋CT多期增强扫描表现。结果：12例巨块型肝癌平扫为低密度，增强扫描动脉期均明显不均匀强化，特点为肿瘤供血血管强化，结节型8例表现为病灶斑片状及边缘强化，肿瘤供血血管不明显，小肝癌5例为动脉期全瘤强化．强化后CT值可增加40HU以上，肝转移瘤动脉期病灶无明显强化。静脉期呈环形轻度强化，呈现典型“牛眼征”。结论：螺旋CT多期增强扫描对明确肿瘤血供和肿瘤生长方式与小肝癌诊断有重要的意义。     

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多时相扫描鉴别诊断肝细胞癌和血管瘤

目的:探讨螺旋CT多时相扫描对肝细胞癌和血管瘤的鉴别诊断。材料和方法:对37例患者(肝癌16例,血管瘤21例)行螺旋CT平扫和增强扫描,分析其表现。结果:37例平扫均发现低密度灶。肝细胞癌在动脉期75%有显著增强,呈高密度,在门静脉期和延迟期则呈低密度;血管瘤54%动脉期有典型增强表现,门静脉期100%有增强,24%全部填充,延迟期91%为高密度或等密度。结论:肝细胞癌和血管瘤在螺旋CT多时相增强扫描中,各有其典型的CT表现,两者鉴别的关键是门静脉期。     

螺旋CT和造影剂快速滴注法作肝脏肿瘤早期增强扫描

目的：评价螺旋ＣＴ作肝脏肿瘤早期增强扫描的作用。材料和方法：用螺旋ＣＴ和造影剂快速滴注法对３６例肝脏肿瘤患者作全肝早期增强扫描。以２ｍｌ／ｓ左右的速度经时前静脉注入浓度为３００ｍｇＩ／ｍｌ的非离子型造影剂１００ｍｌ，在开始滴注造影剂７５秒内扫完全肝。结果：所有图像主动脉密度均高于或等于门静脉密度。与邻近肝组织相比，１５例（２０灶）肝细胞性肝癌（ＨＣＣ）呈高密度。１１例ＨＣＣ呈等或较低密度：２例为弥漫型ＨＣＣ；９例有严重肝动脉－门静脉瘘，其中２例门静脉呈逆向增强。７例肝转移瘤呈低密度。３例（５灶）海绵状血管瘤呈向心性增强。结论：螺旋ＣＴ作肝脏早期增强扫描可如实显示肿瘤血供和血管受侵的情况，有利于病灶性质的鉴别和多血供多发病灶及小病灶的发现。     

Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement

The purpose of this study was to compare dual-phase spiral computed tomography (CT) and magnetic resonance imaging (MRI) using dynamic gadolinium enhancement for liver lesion detection and characterization. Twenty-two consecutive patients underwent dual-phase spiral CT and MRI for the evaluation of focal liver disease within a 1-month period. Spiral CT and MR images were interpreted prospectively, in a blinded fashion by separate, individual, experienced investigators, to determine lesion detection and characterization. Liver lesions were confirmed by surgery and pathology in 6 patients, and by clinical and imaging follow-up in the other 16 patients. Pathological correlation of a primary extrahepatic malignancy was available in 5 of the 16 patients who had metastatic liver disease. Spiral CT and MRI detected 53 and 63 lesions, and characterized 39 and 62 true positive lesions, respectively. A kappa statistic test was applied to assess agreement between MR and CT results. MR versus CT for lesion detection resulted in a kappa statistic of 0.54 (95% confidence interval), indicating moderate agreement, and 0.32 (95% confidence interval) for lesion characterization, indicating only slight agreement. More lesions were detected on MR images than CT images in 6 (27%) patients, with lesions detected only on MR images in 4 (18%) patients. More lesions were characterized on MR images in 9 (41%) patients. In 9 patients with a discrepancy between MR and CT findings, the MR images added information considered significant to patient management in all 9 cases. MRI was moderately superior to dual-phase spiral CT for lesion detection, and was markedly superior for lesion characterization, with these differences having clinical significance.     

CT在肝结核瘤诊断中的价值

目的:分析肝结核瘤的CT表现,探讨CT在诊断和鉴别诊断中的价值.材料和方法:21例肝结核瘤患者行CT动态增强扫描,分析其CT表现.其中男9例,女12例,年龄35～62岁(平均47岁),19例经手术病理证实,2例经穿刺活检证实.结果:21例共27个病灶的CT表现:①平扫:所有病灶为低密度,其中7个病灶可见到钙化(7/27,25.93%),呈点状或簇状,位于病灶的中心或边缘.4例可见到局部肝包膜的增厚,其中1例还伴有包膜下局限性积液.②增强扫描:动脉期23个病灶无强化(23/27,85.19%),4个病灶边缘有轻度强化.门脉期和(或)延迟期4个病灶无强化,呈低密度,其余23个病灶均有不同方式的强化(23/27,85.19%),主要为边缘强化(17/27,62.96%)和分隔强化(3/27,11.11%).结论:螺旋CT双期动态扫描能显示肝结核瘤的一些特征,这有助于该病的诊断和鉴别诊断.     

小肝癌螺旋CT多期扫描不强化的病理基础探讨

目的:分析螺旋CT多期扫描诊断小肝癌的价值,从而探讨少数小肝癌不强化的病理基础。方法:52例小肝癌(SHCC)患者行螺旋CT平扫和多期增强扫描,平扫后分别行动脉期、门脉期和延迟期增强扫描,观察病灶的强化形式。手术病理记录肝脏有无肝硬化、坏死囊变、透明细胞变及脂肪变性等。结果:52例患者共发现病灶72个,CT动脉期扫描有48个病灶有明显强化。SHCC在CT动脉期-门脉期-延迟期扫描中的典型方式为高-低-低密度等高-等-低密度;不典型方式为低-低-低密度和高-等-等密度。术中见肝硬化者占79.2%,18.1%的病灶内见出血坏死,16.7%的病灶出现透明细胞变或全灶为透明细胞癌。结论:大部分小肝癌在动脉期出现强化,多期扫描不强化的占11.1%,不强化主要是坏死造成,脂肪变性和透明细胞变性也是主要原因之一。     

MSCT和MRI对肝脏局灶性结节增生的诊断价值

目的：探讨肝脏局灶性结节增生（FNH）CT和MRI表现及其诊断价值。方法：回顾性分析11例FNH患者的影像学表现。所有患者均行16层螺旋CT及MRI平扫和动态增强扫描检查。结果：CT平扫显示病灶均呈稍低密度灶,1例在脂肪肝背景下呈相对高密度。增强扫描动脉期示病灶均呈明显均匀强化,2例可见扭曲扩张的供血动脉,8例病灶中央可见瘢痕区无明显强化;门静脉期及延时期示病灶稍高于、等于或低于周围肝实质,中心瘢痕灶延时期强化。MRI检查示病变呈等信号或稍低T1信号及稍高T2信号,增强扫描动脉期示病灶明显强化,门脉期和延时期呈稍高信号或等信号,11例显示病灶中央疤痕呈延迟强化。1例行MRS检查提示Cho峰明显升高。4例行DWI检查,病灶呈等信号或稍高信号,ADC图上呈等信号或稍低信号。结论：MRI较CT能更全面地显示FNH的病理特征,DWI和MRS检查有重要辅助诊断价值。     

Liver lesion detection,characterization, and effect on patient management: Comparison of single-phase spiral CT and current MR techniques

This study compares liver lesion detection, characterization, and effect on patient management between single-phase spiral CT and MRI using spoiled gradient echo (SGE), T2-weighted fat-suppressed spin echo, and serial post gadolinium SGE. All patients with suspected liver lesions who underwent spiral CT and MRI within a 1-month period between January 1993 and September 1996 were included in the study. Spiral CT and MRI were interpreted prospectively in a blinded fashion by separate individual experienced investigators, and lesion detection and characterization were determined. Confirmation was obtained by surgery (6 patients), biopsy (18 patients), imaging follow-up (36 patients), or combined reading of all imaging studies and clinical follow-up (29 patients). Effect on patient management was determined by combined chart review and interview of the patients' physicians and by retrospective clinical assessment performed by a surgical oncologist and medical oncologist separately. Eighty-nine patients were included in the study. Regarding true positive lesion detection, 295 and 519 lesions were detected on spiral CT and MR images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were detected on MR than on spiral CT in 44 of 89 patients (49.4%), and 11 of these 44 patients had lesions shown on MRI in whom no lesions were apparent on CT images. No patients had true positive lesions shown on spiral CT that were not shown on MRI. Regarding lesion characterization, 129 and 466 lesions were characterized on spiral CT and MRI images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were characterized on MR than CT images in 67 patients (75.3%). Regarding effect on patient management, chart review with physician interview demonstrated that findings on MRI provided information that altered patient management as compared with findings on spiral CT in 57 patients. Retrospective clinical evaluation by the surgical and medical oncologist showed that MRI was considered to have a greater effect on patient management than spiral CT in 58 and 55 patients, respectively. Comparing current MRI technique to single-phase spiral CT, MRI detected more lesions in 49.4% and characterized more lesions in 75.3% of patients investigated for focal liver disease. MRI had a greater effect on patient management in each of the three methods than singlephase spiral CT in more than 61% of patients.     

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     

肝局灶性病变CT与MRI动态增强对照研究

目的:探讨肝局灶性病变在CT和MRI动态增强中的影像差异及其原因,以提高对CT及MRI各自动态增强表现的认识。方法:搜集17例肝脏局灶性病变患者的临床资料,其中7例肝细胞肝癌,5例海绵状血管瘤,2例腺瘤,2例局灶结节性增生,1例转移瘤。全部病例均分别行CT及MRI的平扫和三期动态增强扫描;MRI采用SE序列加快速扰相梯度回波序列,将CT和MR动态增强图像进行对照观察,包括动态增强各期的强化范围、强化方式和强化幅度,强化幅度的比较用病灶密度(信号)与肝脏密度(信号)的比值进行比较。结果:肝癌、腺瘤和局灶结节性增生在CT与MRI上强化范围相似。1例肝癌动脉期强化幅度MRI大于CT,3例肝癌和2例局灶结节性增生门脉期及延迟期强化幅度MRI大于CT,2例腺瘤增强各期强化幅度MRI均大于CT,以动脉期差异最大。5例海绵状血管瘤强化范围动脉期及门脉期MRI大于CT,延迟期则相仿。1例转移瘤CT增强各期均未见明显强化,MRI门脉期及延迟期可见环状强化。结论:肝局灶性病变CT与MRI动态增强表现存在一定的差异,主要表现为部分病变增强各期强化幅度MRI大于CT,尤以动脉期差异最大;部分病变增强范围MRI大于CT。     

脊柱转移瘤的CT诊断：附41例分析

笔者报告４１例脊柱转移瘤的ＣＴ表现。原发灶以肺癌、乳腺癌和肝癌较多见。ＣＴ表现主要呈溶骨性（６８．３％），亦可呈成骨性（１４．６％）或混合性（１７．１％）。本组４１例中２０例作平片Ｘ线检查。ＣＴ扫描在发现和估价病变方面较平片Ｘ线检查为敏感，如ｘ线平片发现骨破坏仅为５５％，ＣＴ扫描为１００％；Ｘ线平片显示椎管受累为１４％，ＣＴ扫描为６５％。对脊柱转移瘤的ＣＴ表现、ＣＴ诊断和鉴别诊断价值等进行了讨论。