MSCT THPE鉴别诊断肝癌和血管瘤的价值

目的:研究多层螺旋CT多期增强扫描中肝血管瘤和肝细胞癌瘤周一过性异常血运灌注(THPE)的诊断价值。方法:所有病例均行多层螺旋CT多期扫描,其中46例肝血管瘤和32例肝细胞癌的肿块最大直径为5cm,分别发现71个肝血管瘤和47个肝癌结节。THPE表现为在动脉期肿瘤周围的肝实质出现楔形或不规则均匀强化,在门静脉期表现为等密度或略高密度。结果:肿块在3cm以下的肝血管瘤的THPE的发生率明显高于肝细胞癌(P<0.05);肿块在3～5cm的肝血管瘤的THPE的发生率与肝细胞癌差异无显著性意义(P>0.05)。肝血管瘤中THPE的发生率为23.94%,肝血管瘤的大小与THPE的发生无明显相关性,THPE常出现在快速强化的小血管瘤(58.82%)。结论:尽管缺少特异性,在<3cm快速强化的肿块中,血管瘤THPE的发生率要大于肝细胞癌,正确认识THPE能够对肿瘤的大小准确的评估并且为不典型肝小血管瘤和早期肝癌的鉴别提供佐证。     

螺旋CT扫描肝血管瘤周围实质一过性异常强化的初步探讨

目的:探讨螺旋CT扫描时肝血管瘤周围肝实质一过性异常强化(THPE)征象及其产生的原因和临床意义。方法:经临床或病理证实的肝血管瘤患者248例(356个病灶)中出现THPE征象的患者60例(79个病灶),均行螺旋CT平扫及3期动态增强扫描,分析THPE征象与病灶大小及强化速度之间的关系。结果:79个出现THPE征象的病灶中53个(72.2%)为快速充填型血管瘤明显多于慢速充填型(7个,占27.8%);有60个为小血管瘤(直径≤2cm),明显多于大血管瘤(直径>2cm)的19个病灶(24%)。结论:肝血管瘤伴有THPE征象并非少见,其更容易出现在快速强化型小血管瘤中,正确认识和识别这种征象,有助于肝血管瘤的诊断及鉴别诊断。     

16层螺旋CT多期动态增强扫描对肝脏小血管瘤合并动静脉瘘的诊断

目的探讨肝脏小血管瘤合并动静脉瘘在多层螺旋CT多期动态增强扫描的表现,分析其形成机制和影响因素。方法回顾性分析33例52个肝脏小血管瘤的多期动态增强CT表现,动静脉瘘的诊断标准为:肝动脉期病灶周围肝实质一过性楔形或不规则形强化区,在门静脉期和延迟期变为稍高密度或等密度;或者表现为动脉期在上述楔形强化区域同时可见到早显的细小门静脉分支影。分析肝脏小血管瘤合并动静脉瘘的几率与病灶强化方式的关系。结果52个肝脏小血管瘤病灶中13个(25%)出现动静脉瘘,均表现为肿瘤周围一过性强化区,其中有7个病灶动脉期在上述楔形强化区域同时可见到早显的细小门静脉分支影,在21个快速强化型瘤体中有11个(52.4%)合并动静脉瘘,而31个慢速强化的瘤体中仅仅有2个(6.5%)合并动静脉瘘(P<0.05)。结论肝脏小血管瘤合并动静脉瘘并非很少见。合并动静脉瘘的肝小血管瘤更容易出现在快速强化型瘤体中。     

肺结节的不均匀灌注

目的 利用16及64层螺旋CT评价孤立性肺结节容积灌注是否均匀.方法 85例孤立性肺结节(直径≤4.0 cm,57例恶性结节,15例活动性炎症,13例良性结节)患者,在增强前、后采用16层(30例)及64层(55例)螺旋CT进行同层动态扫描.注入对比剂后11-41 s,每秒扫描1次;90 s扫描1次.16层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时8.0 mm;2.0～3.0 cm时6.0 mm;1.5～2.0 cm时4.0 mm;1.0～1.5 cm时3.0 mm;<1.0 cm时2.0 mm(其中病灶直径3.0 cm时,层厚8.0 mm;2.0 cm时,6.0mm;1.5 cm时,4.0 mm).64层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时5.0mm;<3.0 cm时2.5 mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节3个中央有效层面强化值、灌注值、结节一主动脉强化值比、平均通过时间.使用均数间方差检验进行统计学分析.结果 3个中央层面强化CT值分别为(30.95±14.53)、(25.10±13.32)、(32.37±15.85)HU、灌注值分别为(33.01±21.35)、(23.70±12.87)、(29.00±15.47)ml·min-1·100 g-1,结节-主动脉强化值比分别为(13.58±6.41)%、(10.95±5.76)%、(13.64±6.20)%,平均通过时间分别为(11.61±5.74)、(11.97±3.55)、(13.44±3.74)s,差异均有统计学意义(F值分别为5.913、6.464、5.333、3.837,P值分别为0.003、0.002、0.005、0.023).平扫的CT值差异无统计学意义(F=0.032,P=0.968).结论 孤立肺结节容积灌注是不均匀的,推荐采用CT容积灌注成像的方式对孤立肺结节血流模式进行研究.     

超声造影和增强CT对肝血管瘤的诊断价值比较

目的 探讨增强CT与超声造影(CEUS)对肝血管瘤的诊断价值,从而提高肝血管瘤的诊断水平.方法 回顾性分析在本院同时进行上腹部CT多期扫描和CEUS检查的肝血管瘤患者61例.统计分析2种检查对肝血管瘤的诊断效率.并进一步分别比较增强CT对不同大小的瘤体的检出率及CEUS对脂肪肝患者及非脂肪肝患者肝血管瘤的检出率,并对其结果分别做了统计学分析.结果 61例患者中,增强CT共发现52例,CEUS共发现54例,二者的差别无统计学意义(P>0.05).增强CT对于瘤体直径>4 cm的肝血管瘤完全检出;对于<4 cm的,直径越小检出率越低且其差别具有统计学意义(P<0.05).CEUS对于脂肪肝组患者的检出率为61.54%,对非脂肪肝组患者的检出率为95.83%,差异具有统计学意义(P<0.05).结论 增强CT和CEUS对于肝血管瘤的诊断各有优势,合理选择可以明显地提高诊断准确率.     

孤立肺结节多层螺旋CT容积灌注成像的临床价值

目的 探讨多层螺旋CT容积灌注成像在孤立肺结节诊断中的价值.资料与方法 85例孤立肺结节(直径≤4cm,57例恶性,15活动性炎性,13例良性)患者,在增强(从肘静脉注入非离子型对比剂)前、后采用ToshibaAquilionMarconi16层螺旋CT(采用4×i模式,i代表扫描层厚)及GELightspeed64层螺旋CT(采用8×i或16×i模式,i代表扫描层厚)进行同层动态扫描.11～41s,每1s扫描1次;90s扫描1次.16层螺旋CT:病灶直径3～4cm时,扫描层厚8mm;2～3cm时,扫描层厚6mm;1.5～2cm时,扫描层厚4mm;1～1.5cm时,扫描层厚3mm;＜1cm时,扫描层厚2mm.64层螺旋CT:病灶直径3～4cm时,扫描层厚5mm;＜3cm时,扫描层厚2.5mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节有效层面的强化值、灌注值、结节-主动脉强化值比、平均通过时间,有效层面参数的平均值作为肺结节的容积灌注成像定量参数.结果 恶性(36.52±11.07)HU与炎性(37.69±7.10)HU结节强化值明显高于良性(7.02±5.85)HU结节(P＜0.001;P＜0.001).恶性与炎性结节强化值无显著差异(P=0.686＞0.05).炎性结节与大动脉增强峰值比(17.49±3.78)%明显高于良性(2.78±2.23)%与恶性(14.73±4.28)%结节(P＜0.001;P=0.019＜0.05).恶性结节与大动脉增强峰值比明显高于良性结节(P＜0.001).炎性(47.83±31.29)mlmin-1100g-1结节灌注值明显高于良性(3.03±3.01)mlmin-1100g-1与恶性(31.15±9.66)mlmin-1100g-1结节(P＜0.001;P＜0.001).恶性结节灌注值明显高于良性结节(P＜0.001).炎性(33.00±8.87)HU与恶性(40.45±7.03)HU结节平扫的CT值明显低于良性(50.51±10.87)HU结节(P＜0.001;P＜0.001).炎性低于恶性结节平扫的CT值(P=0.002＜0.01).结论 多层螺旋CT容积灌注成像有助于结节鉴别诊断.     

HIF-1α介导肝癌血管生成的多层CT灌注研究

目的 研究多层CT灌注与缺氧诱导因子-1α(HIF-1α)介导肝癌血管生成的相关性及临床意义.方法 手术、病理证实的34例肝癌、11例肝血管瘤行多层CT灌注成像,获取参数.免疫组化SP法检测34例肝癌、11例肝血管瘤及周围正常肝中缺氧诱导因子-1α、血管内皮生长因子(VEGF)的表达,CD34单克隆抗体标记微血管密度,将两者对比研究.结果 肝癌的肝动脉灌注量(HAP)、肝动脉灌注指数(HAI)均高于肝血管瘤及周围正常肝(P<0.01).肝癌缺氧诱导因子-1α与VEGF及CD34的表达呈正相关(P<0.01).肝癌HAP和HPI与HIF-1α、VEGF及CD34的表达呈正相关(P<0.05).肝癌的Edmondson-Steiner组织学分级从Ⅰ级、Ⅱ～Ⅲ级、Ⅳ级间HAP、HAI、MVD的差异有统计学意义(P<0.05).结论 多层CT灌注在一定程度上反映HIF-1α介导的缺氧条件下的肝癌血管生成.     

肺部肿瘤首过期CT灌注成像及其临床应用价值研究

目的 通过多层螺旋CT动态增强首过期灌注值和强化峰值来描述周围型肺癌、中央型肺癌和肺部转移瘤的灌注特征.资料与方法 92例肺部肿瘤患者(包括48例周围型肺癌,31例中央型肺癌,13例单侧肺转移瘤)接受检查.注射对比剂同时屏气,在固定层面连续扫描30层(1层/s).分别以整个肿瘤、肿瘤富强化区、肿瘤少强化区取感兴趣区来评价其时间密度曲线.通过Miles最大斜率法计算灌注值和强化峰值,依据肿瘤大小、位置(中央型/周围型或转移瘤)及病理类型的不同进行比较.结果 大的肿瘤(直径＞4cm)的灌注值及强化峰值明显低于小的肿瘤(直径≤4cm),其差异有统计学意义(P＜0.0001).不考虑大小因素,中央型肺癌的灌注值与周围型肺癌的灌注值差异有统计学意义.另外,两者的强化峰值差异亦有统计学意义;中央型肺癌与转移瘤灌注值及强化值差异有统计学意义,周围型肺癌与转移瘤灌注值及强化值差异则无统计学意义.非小细胞肺癌与小细胞肺癌的上述参数的差异均无统计学意义.结论 肿瘤灌注值及强化峰值与肿瘤大小位置有,但与病理类型无,可以对不同大小、位置的肿瘤预后进行评估.     

模拟肾囊肿假性强化的实验研究

目的 利用体模评价在不同强化背景下、不同扫描方式、不同直径及不同CT机对囊肿假性强化的影响.方法 使用GE Light Speed Pro 32和SIEMENS SOMATOM Sensation Open 2种CT机型,设计模拟肾脏的水膜和模拟不同直径肾内囊肿的试管作为研究对象,验证CT机型和扫描方式(螺旋和断层)可能产生的影响.肾囊肿假性强化的研究使用1个30 cm×21 cm×18 cm 的塑料水箱作为1个模拟人体内环境的水模,用1个直径7 cm的塑料圆筒模拟肾脏,3支不同直径的塑料试管(5 mm、13 mm、18 mm)作为模拟1个肾脏内的3个囊肿,"肾脏"内分别加入含有不同浓度(0%、0.5%、1.0%和2.0%)碘的对比剂.同一机型均采用螺旋扫描和断层扫描2种方式,重建层厚均为5 mm,2种扫描方式均固定CTDIvol 为8.71 mGy.结果 GE MDCT机有假性强化的现象发生,SIEMENS MDCT没有表现"伪强化"现象.模拟肾囊肿在不同浓度背景测得的CT值范围是-17.5～39.81 HU.采取正交设计的方差分析得到2种CT机之间CT值有明显差异(F=82.65,P<0.000 1),不同直径的"囊肿"之间CT值有明显差异(F=19.94,P<0.000 1),3种直径的"囊肿"其CT值增加均超过10 HU.螺旋扫描方式造成"伪强化"的程度大于断层方式(F=8.51,P=0.004),这样的表现在GE的MDCT机中表现的尤为突出.不同的背景浓度对"囊肿"的"伪强化"也有显著的影响(F=27.27,P<0.000 1).1%与2%浓度的模拟肾脏背景浓度可以造成假性强化,但是在0%和0.5%的背景浓度下"囊肿"均未出现"伪强化"现象.结论 (1)肾囊肿假性强化在体外研究中是客观存在的现象.(2)螺旋扫描模式比断层扫描模式假性强化现象更明显.(3)在排除部分容积效应的影响的条件下,体外实验不同直径的"囊肿"假性强化无规律性.(4)不同CT机会对囊肿的假性强化产生影响.     

螺旋CT血管成像对肝血管瘤并发周围型动-门静脉瘘的诊断价值

目的 探讨肝血管瘤并发周围型肝动脉-门静脉瘘(APS)多层螺旋CT血管成像的影像表现和诊断价值.方法 搜集12例经多层螺旋CT三期扫描确诊的肝血管瘤并发周围型APS,对肝动脉期CT血管成像进行回顾性分析.结果 容积再现(VR)和最大密度投影(MIP)三维重建法均可较好地显示周围型APS和肝实质一过性强化.APS血管成像可分为4种类型,类型Ⅰ:瘤周可见早显的门静脉分支,多有肝动脉支伴行,有时可见"双轨"征;类型Ⅱ:自瘤体发出数条纤细的早显小门静脉支,呈细线或虚线状,无肝动脉支伴行,早显的小门静脉支多位于短暂肝实质强化区中;类型Ⅲ:同时具备类型Ⅰ和类型Ⅱ的影像表现;类型Ⅳ:瘤周无早显的门静脉分支,仅显示楔形或片状浓染区.肝实质一过性强化表现为瘤周片状浓染区.结论 多层螺旋CT血管成像是诊断肝血管瘤并发周围型APS有效的检查手段.     

Arterioportal shunt: prevalence in small hemangiomas versus that in hepatocellular carcinomas 3 cm or smaller at two-phase helical CT

PURPOSE: To compare the prevalence of arterioportal (AP) shunting associated with (a) small (< or =3 cm) hemangiomas and (b) hepatocellular carcinomas (HCCs) (< or =3 cm) at two-phase helical computed tomography (CT). MATERIALS AND METHODS: Two-phase helical liver CT was performed in 107 patients (61 men, 46 women; age range, 25-73 years; mean, 48.6 years) with 169 small hemangiomas and in 384 patients (292 men, 92 women; age range, 18-82 years; mean, 58.3 years) with 598 HCCs 3 cm or smaller. Diagnosis of HCC was verified with histologic findings (n = 30) or typical imaging and clinical findings (n = 568); that of all hemangiomas was verified with typical imaging and clinical findings. Three radiologists retrospectively reviewed all CT images in consensus. Contrast material-enhanced CT scans were obtained during the hepatic arterial and portal venous phases. AP shunt was considered to be present when wedge-shaped or irregularly shaped homogeneous enhancement peripheral to tumor appeared at hepatic arterial phase CT and isoattenuation or slight hyperattenuation in that area appeared at portal phase CT. The prevalence of AP shunting associated with hemangiomas and that associated with HCCs were compared with multivariate model testing. Speed of lesion enhancement (rapid enhancement, when extent of intratumoral enhancement at hepatic arterial phase CT was >50%; slow enhancement, when extent of intratumoral enhancement was < or =50%) and presence of AP shunt were correlated with chi2 or Fisher exact testing. RESULTS: AP shunts were more frequently found in hemangiomas (36 lesions [21.3%]) than in HCCs (25 lesions [4.2%]) (P <.001). Twenty-four (38%) of the 64 hemangiomas with rapid enhancement had AP shunts, whereas only 12 (11.4%) of the 105 hemangiomas with slow enhancement had AP shunts (P <.001). There was no significant difference between prevalence of AP shunt in the 573 HCCs with rapid enhancement (24 lesions, 4.2%) and that in the 25 HCCs with slow enhancement (one lesion, 4.0%). CONCLUSION: AP shunts were more frequently seen at two-phase helical CT in small hepatic hemangiomas than in HCCs and thus represent a suggestive but not specific finding of hemangioma. Small hemangiomas with AP shunts tend to show rapid rather than slow enhancement.     

Hepatic cavernous hemangioma: temporal peritumoral enhancement during multiphase dynamic MR imaging

PURPOSE: To determine whether temporal parenchymal enhancement around hepatic cavernous hemangiomas can be correlated with the rapidity of intratumoral contrast material enhancement and/or tumor volume at dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Dynamic MR images obtained in 94 patients with 167 hemangiomas were retrospectively reviewed for peritumoral enhancement. Tumor volume was estimated by using the longest dimension on nonenhanced images. Speed of intratumoral contrast material enhancement was determined with early nonequilibrium phase images and was categorized as rapid (>75% of tumor volume), intermediate (25%-75% of tumor volume), or slow (<25% of tumor volume). RESULTS: Thirty-two of the 167 hemangiomas (19%) had temporal peritumoral enhancement, which was more common in hemangiomas with rapid enhancement (20 of 49 [41%]) than in those with intermediate (12 of 62 [19%]) and slow (0 of 56 [0%]) enhancement (P: <.001). The mean diameter of the hemangiomas with peritumoral enhancement was not significantly different from that of hemangiomas without peritumoral enhancement (P: >.05). Hemangiomas with rapid enhancement (mean diameter, 16 mm +/- 8), however, were significantly smaller than those with intermediate enhancement (mean diameter, 33 mm +/- 34) (P: <.001). CONCLUSION: Temporal peritumoral enhancement on dynamic MR images of hepatic hemangiomas correlates well with the speed of intratumoral contrast material enhancement and was most commonly encountered in rapidly enhancing small lesions. There was no statistically significant relationship, however, between peritumoral enhancement and tumor volume.     

Temporal peritumoral enhancement of hepatic cavernous hemangioma: findings at multiphase dynamic magnetic resonance imaging

OBJECTIVE: To evaluate the occurrence rate of temporal peritumoral enhancement associated with hepatic cavernous hemangiomas and to correlate that with the speed of intratumoral contrast enhancement and tumor volume. METHODS: Dynamic magnetic resonance imaging (MRI) of 69 consecutive patients with 136 hemangiomas was reviewed for peritumoral enhancement. Tumor volume was estimated by the largest diameter on T2-weighted images. Speed of intratumoral contrast enhancement was determined by portal phase image and was categorized as rapid (>75% of tumor volume), intermediate (25%-75% of tumor volume), or slow (<25% of tumor volume). RESULTS: Temporal peritumoral enhancement was found in 37 (26.6%) of 136 hemangiomas. It was more common in hemangiomas with rapid enhancement (30 of 67 cases [44.8%]) than in those with intermediate (3 of 22 cases [13.6%]) and slow (4 of 47 cases [8.5%]) enhancement (P < 0.05). There was no statistically significant relation between lesion size and presence of temporal peritumoral enhancement (P > 0.05). CONCLUSIONS: Temporal peritumoral enhancement is not uncommonly seen in hepatic cavernous hemangiomas at dynamic MRI. It is most commonly encountered in rapidly enhancing small lesions. There is no statistically significant relation between temporal peritumoral enhancement and tumor volume, however.     

Hepatic Cavernous Hemangioma in Cirrhotic Liver: Imaging Findings

Objective

To document the imaging findings of hepatic cavernous hemangioma detected in cirrhotic liver.

Materials and Methods

The imaging findings of 14 hepatic cavernous hemangiomas in ten patients with liver cirrhosis were retrospectively analyzed. A diagnosis of hepatic cavernous hemangioma was based on the findings of two or more of the following imaging studies: MR, including contrast-enhanced dynamic imaging (n = 10), dynamic CT (n = 4), hepatic arteriography (n = 9), and US (n = 10).

Results

The mean size of the 14 hepatic hemangiomas was 0.9 (range, 0.5-1.5) cm in the longest dimension. In 11 of these (79%), contrast-enhanced dynamic CT and MR imaging showed rapid contrast enhancement of the entire lesion during the early phase, and hepatic arteriography revealed globular enhancement and rapid filling-in. On contrast-enhanced MR images, three lesions (21%) showed partial enhancement until the 5-min delayed phases. US indicated that while three slowly enhancing lesions were homogeneously hyperechoic, 9 (82%) of 11 showing rapid enhancement were not delineated.

Conclusion

The majority of hepatic cavernous hemangiomas detected in cirrhotic liver are small in size, and in many, hepatic arteriography and/or contrast-enhanced dynamic CT and MR imaging demonstrates rapid enhancement. US, however, fails to distinguish a lesion of this kind from its cirrhotic background.     

肝细胞性肝癌的磁共振成像定量分析

对５７例肝细胞性肝癌（ＨＣＣ）的７１处瘤灶用１．０ＴＭＲＩ进行６项定量测定，最小病灶的直径为１．５ｃｍ。分别对６例肝转移癌（ＨＭＣ）、４０例肝海绵状血管瘤（ＨＣＨ）、１１例肝囊肿（ＨＣＹ）的１２、７０、１７处病灶也作了相应的测定。在所测６项数据中，Ｔ２值对ＨＣＣ与ＨＣＨ和ＨＣＹ的鉴别意义最大：ＨＣＣ的Ｔ２值＜９０ｍｓ，ＨＣＨ和ＨＣＹ的Ｔ２值分别＞１００ｍｓ和＞１２０ｍｓ。ＨＣＣ与ＨＭＣ用定量方法较难鉴别。本文还对有关定量测定的一些问题作了简要讨论。     

射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价

目的探讨射频消融（RFA）联合肝动脉栓塞（TAE）治疗巨大肝血管瘤（直径≥10 cm）的可行性、安全性及有效性。 方法收集我院2007年10月—2015年5月期间,经TAE序贯RFA治疗15例患者15个巨大肝血管瘤的临床资料。回顾性分析其一般资料、RFA治疗策略、消融相关并发症、完全消融率、消融灶直径变化及复发情况等。 结果所有患者均成功完成RFA联合TAE治疗。TAE后血管瘤的平均直径从（13.0±2.2）cm缩小至（7.1±2.0）cm。RFA治疗后,14个血管瘤（93.3%）获得完全消融。RFA治疗后1个月,消融灶平均直径缩小至（6.1±2.0）cm;6个月后缩小至（4.9±1.6）cm。15例患者中,4例患者发生了6个消融相关并发症;根据Dindo–Clavien分级,均属轻微并发症（I级）。 结论RFA联合TAE治疗巨大肝血管瘤是安全、有效的;TAE可有效阻断血管瘤血供,使瘤体缩小,降低后续RFA治疗的难度,减少消融相关并发症。     

Effect of electrocardiogram triggering on reproducibility of coronary artery calcium scoring

PURPOSE: To determine the prevalence of arterioportal shunt associated with hepatic hemangiomas, describe the two-phase spiral computed tomographic (CT) findings, and correlate the presence of arterioportal shunt with the size and rapidity of enhancement of hemangiomas. MATERIALS AND METHODS: The study group consisted of 109 hepatic hemangiomas in 69 patients who underwent two-phase spiral CT during 1 year. CT scans were obtained during the hepatic arterial (30-second delay) and portal venous (65-second delay) phases after injection of 120 mL of contrast material (3 mL/sec). Arterioportal shunts were diagnosed when hepatic arterial phase CT scans showed a wedge-shaped or irregularly shaped homogeneous enhancement in the liver parenchyma adjacent to the tumor and when portal venous phase CT scans showed isoattenuation or slight hyperattenuation, compared with normal liver in that area, and when there was no demonstrable cause of these attenuation differences. The presence of arterioportal shunt in hemangioma was correlated with the size of the tumor and the rapidity of intratumoral enhancement. RESULTS: Arterioportal shunt was found in 28 (25.7%) of 109 hemangiomas. There was no statistically significant relationship between lesion size and presence of the arterioportal shunt (P =.653). Arterioportal shunt was more frequently found in hemangiomas with rapid enhancement (P <.01). CONCLUSION: Arterioportal shunts are not uncommonly seen in hepatic hemangiomas at two-phase spiral CT. Hemangiomas with arterioportal shunts tend to show rapid enhancement.     

Perfusion characteristics of hepatic cavernous hemangioma using intravenous CT angiography (IVCTA).

Thirty-three patients with 35 proven hepatic cavernous hemangiomas (HCH) were studied with intravenous CT angiography (IVCTA). 15 scans were performed during the first 30 s after bolus (6 ml/s) injection of 50 ml iodinated contrast material. Thereafter 2 scans/min were obtained up to 30 min. Three criteria were utilized at IVCTA to make a specific diagnosis of HCH: (1) detection of an intense mural nodular enhancement in the arterial phase. The density in the nodular region(s) should have a density level similar to that of the aorta or hepatic arteries; (2) well-defined nodular area(s); and (3) centripetally oriented enlargement of the nodular region(s). These criteria were seen in 31 of 35 hemangiomas. In contrast the 'typical' Freeny-Marks criteria were present in only 23 of 35 hemangiomas. The results show that our criteria may provide greater specificity.     

应用体内标记99mTc-RBC和SPECT诊断肝海绵状血管瘤

目的 评价体内标记99^mTc-RBC和SPECT对肝海绵状血管瘤的诊断准确性。方法 对219例肝血池显像进行分析。结果 根据瘤体直径本组显像阳性率分别为：直径小于1.5cm者为40%，1.5～2.0cm者为72.1%，2.0～4.0cm者为97.3%，4.0～6.0cm者为100%，大于6.0cm者为100%。结论 肝血池显像诊断肝脏海绵状血管瘤，尤其是直径大于2.0cm的海绵状血管瘤具有良好的特异性，是一种无创、安全、便捷的检查方法。     

Transient peritumoral enhancement during dynamic MRI of the liver: cavernous hemangioma versus hepatocellular carcinoma

PURPOSE: The purpose of this work was to compare the incidence and pattern of transient peritumoral parenchymal enhancement for cavernous hemangioma and hepatocellular carcinoma during dynamic MRI of the liver. METHOD: Two hundred seven hemangiomas and 155 hepatocellular carcinomas up to 4 cm in size were retrospectively assessed. The peritumoral enhancement was comparatively analyzed in terms of the shape, extent, signal intensity, and dependence on the size and degree of contrast enhancement of each tumor. RESULTS: For small lesions (<2 cm), hemangiomas (16/141; 11.3%) showed a higher incidence (p = 0.026) of peritumoral enhancement than hepatocellular carcinomas (3/87; 3.5%). For larger lesions (2-4 cm), there was no significant difference (p > 0.05) in the incidence of peritumoral enhancement of hemangiomas (15/66; 22.7%) and hepatocellular carcinomas (15/68; 22.1%). Nineteen (61.3%) of the 31 hemangiomas showed contrast agent filling the entire tumor volume at the phase of peritumoral enhancement. CONCLUSION: In spite of the limited specificity, for a <2 cm small focal lesion with homogeneous contrast enhancement on early phase dynamic MR images in the liver, peritumoral enhancement could suggest a higher possibility of hemangioma rather than hepatocellular carcinoma.