肝癌TACE后CT随访评价

近年来，经肝动脉化疗栓塞(TACE)已成为非手术治疗肝癌的首选方法。其治疗效果的随访除临床检验指标外，影像学检查也是疗效评价的重要手段。我们回顾性分析了52例行TACE后患者的CT随访图像，评价CT随访的价值。     

Malignant hepatic tumors: Changes on MRI after hepatic arterial chemoembolization – preliminary findings

This study describes the MR appearances of malignant hypervascular liver lesions pre- and post-hepatic-arterial chemoembolization, with correlation to serial imaging and clinical responses. Eight patients with malignant hypervascular liver lesions underwent pretreatment and posttreatment MR examination on a 1.5-T MR imager. MR sequences included T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed spin echo or turbo spin echo, and dynamic gadolinium-enhanced SGE images. All patients underwent pretreatment, initial posttreatment, and subsequent posttreatment MR studies. The histology of primary tumors included various types of hepatocellular carcinoma (HCC) (four patients: fibrolamellar HCC [one patient], HCC [two patients], mixed HCC/cholangiocarcinoma [one patient]) and liver metastases (four patients: untyped islet cell tumor [two patients], gastrinoma [one patient], carcinoid [one patient]). Response to chemoembolization was determined by three assessments: MR response, serial imaging response, and clinical response. The appearance of MR response to chemoembolization was determined based on the correlation with clinical and serial imaging response. The MR response of lesions that showed good clinical response included: increase in signal intensity on T1-weighted images (three patients), decrease in signal intensity on T2-weighted images (three patients), and negligible or minimal enhancement on immediate postgadolinium images (four patients) after chemoembolization. The most marked change in lesion appearance was observed in lesions < 1 cm, which had intense homogeneous enhancement on pretreatment MR studies and negligible enhancement on initial posttreatment MR examinations. MR response of lesions that showed moderate clinical response demonstrated a variety of lesion appearances from substantial change to minimal change. MR response of lesions that showed poor clinical response demonstrated no change in lesion appearances compared with the pretreatment MR study. Our results demonstrated change in appearance of liver lesions between pre- and post-hepatic-arterial chemoembolization MR studies. MR response correlated with response determined by serial imaging studies and clinical findings.     

Iodized oil accumulation in hypervascular hepatocellular carcinoma after transcatheter arterial chemoembolization: comparison of imaging findings with CT during hepatic arteriography

PURPOSE: To compare the degree of tumor enhancement seen on computed tomography (CT) during hepatic arteriography (CT/HA) performed before transcatheter arterial chemoembolization (TACE) versus that determined based on the accumulation of iodized oil seen on CT images obtained after TACE in patients with hypervascular hepatocellular carcinoma (HCC) and evaluate the discrepancy in findings between the two imaging modalities (more or less oil accumulation after TACE compared with enhancement on CT/HA). MATERIALS AND METHODS: CT/HA, TACE, and iodized oil CT after TACE were performed in 69 patients with 83 hypervascular HCCs with use of an interventional CT system. The degree of contrast enhancement of the lesion on CT/HA and the iodized oil accumulation on unenhanced CT after TACE were compared. RESULTS: Among 83 HCCs, the degree of enhancement on CT/HA before TACE corresponded to the iodized oil accumulation on CT in 56 (67.5%). Fifteen of 83 HCCs (18%) showed incomplete or poor accumulation of iodized oil despite good enhancement on CT/HA images. Twelve of 83 HCCs (14.5%) showed moderate or complete accumulation of iodized oil despite poor or no enhancement on CT/HA images. In particular, in two patients with occluded portal veins, iodized oil did not accumulate in the tumor despite good visualization on CT/HA. CONCLUSIONS: Although iodized oil accumulation in hypervascular HCCs correlates with the degree of lesion enhancement on CT/HA in most cases, a discrepancy may occur in a substantial number of cases, which likely affects the prediction of therapeutic effects in hypervascular HCCs.     

肝脏血管平滑肌脂肪瘤的CT影像表现

目的探讨分析肝脏血管平滑肌脂肪瘤（angiomyolipoma,AML）CT表现及特征。方法回顾性分析8例经手术病理证实,且均进行了CT检查的肝脏AML患者资料。结果8例肝脏AML中脂瘤型1例,以脂肪成分为主,CT显示大片脂肪密度;血管瘤型2例,以血管成分为主,CT增强动脉期明显强化;肌瘤型1例,主要是由平滑肌成分组成,平扫密度均匀,增强呈均一或不均匀强化;混合型4例,三种成分含量相似,增强扫描呈不均匀强化。结论不同病理类型的肝脏AML的CT表现有所不同,CT检查可以清晰的显示出肿瘤的影像特征,了解肝脏AML的病理类型与CT表现之间的关系,有助于提高肝脏AML的cT诊断率。     

原发性肝脏肉瘤的CT表现

原发性的肝脏肉瘤是临床上诊断非常困难的罕见肿瘤。不同的原发性肝脏肉瘤可能有不同的临床、形态学和放射学特点。在此次影像回顾中,总结了一些相对常     

Primary hepatic sarcomas: CT findings

Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography (CT) findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma (EHE), liposarcoma, undifferentiated embryonal sarcoma (UES), leiomyosarcoma, malignant fibrous histiocytoma (MFH), and carcinosarcoma (including cystadenocarcinosarcoma). To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas.     

Determinants of postembolization syndrome after hepatic chemoembolization

PURPOSE: Postembolization syndrome (PES) occurs in the majority of patients undergoing hepatic chemoembolization, and is the major reason for hospitalization after the procedure. The ability to identify which groups of patients are at increased or decreased risk of PES would be useful to better counsel patients, to minimize toxicity, and to plan inpatient versus outpatient therapy. MATERIALS AND METHODS: Seventy hepatic chemoembolization procedures were performed in 29 patients using cytotoxic drugs mixed with Ethiodol and polyvinyl alcohol. The following procedural variables were retrospectively assessed and evaluated for association with PES and length of postprocedural hospitalization: gallbladder embolization, lobe embolized, percentage liver volume embolized, percentage embolized volume occupied by tumor, previous embolization of the same territory, and dose of chemoembolic emulsion. Logistic regression was used to quantify the relative effect of each procedural variable. RESULTS: Gallbladder embolization and dose administered were associated with an increased risk of PES and an extended hospitalization, with odds ratios of 2.8 and 3.0, and 3.0 and 4.6, respectively. Previous embolization was associated with a decreased risk of both PES and extended hospitalization, with odds ratios of 0.5 and 0.4, respectively. There was a statistical trend toward significance for gallbladder embolization (P = .06), dose administered (P = .07), and previous embolization (P = .14). CONCLUSION: Clinically relevant predictors of the severity of PES and length of postprocedural hospitalization may exist. Avoiding embolization of the gallbladder reduces the risk of PES. Re-embolization of previously treated vessels is associated with decreased toxicity and may assist in selecting patients for treatment on an outpatient basis, especially when a reduced dose is required.     

肝胆管囊腺瘤的CT表现

目的：探讨肝胆管囊腺瘤（HBC）的螺旋CT影像特征,提高肝胆管囊腺瘤的诊断准确率。方法：回顾性分析12例经病理证实的肝胆管囊腺瘤的CT表现,并复习文献。结果：12例肝胆管囊腺瘤的CT均表现为多房囊性病变,囊内有分隔,囊壁较薄,光滑,部分囊壁均匀增厚,增强后囊壁及分隔轻度强化,延迟期呈等密度。结论：平扫加动态增强CT能较好反应HBC的影像学特点,提高了和其它肝脏肿瘤的鉴别诊断能力。     

经肝动脉途径行肝癌化疗栓塞后胆汁瘤形成的CT表现与临床意义

目的 探讨肝癌经动脉穿刺化疗栓塞（transcatheter arterial chelnoelnbolization，TACE）治疗后肝内胆汁瘤形成的CT表现和临床意义。方法 搜集我院2000年至2004年经CT检查系列随访的肝癌TACE后患者共3948例。观察TACE术后有无胆管阻塞和扩张等表现。结果 共发现35例（09％，35／3948）胆汁瘤，其中沿Glisson鞘呈分支样分布的低密度区4例，残癌病灶周围柱状改变7例，囊状改变33例。结论 胆汁瘤是肝癌介入治疗后并发症之，随病情进展可以有不同CT表现。治疗上可采取以内科保守治疗为主的多种方法。     

肝脏恶性肿瘤肝动脉化疗栓塞后CT增强扫描中的护理

自2002年11月～2004年5月,我院对106例原发性及转移性肝癌患者行肝动脉化疗栓塞(transhepatic arterialche motherapeutic embolism,TACE)后,利用CT强化扫描确定肿瘤组织供血情况,据此指导再次行TACE的时间,取得满意效果.现将此过程的护理体会报告如下.     

肝血管平滑肌脂肪瘤的CT及MRI表现

目的:探讨肝血管平滑肌脂肪瘤(HAML)的CT和MR表现.方法:回顾性分析7例(男2例,女5例)病理确诊的HAML患者的CT及MRI影像学表现.结果:CT平扫7例,为低密度到中等密度病灶,4例测得CT值-35.5～-99HU,除1例增强扫描强化不明显外,其余动脉期明显强化.MRI检查4例,T1WI上肿瘤为高信号,脂肪抑制或反相位图像上病灶信号衰减,T2WI上病灶为相对高信号.结论:在影像上肝血管平滑肌脂肪瘤具有一些特征:①含有成熟脂肪组织为脂瘤型HAML相对特征的影像学表现;②病灶内含有强化的血管影是诊断HAML的重要征象.     

Evolution of CT findings in hepatic hematoma

This report evaluates the CT findings of posttraumatic, intrahepatic lesions in 10 patients. The change in appearance of the lesions on follow-up examinations, in the absence of surgical intervention, is described. Similar lesions were produced in dogs and are compared with the human lesions and with hematomas in nonhepatic tissue.     

CT findings in hepatic and splenic amyloidosis

In a patient with biopsy proven focal amyloidosis of the liver CT showed a uniform decrease in attenuation, with a focal large low-density lesion in the right hepatic lobe. Following intravenous contrast medium injection, there was poor contrast enhancement.     

肝吸虫病的CT表现特征

目的 :分析肝吸虫病导致肝胆管病变的CT表现特征。方法 :回顾性分析 12 8例肝吸虫病患者CT表现及临床资料。结果 :CT主要表现为肝边缘部小胆管小囊状、细枝状扩张 ( 65例 ) ;近肝门侧胆管树枝状扩张 ( 4 1例 ) ;肝实质结节或小斑片低密度灶 ( 6例 ) ;胆囊内条片状软组织影 ( 1例 )。结论 :肝边缘部细枝状、小囊状扩张为肝吸虫病CT表现特征 ;肝内结节、斑片低密度灶可能与炎性肉芽肿及胆管周围炎有关。肝吸虫病具有特征性CT表现 ,CT是肝吸虫病早期诊断有效的检查方法。     

CT findings after uncomplicated percutaneous laparoscopic cholecystectomy.

To investigate the postoperative pulmonary and abdominal findings following uncomplicated percutaneous laparoscopic cholecystectomy, 27 patients were studied by upper abdominal CT within 24 h of the surgical procedure. Both pneumoperitoneum (70%) and subcutaneous emphysema (56%) were commonly observed. Postoperative atelectasis and pleural effusions were observed in 44 and 33% of the patients, respectively. Forty-eight percent of the patients had a postoperative ileus demonstrated by CT. Approximately 22% of the patients had fluid in the abdomen as either edema in the gallbladder fossa or small amounts of ascites. In our patients the amount of ascitic fluid was small and no clinical significance could be attributed to the intraabdominal fluid collections.     

Risk factors for liver abscess formation after hepatic chemoembolization

PURPOSE: To assess the frequency and risk factors for liver abscess after hepatic chemoembolization. MATERIALS AND METHODS: The authors performed retrospective analysis of 397 chemoembolization procedures in 157 patients. All patients received prophylactic intravenous antibiotics before the procedure and 5 days of oral antibiotics after the procedure. The association between abscess formation and risk factors was determined with use of chi(2) analysis and the Fisher exact test and expressed as an odds ratio. RESULTS: Liver abscess occurred in seven of 157 patients (4.5%) after eight of 397 procedures (2.0%) at a mean of 19 d +/- 7 after chemoembolization. No patients had neutropenia. Organisms isolated reflected intestinal flora. Six patients required percutaneous drainage for 35 d +/- 29. The seventh patient required drainage for the remainder of life as a result of a nonhealing biliary fistula. Three of 24 patients with neuroendocrine tumors had abscesses (12.5%; odds ratio, 4.6; 95% CI, 0.96-22.1; P =.07), as did three of 14 patients with gastrointestinal sarcomas (21%; odds ratio, 9.5; 95% CI, 1.9-47.8; P =.016), and one of two with pancreatic adenocarcinoma. Six of the seven patients with abscesses underwent a Whipple procedure before chemoembolization. Only one patient with a history of a Whipple procedure did not develop an hepatic abscess. In the absence of a bilioenteric anastomosis, abscess occurred in only one of 150 patients (0.7%), or one of 383 procedures (0.3%). The odds ratio for liver abscess among patients with a bilioenteric anastomosis was 894 (95% CI, 50-16,000; P <.0001). CONCLUSION: Earlier bilioenteric anastomosis is the major determinant of liver abscess formation after hepatic chemoembolization. The prophylaxis regimen used failed to prevent abscess formation in patients with earlier bilioenteric anastomosis.     

原发性肝脏淋巴瘤的多层螺旋CT表现(附2例报告)

原发性肝脏淋巴瘤(primary hepatic lymphoma,PHL)是起源于肝脏淋巴组织和残留造血组织的罕见恶性肿瘤,占肝脏恶性肿瘤的0.1%,占结外淋巴瘤的0.4%[1].笔者搜集2例经手术或穿刺活检病理证实的肝脏淋巴瘤的CT影像学资料,结合文献分析其影像学特征,旨在提高对该病的认识.     

CT findings in hepatic involvement by Echinococcus granulosus

The CT findings in hepatic involvement by Echinococcus granulosus are described. Pathognomonic signs of the hydatid nature of a cystic lesion are visualization of the cystic wall on plain CT, calcification of the cyst wall, daughter cysts, and membrane detachment.     

肝脏血管平滑肌脂肪瘤的CT表现及强化特征

目的探讨肝脏血管平滑肌脂肪瘤(HAML)的CT表现与强化特征,并评价其诊断意义。方法 9例(男2例,女7例;年龄25～66岁,中位年龄43岁)由临床与病理证实的HAML患者均经腹部CT平扫及动态增强的动脉期、门静脉期及延迟期扫描。对所有患者的CT表现与强化特征进行了回顾性分析。HAML病灶依其脂肪成分含量多寡分为下列4型:脂瘤型,肌瘤型,血管瘤型及混合型。结果 9例HAML患者中有4例脂瘤型,2例肌瘤型,1例血管瘤型及2例混合型;7例位于肝右叶,2例位于肝左叶。于动态增强动脉期,肿瘤内的软组织成分明显强化,于门静脉期及延迟期持续强化,但强化程度逐渐减退。部分病灶内可见点状、线条状强化血管影。然而,不同类型HAML随脂肪成分含量多寡强化类型彼此有别。结论 HAML的CT表现及强化类型有一定特征性,可为本病的明确诊断以及同肝脏其他疾病鉴别提供重要依据。