CTHA、CTAP、Lp-CT判别原发性肝癌术后复发及瘢痕病灶

目的探讨CTHA、CTAP和碘油CT（Lp-CT）在判别原发性肝癌术后小复发灶,特别是手术口周复发与瘢痕灶的应用价值。方法分析8例原发性肝癌术后患者19个≤3cm复发灶及手术口瘢痕的螺旋CT、DSA、CTHA、CTAP和Lp-CT表现。结果 Lp-CT19个碘油沉积灶,其中16个肝内病灶。螺旋CT、DSA、CTHA和CTAP结合检出个数分别是12、9、15,检出率分别是75%、56.3%、93.8%。手术瘢痕周围3个小复发灶,螺旋CT、DSA、CTHA和CTAP均未明确显示。结论 CTHA和CTAP结合是发现肝内复发小肝癌灶最敏感的方法,Lp-CT在发现微小肝癌和肝癌术后瘢痕周围小复发灶优于CTHA、CTAP。CTHA、CTAP和Lp-CT结合是区别肝癌术后瘢痕和复发灶最敏感的方法。     

CTHA与CTAP在肝癌介入治疗中的应用

目的:探讨螺旋CT的肝动脉造影CT(CTHA)和经动脉门脉造影CT(CTAP)在肝癌介入治疗中的应用价值。方法:对4l例肝癌患者CTHA/CTAP图象与螺旋CT三期增强扫描和数字减影血管造形(DSA)进行分析对照,其中包括16例原发性肝癌经肝动脉化疗栓塞术(TACE)术后患者。结果:三期增强扫描病灶检出率为72.4%,CTHA/CTAP联合应用病灶检出率为98.7%;CTHA/CTAP发现栓塞周边复发新发病灶25个.DSA发现8个。结论:CTHA/CTAP联合应用在肝癌介入治疗中对于疗效评价及早期发现病灶具有重要意义。     

Multiple necrotic nodules of the liver simulating liver metastasis

A 70-year-old man was referred to our hospital due to anemia and elevated serum tumor marker levels. He had advanced colon cancer, and hepatic lesions were found incidentally. On ultrasonography (US) and computed tomography (CT), the hepatic lesions had a maximum diameter of 20 mm and were located in Couinaud's segments V, VI, VII, and VIII, which suggested liver metastasis. On early- and late-phase CT during hepatic arteriography (CTHA), all of the lesions had rim enhancement. On early-phase CT during arterioportography (CTAP), all of the lesions were seen as nodules with an irregular perfusion defect, and on late-phase CTAP, all the lesions gradually became iso-dense, and their shape and size changed. Based on the CTAP findings, these lesions were thought to be fibrotic tumors. Partial resection of the liver (including the lesions in Couinaud's segments V and VIII) was done. Histological examination revealed that the lesions were necrotic nodules. Thus, CT angiography (CTHA and CTAP) was useful for identifying necrotic nodules, because their appearance on this modality is different from that of liver metastases.     

螺旋CT对小肝癌的诊断意义

目的 探讨螺旋ＣＴ扫描在肝动脉造影ＣＴ（ＣＴ ｈｅｐａｔｉｃ ａｒｔｅｒｉｏｇｒａｐｈ,ＣＴＨＡ）和经动脉门脉造影ＣＴ（ＣＴａｒｔｅｒｉａｌ ｐｏｒｔｏｇｒａｐｈｙ,ＣＴＡＰ）中的应用价值。方法 分析２８例小肝癌灶（直径≤３．０ｃｍ）ＣＴＡＰ和ＣＴＨＡ的图像,并与双期增强扫描进行对照。结果 ＣＴＡＰ病灶检出率为９１．５％。可检出０．２～０．５ｃｍ的小病灶。ＣＴＨＡ和ＣＴＡＰ均可出现非病理性表现,Ｃ     

B超和CTHA在肝癌诊断中的对比分析

肝脏动脉造影CT(CT hepatic arteriography,CTHA)是采用Seldinger法将导管插至肝固有动脉后注入适量对比剂,再行CT扫描。是目前肝脏结节性病变中最具敏感性和特异性的影像学诊断方法[1]。我们自2000年对肝硬化患者同时实施肝脏动脉造影螺旋CT和B超检查,以诊断肝脏结节病变,现报     

探讨肝动脉造影CT和经动脉门脉造影CT在肝癌介入术后复发中的诊断价值

目的 回顾分析肝动脉造影CT(CTHA)和经动脉门脉造影CT(CTAP)在肝癌介入术后复查中的作用.方法 对19例肝癌TACE术后AFP明显升高的患者行CTHA/CTAP及DSA造影.结果 CTHA/CTAP发现14例栓塞周边复发,新发病灶15枚,DSA发现6例栓塞周边复发,新发病灶8枚.结论 与DSA相比,CTHA/CTAP是评价介入疗效及发现新发病灶更可靠的方法 .     

Ferumoxide-enhanced MR imaging of hepatocellular carcinoma: correlation with histologic tumor grade and tumor vascularity

PURPOSE: To evaluate ferumoxide-enhanced MR imaging findings of hepatocellular carcinomas (HCCs) in correlation with the histologic tumor grades and the tumor vascularity evaluated by CT hepatic arteriography (CTHA) and CT during arterial portography (CTAP) combined. MATERIALS AND METHODS: By searching the radiologic, surgical, and pathologic reports of our institution between January 1999 and February 2001, we identified 43 patients with 51 pathologically confirmed HCCs who underwent ferumoxide-enhanced MR imaging and combination CTHA and CTAP within two weeks. The HCCs consisted of 17 well-differentiated, 28 moderately differentiated, and six poorly differentiated tumors. The MR and CT were retrospectively reviewed by two radiologists in consensus for signal intensity on MR images and vascularity on CT. The Spearman's rank correlation coefficient was calculated to correlate the frequency of tumors with ferumoxide uptake with the histologic tumor grades and the tumor vascularity on CTHA and CTAP. RESULTS: A total of 45 tumors (88%) did not take up ferumoxide, and thus showed distinct, homogeneous hyperintensity. Six tumors (12%) ranging 5-16 mm in size (mean, 11 mm) took up ferumoxide, and thus showed isointensity, mixed intensity, or hypointensity, including five of 17 (29%) well-differentiated tumors and one of 28 (4%) moderately differentiated tumors. Five of the six tumors (83%) showed hyper- or hypovascularity on CTHA or hypovascularity on CTAP. The frequency of tumors with ferumoxide uptake showed weak correlation with tumor grades (coefficient = 0.26, P < 0.01) and vascularity on CTHA (-0.35, P < 0.05) and CTAP (0.39, P < 0.01). CONCLUSION: Although a small number of well-differentiated HCC take up ferumoxide and show iso-, mixed, or hypointensity, most such tumors show increased hepatic arterial or decreased portal venous perfusion. The present results suggest the limitation of reticuloendothelial contrast imaging, particularly in the diagnosis of small, well-differentiated HCC.     

Multiple necrotic nodules of the liver simulating liver metastasis

A 70‐year‐old man was referred to our hospital due to anemia and elevated serum tumor marker levels. He had advanced colon cancer, and hepatic lesions were found incidentally. On ultrasonography (US) and computed tomography (CT), the hepatic lesions had a maximum diameter of 20 mm and were located in Couinaud's segments V, VI, VII, and VIII, which suggested liver metastasis. On early‐ and late‐phase CT during hepatic arteriography (CTHA), all of the lesions had rim enhancement. On early‐phase CT during arterioportography (CTAP), all of the lesions were seen as nodules with an irregular perfusion defect, and on late‐phase CTAP, all the lesions gradually became iso‐dense, and their shape and size changed. Based on the CTAP findings, these lesions were thought to be fibrotic tumors. Partial resection of the liver (including the lesions in Couinaud's segments V and VIII) was done. Histological examination revealed that the lesions were necrotic nodules. Thus, CT angiography (CTHA and CTAP) was useful for identifying necrotic nodules, because their appearance on this modality is different from that of liver metastases.     

CTHA、CTAP在肝癌介入治疗后复查中的作用和意义

研究ＣＴＨＡ、ＣＴＡＰ在肝癌介入治疗复查中的应用价值和意义。材料与方法１４例原发性肝癌ＴＡＥ术后患者进行ＣＴＨＡ、ＣＴＡＰ检查。结果ＣＴＨＡ、ＣＴＡＰ发现已栓塞灶周边复发２１个,新病灶３７个。结论ＣＴＨＡ、ＣＴＡＰ是肝癌介入治疗复查中最敏感和特点和特异的方法,对于评价疗效及早期发现病灶都有重要作用。     

Radiological detectability of minute hepatic venous invasion in hepatocellular carcinoma

Objective

To determine if minute hepatic venous invasion in hepatocellular carcinoma (HCC) can be diagnosed radiologically.

Materials and methods

CT hepatic arteriography (CTHA) and CT arterioportography (CTAP) of 95 cases with HCCs were examined. Histopathology after surgery has been the gold standard in all patients. Based on the presence of microscopic portal venous invasion (MPVI) and microscopic hepatic venous invasion (MHVI), the cases were classified into four groups as follows: Group vp0vv0, negative MPVI and MHVI; Group vp1vv0, positive MPVI and negative MHVI; Group vp0vv1, negative MPVI and positive MHVI; Group vp1vv1, positive MPVI and MHVI. An area showing low attenuation on CTAP and high attenuation on CTHA around the tumor was defined as an area of peritumoral hemodynamic change (APTHC). The shape and size of APTHC were compared between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0. The ratio of APTHC volume to tumor volume (RAT) was employed as an indicator of APTHC size. Each comparison was also made independently when tumor diameter was limited to either less than 3 cm or 3 cm or more.

Results

Three types of APTHC were identified: wedge-shaped, belt-shaped or irregular, and linear. No significant difference in the frequency of each type of APTHC was observed between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0. There was no significant difference in RAT between Groups vp0vv1 and vp0vv0 or between Groups vp1vv1 and vp1vv0, unrelated to tumor size.

Conclusions

The presence of minute hepatic venous invasion in HCC is difficult to determine even on combined CTHA and CTAP.