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。

Exploration of the pathological basis of non-enhanced small HCC on multiphase spiral CT scanning

Objective:To analyze the value of multiphase sprial CT for the diagnosis of small hepathocellular carcinoma(SHCC),and to investigate the pathology of non-enhanced small HCC.Methods:52 cases of HCC were performed pre-and post contrast CT scanning,the arterial-phase,portal venous-phase and delayed phase scan of spiral CT were carried out after the pre-contrast scanning of the liver.The pattern of lesions enhanced were observed subsequently.Present or absent of cirrhosis,necrosis,cellular hyaline degeneration and fat degeneration founded on surgery and pathologic examination were also documented.Results:Seventy-two lesions were found in 52 patients,48 lesions were enhanced obviously in spiral CT arterial-phase scans.The typical enhancement patterns of SHCC in the arterial-phase,portal venous-phase and delayed phase scan of spiral CT were hyper-hypo-hypodense and hyperdense,isodense and hypodense.Atypical enhancement patterns were hypodense-hypodense,hypodense and hyperdense,-isodense and isodense.Cirrhosis in 79.2% cases was found in surgery on pathological examination,necrosis(18.1%) and hyaline degeneration(16.7%) within the lesions were seen.Conclusion:During arterial phase most small HCC show enhancement,only 11.1% of lesionS are not enhanced during spiral CT multiphase contrast scanning.The reasons for non-enhancement are mainly due to necrosis and,perhaps hyaline degeneration and fat degeneration were another causes.