CT横断面与横断面基础上CTA成像对肝细胞癌合并肝动脉-门静脉分流诊断能力对比性研究

目的:对比CT血管成像(CT angiography,CTA)技术及CT横断面在肝细胞癌(hepatocellular carcinoma,HCC)合并肝动脉-门静脉分流(arterioportal shunt,APS)诊断能力.方法:63例HCC患者分别进行了肝脏多层螺旋CT动态增强扫描和数字减影肝动脉造影(DSA)检查,间隔时间为3d～30d.对CT动态增强扫描和DSA发现的APS阳性患者进行肝动脉期CTA重建.以DSA为标准,对照分析CT横断面和CTA上APS的表现特征及其对APS的诊断能力.结果:63例HCC患者,26例(41.3%)经DSA证实合并APS,其中中央型17例(27%),周围型9例(14.1%).DSA证实为中央型的17例,CT横断面和CTA均无假阴性病例;CT横断面发现2例假阳性病例,结合CTA可完全排除.DSA证实为周围型9例,其中1例在CT横断面和CTA均表现假阴性;CT横断面发现4例假阳性,结合CTA可排除其中3例.CT横断面结合CTA诊断APS的敏感度为96.2%(25/26),特异度为97.3(36/37),准确度为96.8(61/63).阳性预测值为96.2%(25/26),阴性预测值为97.3%(36/37).结论:在多层CT动态增强扫描基础上进行CTA成像,可以明显提高诊断APS的准确性和特异性.

TO CONTRAST THE DIAGNOSTIC ABILITY OF TRANSVERSE CT AND CT ANGIOGRAPHY IN DIAGONSIS OF ARTERIOPORTAL SHUNTS ASSOCIATED WITH HCC

Objective:To contrast the diagnostic ability of CT and CT angiography (CTA) in diagnosis of arterioportal shunts (APS) associated with hepatocellular carcinoma (HCC). Methods: 63 patients with HCC accepted both dynamic enhancement CT and digital subtraction angiography (DSA) examinations. The interval between CT and DSA exam 3 to 30 days. Based on transverse CT images in hepatic artery phase, CTA was performed to all the patients with positive APS signs in dynamic enhancement CT and DSA exams.To contrast with DSA results, we analyzed the features of APS and the capabilities of transverse CT and CTA images in APS diagnosis.Results:In all 63 HCC cases, 26 cases with APS were conformed by DSA (41.3%), 17 with central type of APS (27%), 9 with peripheral type (14.1%). For all 17 cases with central type of APS conformed by DSA,No false negative cases were found both on transverse CT and CTA images; combined with CTA, we excluded all the 2 false positive cases showed by transverse CT images. For the 9cases with peripheral type of APS in DSA,One displayed false negative results both in transverse CT and CTA images; CTA excluded 3 from 4 false positive cases displayed in transverse CT images. Combined CTA to transverse CT images, diagnosis sensitivity of APS reached to 96.2% (25/26); specificity reached to 97.3% (36/37); accuracy reached to 96.8% (61/63); the predictive value of positive cases was 96.2% (25/26) and the predictive value of negative cases was97.3% (36/37). Conclusion:Using CTA techniques based on the dynamic enhancement CT exam,the accuracy of APS diagnosis couldbe improve greatly.