巨块型肝细胞癌螺旋CT双期增强扫描的诊断价值

目的:探讨巨块型肝细胞癌螺旋CT双期增强扫描的诊断价值。材料和方法:对53例巨块型肝细胞癌进行全肝螺旋CT平扫及双期增强扫描,分析有关的CT征象。结果:①肿瘤实质均呈不均匀性强化,并可出现3种基本形态的肿瘤血管,它们与瘤内“密度更低区”有一定的关系;②部分肿瘤边缘部或包膜分别或同时在动脉期及门脉期出现环形强化;③91.9％的巨块型肝细胞癌肝内转移性子灶只在动脉期才被检出。结论:①巨块型肝细胞癌螺旋CT双期增强扫描的强化特点及动脉期瘤内出现肿瘤血管,不但是巨块型肝细胞癌的主要特征,而且具有重要的鉴别诊断价值;②部分巨块型肝细胞癌边缘部或包膜存在肝动脉、门脉或动、门脉双重血供;③巨块型肝细胞癌术前必须进行全肝范围的动脉期增强扫描,以利于发现占大多数平扫及门脉期均呈等密度的肝内转移性子灶。

Dual phase dynamic helical CT scan of the liver: an evaluation in the diagnosis of large nodular hepatocellular carcinoma

Purpose: This is an evaluation of diphasic dynamic helical CT scan in the diagnosis of the large nodular hepatocellular carcinoma. Materials and Methods: Diphasic dynamic helical CT scan was performed in 53 cases with large nodular hepatocellular carcinoma to obtain the CT findings with diagnostic significance. Results: Uneven contrast enhancement was observed in the nidi as well as the feeding arteries, which were revealed in 3 patterns and related to the "more hypodense areas". Circular arterial phase enhancement of the margin or the capsule of tumor was demonstrated in some cases. Intrahepatic metastasis was revealed only in artenal phase in 91.9% cases. Conclusion: The characterized enhancement and the revealed feeding arteries in diphasic dynamic helical CT scan have important value in differential diagnosis. Double blood supply of the margin or the capsule of tumor from hepatic artery and portal vein exists in some cases. Whole liver diphasic dynamic helical CT scan should be performed in patients before they undergo surgical or interventional procedures, in order to detect the intrahepatic metastasis which has the equal dense with the surrounding liver tissue in plain film and portal phase of contrast CT scan.