多层螺旋CT在肝局灶性结节增生的诊断与鉴别诊断中的应用价值

目的总结CT诊断肝脏局灶性结节增生的要点,提高与其他血管丰富的恶性肿瘤的鉴别诊断能力。方法回顾性分析临床与病理证实的32例肝脏局灶性结节增生的CT平扫与增强后的表现。结果共检出36个病灶,28例为单发病灶,4例2个病灶。CT平扫病灶均呈等密度或轻微低密度,均匀或不均匀;增强扫描动脉期除中心瘢痕外,所有病灶均有明显的均匀强化,其中19个病灶中心或周边见增粗、扭曲的供血动脉;门脉期病灶呈稍高密度,延时期病灶呈等密度;17个病灶伴有中心瘢痕者均有延迟强化,CT正确诊断28例,诊断符合率87.5%。结论多层螺旋CT动态增强扫描能较全面显示肝脏局灶性结节增生的病理特征和血供特点,对大部分肝脏局灶性结节增生可在术前作出正确诊断,可明显提高与血管丰富的肝细胞癌及肝血管瘤等的鉴别诊断能力。

Clinical Application of Spiral CT in Diagnosis and Differential Diagnosis of Hepatic Focal Nodular Hyperplasia

Objective To investigate unenhanced and dynamic contrast-enhanced multi-slice spiral CT of the hepatic focal nodular hyperplasia,to sum up the main points of CT diagnosis of hepatic focal nodular hyperplasia,and to improve the ability in differentially diagnosing other vascular-rich malignant tumors.Methods CT scan with the enhanced performances of 32 cases of hepatic focal nodular hyperplasia confirmed by clinical diagnosis and pathology were retrospectively analyzed.Results Thirty-six lesions were found,28 cases were single lesions,and 4 cases had 2 lesions.CT scan lesions showed isodense or slightly low density,homogeneous or inhomogeneous.In enhanced scan arterial phase,all lesions were significantly enhanced uniformly except central scar,of which 19 central or peripheral lesions were found thickening and distorted blood supply artery.Portal venous phase lesions were slightly higher density,and delay period showed lesions with equi-density.17 lesions associated with central scar showed delayed enhancement.28 cases were correctly diagnosed by CT,with the diagnostic accuracy of 87.5%.Conclusions The dynamic contrast-enhanced multi-slice spiral CT scan can comprehensively shows the pathological characteristics and the blood supply of hepatic focal nodular hyperplasia,correctly diagnose most of the cases of hepatic focal nodular hyperplasia before the surgery,and significantly improve the ability in differentially diagnosing hepatocellular carcinoma and liver hemangioma.