肝硬化退变结节及小肝细胞癌的CT诊断（附20例报告）

目的探讨CT扫描对肝硬化退变结节（DN）及小肝细胞癌（SHCC）的诊断准确性。方法20例经手术病理证实的SHCC患者起初均经CT平扫与增强扫描，随后又经数字减影血管造影（DSA）检查。结果20例患者共检出SHCC病灶28个，在平扫CT像上，21个病灶呈略低密度，7个病灶接近于等密度而未显示；于增强扫描动脉期，18个病灶呈轻或中度强化，3个病灶呈低密度，其余7个病灶CT平扫呈等密度的6个出现强化。CT检出病灶直径介于0．8—2．0cm。DSA显示27个肿瘤血管丰富，仅1个未见肿瘤染色。分化较好的SHCC与高度变异性DN的血供状况无明显差别。结论CT增强扫描对SHCC有极高的诊断准确性，它可作为临床可疑SHCC患者的常规检查，一经发现动脉供血结节，若患者肝功能好，则应尽早进行手术或介入治疗。

CT diagnosis of degenerative nodules of cirrhosis and small hepatocellular carcinoma;a report of 20 cases

Objective To discuss the accuracy of CT scans in the diagnosis of degenerative nodules （DN） of cirrhosis and small hepatocellular carcinoma （SHCC）. Methods Twenty patients with surgically and pathologically proved SHCC initially underwent CT scans without and with contrast enhancement and then digital subtraction angiography （DSA）.Results CT demonstrated that there were 28 lesins of SHCC in 20 cases.On CT images without contrast enhancement,21 lesions were hypodense,7 lesins approached to isodense and therefor were undetected.On arterial phase images after administration of contrast medium,18 lesion were slightly or middling enhanced,3 lesions were hypodense and other 6 of 7 lesions which was isodense on plain scan CT images were enhanced. The tumoral diameter detectable on CT images ranged from 0.8 cm to 2.0 cm.DSA showed that 27 tumoral lesions were multivaseular but only one lesion no tumoral stain was found.The blood-supply state between well differentiated SHCCs and premalignant DNs was not significant difference. Conclusion CT scanning with contrast enhancement has high accuracy for diagnosing SHCC so that it shoul be taken as a conventional examination in the patients with clinically suspected SHCC. If one once the nodules with arterial blood-supply be found ,surgery or interventional therapy should be performed as early as possible when the liver function of the patient is well.