64 层螺旋 CT 血管重建对肝癌非肝动脉供血的研究

目的 探讨肝细胞癌（hepatocellular carcinoma，HCC）非肝动脉供血的形成与肿瘤大小、肿瘤位置、肿瘤包膜和病理分级等因素的关系。方法 对手术病理证实的121例HCC患者术前采用64层螺旋CT行动态增强扫描，并通过工作站获取血管重建图像；将全部病例的影像学和病理学信息（CT检查显示的癌灶大小及其位置和包膜、非肝动脉供血的血管情况及肿瘤病理分级等）与手术证实的非肝动脉形成情况进行相关性分析。结果 全组121个癌灶中，手术证实24个癌灶有28支非肝动脉供血血管，发生率为19.8%；CT发现27个癌灶中有30支非肝动脉供血血管。与手术所见进行对照分析，CT检查显示肿瘤非肝动脉供血血管的敏感性、特异性和正确率分别为96.0%、96.9%和96.7%。多因素分析显示肿瘤大小及其位置与非肝动脉供血的形成密切相关（P〈0.05），肿瘤包膜完整与否和肿瘤病理分级与非肝动脉供血的形成无相关（P〉0.05）。结论 螺旋CT血管重建可较准确地显示HCC的非肝动脉供血血管；肿瘤位置、肿瘤大小等影像学信息是判断肿瘤有无非肝动脉供血的重要参考因素。

64 layers spiral computed tomography for the diagnosis of extrahepatic feeding arteries in hepatocellular carcinoma

Objective To investigate factors at initial presentation of hepatocellular carcinoma（HCC） that are associated with the presence of extrahepatic collateral arteries（ExCAs）. Methods A consecutive sample of 121 patients newly diagnosed with HCC based on pathology were prospectively enrolled.Thin-section computed tomography（CT） findings were compared with surgical and pathological findings.Several features were analyzed for their potential relationship with the presence of ExCAs,including tumor size, surface location,pseudocapsule,and histopathological grade of ExCA blood supply to HCC. Results Pathology analysis identified 24 of 121 patients （19.8%） with 28 ExCAs supplying tumors; CT identified 27 patients with 30 ExCAs. CT showed high sensitivity （96.0%）,specificity （96.9%） and accuracy （96.7%） for detecting ExCAs.Multiple logistic regression identified tumor size and surface location as significantly associated with the presence of ExCAs（P〈0.05）,while histopathological grade and the presence of pseudocapsule were not（P〉0.05）. Conclusion CT reconstruction techniques can accurately reveal ExCAs in HCC patients. Certain CT findings（tumor size, surface location）are significant predictors of the presence of ExCAs.