螺旋CT对肝局灶性病变的诊断与鉴别诊断

目的探讨螺旋CT对肝脏局灶性病变的诊断与鉴别诊断。方法146例肝局灶性病变,回顾分析其CT多期扫描特点。结果65例原发性肝细胞癌（HCC）,平扫50例为低密度、12例为等密度,3例为高密度;增强动脉期：38例病灶明显均匀强化,19例呈不均匀强化,8例轻微强化或不强化。门脉期HCC55例为低密度,10例为混杂密度;58例肝血管瘤平扫均为低密度。动脉期：52例病灶边缘呈结节状、点状及小球状高密度强化,5例几乎不强化,1例不强化;门脉期：43例边缘点状强化,10例强化高于肝实质,5例强化呈等密度。18胆管细胞癌平扫均为低密度。动脉期轻度强化,门脉期强化不断增强,延迟呈持续强化。3例肝局灶性结节增生（FNH）,平扫均为低密度,动脉期强化为高密度,中央见低密度低密度不强化影,门脉期强化呈略高密度,延迟呈相对低密度,其中2例中心瘢痕区可强化,呈相对高密度。2例肝腺瘤平扫为低密度,动脉期为高密度,门脉期为等密度。结论严格控制螺旋CT的多期扫描时间,掌握好多期CT影像改变特点,螺旋CT对大多数HCC、肝血管瘤能做出正确诊断,其他如不典型HCC、肝腺瘤、FNH单从影像对其鉴别诊断较困难。

Diagnosis and differentiation of liver focal lesions with spiral CT

Objective To evaluate Diagnosis and Differentiat on. Methods In liver focal lesions of 150 cases, the characteristic of multi-phases CT scan were respectively analysed. Results Of 65 primary hepatocellular carcinomas, 50 cases appeared low density, 12 were equal density, 3 were high density scans in plain. The 38 cases appeared obviously enhanced, 19 were unhomoenhancement, 8 were mildly enhanced or no en- hanced in the arterial phase of enhancement. The 55 appeared low density in portal phase. Of 58 hepatic hemangioma, all the lesions were low density in plain scans. The lesions of 52 cases appeared nodus, dot or small ball enhancement in the brim, 5 were not almost enhanced and 1 were not entirely enhanced in the arterial phase. Enhancement of 43 cases appeared nodus shape in the brim, density of lesions in 10 cases was higher than liver parenchyma, density of lesions in 5 cases was equal to liver parenchyma in portal phase. Of 18 cholangiocarcinomas, all the tumors were low density in plain scans and appeared durative enhancement in both portal and delay phases. Of 3 foacl nodus hyperplasia(FNH), all the lesions were low density in plain scans. The lesions of 2 cases were enhanced and appeared high density in which center were not enhanced and appeared low density in arterial phases. They were mildly high density in portal phases and were relatively low that were compared with liver in delay phase. The scars of the center in lesions were enhanced and appeared relatively high density. Of 2 adenomas, They were low density in plain scans , high density in the arterial phase and equal density in the portal phase. Conclusion Most HCC and hepatic hemangioma can be correctly diagnosed with spiral CT in condition of strictly controlling the time of multi- phase scan and holding the imaging characteristics of diseases of multi-phase spiral CT. But it is difficult that atypical HCC, adenomas and FNH were correctly diagnosed only with imaging method.