肝细胞癌与肝内周围型胆管细胞癌的螺旋CT动态增强与病理分析

目的 分析肝细胞癌与肝内周围型胆管细胞癌的螺旋CT动态增强特征.方法 回顾性分析经手术病理证实的80例肝细胞癌和21例肝内周围型胆管细胞癌的螺旋CT动态增强特点.结果 80例肝细胞癌共116个癌灶,增强动脉期均呈明显强化.门静脉期多表现为相对低密度(97/116),其中86个瘤灶高于动脉期密度,延迟扫描116个瘤灶强化程度不同程度下降,与邻近正常肝实质相比呈相对低密度,其中73个瘤灶高于动脉期密度;116个HCC中,64个呈现马赛克征,37个呈现假包膜征.肝内周围型胆管癌增强动脉期19例呈边缘环状强化,2例无强化,门静脉期14例呈中心片状、团簇状强化,5例延迟扫描中心强化更明显.结论 螺旋CT多期增强扫描特别是肝动脉期和延迟扫描,是肝细胞癌和肝内周围型胆管细胞癌诊断和鉴别诊断的关键扫描技术,肝细胞癌和肝内周围型胆管细胞癌增强后时间密度变化及对比剂在瘤内分布的差别,能大致反映肿瘤的病理学特征,为二者的诊断和鉴别诊断提供了重要的影像学依据.

Dynamically enhanced patterns of hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma by helical CT and pathological analysis

Objective To analyze the dynamically enhanced features of hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma by helical CT.Methods The dynamically enhanced features of in 80 patients with hepatocetlular carcinoma and 21 with intrahepatic peripheral cholangiocarcinoma proved by surgery and pathology were retrospectively analyzed.Results A total of 116 foci in 80 HCCs showed hypervascularity and obvious enhancement in the first series(hepatic arterial phase),97 of them demonstrated hypoattenuating masses relative to adjacent liver parenchyma on portal venous phase images.All of the 116 foci demonstrated predominant hypoattenuation relative to adjacent liver parenchyma.Among the 116 foci,86 and 73 loci showed higher attenuation on portal venous phase images and on delay phase images than in the first series,respectively.The enhancement patterns for HCC include masaic pattern(64/116)and pseudocapsule pattern(37/116).For Intrahepatic peripheral cholangiocarcinoma,the frequent enhancement patterns were rim-like enhancement(19/21)and central region enhancement(14/21)on hepatic arterial phase images and portal venous phase images,respectively,and on delay phase images,the tumor attenuation in the central region increased markedly.Conlusion The evolution over time in the intensity and the spatial distribution of contrast material in HCC and IHPCC differs sufficiently to make this diagnosis and distinguishing between them.Dynamic contrast enhancement scan of helical CT is the important imaging means.The hepatic arterial phase and delay phase are particularly pivotal.