肝脏一过性灌注异常在原发性肝癌动态增强中诊断价值.docVIP

肝脏一过性灌注异常在原发性肝癌动态增强中诊断价值 　 作者：王俊明 姚晓新 张小妮 王利 连鹏 【摘要】 目的 分析原发性肝癌动态CT增强扫描时肝实质一过性强化(THAE)征象，探讨其产生的病理基础。方法 回顾性分析经临床或病理证实的196例原发性肝癌的动态增强CT表现。全部病例先做上腹部常规螺旋CT平扫；注射造影剂后20～25s行动脉期扫描，60～65s行门静脉期扫描，部分病例行5～10min延迟扫描。结果 21例(10.7%)共发现28处肝动脉期THAE，其中25处(89.3%)平扫时未显示密度异常，3处(10.7%)呈稍低密度灶。所有21例THAE在动脉期均呈均匀高密度影，门脉期均呈等密度或稍高密度影，其形状多为楔形或扇形。结论 肝实质一过性灌注异常在原发性肝癌的诊断中有重要价值，它反映了肝脏血流动力学的改变。 【关键词】 肝肿瘤 灌注 体层摄影 X线计算机 【Abstract】 Objective To study the features of transient hepatic abnormal enhancement (THAE) in the hepatocellular carcinoma，and to discuss its pathologic basis.Methods 196 cases of HCC proved by clinical-or pathology were reviewed retrospectively.Unenhanced spiral CT image were routinely obtained before injection of contrast material，then spiral CT scans were performed during the HAP (20～25 seconds) and the PVP (60～65 seconds)，respectively，and delayed phase scans of the local lesion in some patients were also acquired 5～10 minutes after the initiation of injection.Results There were 28 THAEs in the 21(10.7%) patients.In unenhanced imaging，most(n=25，89.7%) of THAEs showed no attenuating abnormality，while some of them(n=3，10.3%) were faintly hypoattenuating.All of 28 THAEs in HAP imaging showed homogeneous hyperattenuating，and they changed to isoattenuating or slightly hyperattenuating.The morphology of THAE was HAP imaging was wedge-shaped or fan-shaped mostly.Conclusion Transient hepatic abnormal enhancement is another valuable dynamic enhanced CT sign for the diagnosis of HCC.It was useful to reflect hepatic hemodynamic changes. 【Key words】 liver neoplasms perfusion tomography X-ray computed 肝脏动态增强扫描时肝实质一过性异常强化(transient hepatic abnormal enhancement，THAE)现象最初由Itai等［1］报道，其特征表现为动脉期肝实质分部呈叶、段或亚段的高密度增强，而门脉期变为等密度或稍高密度。随着螺旋CT的广泛应用，THAE研究日渐增多，其产生的原因有多种，而原发性肝癌(HCC)动态增强扫描是产生THAE的主要原因之一［2，3］，它反映了肝脏血流动力学的改变，从而引起肝实质局部密度变化(灌注异常)。本文回顾性分析21例产生HCC的HCC动态增强CT表现，以探讨其产生的病理基础及诊断价值。 1 资料与方法 1.1 一般资料 回顾性分析196例原发性肝癌的平扫及螺旋CT动态扫描资料(包括平扫、肝动脉期、门脉期及部分延迟扫描图像)，在196例原发性肝癌中共发现21例28处THAE表现。其中男13例，女8例，年龄