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目的 :分析巨块型肝癌螺旋 CT多期增强扫描的表现 ,评价其诊断价值。 方法 :应用螺旋 CT对 48例经临床手术或病理结果证实的巨块型肝细胞癌病人分别行肝区平扫、增强后全肝双期或三期螺旋扫描 ,观察和分析瘤灶及肝内转移性子灶的多期动态增强扫描的 CT征象。结果 :( 1)肝动脉期肿瘤实质出现密度高于肝实质的肿瘤血管和瘤区强化 ,门静脉期其密度迅速降低 ,至平衡期为低密度 ;( 2 )肿瘤边缘于肝动脉期和门静脉期均可见环行强化 ;( 3)转移性子灶仅在肝动脉期明显强化 ,门脉期全瘤密度迅速降至等密度 ;( 4)门静脉受累表现为肝内分支的边缘侵蚀、破坏、中断 ,或为不规则的充盈缺损。 结论 :多期螺旋 CT增强扫描能显示肝癌“快进快出”的增强特点 ,明确肿瘤的供血特征和门脉受累情况 ,检出伴发的肝内转移性子灶 ,为明确诊断和指导治疗提供了可靠的影像依据
Objective : To analyze the performance of spiral CT multi-phase enhanced scanning for massive hepatocellular carcinoma and evaluate its diagnostic value. METHODS: Spiral CT was performed on 48 patients with massive hepatocellular carcinoma confirmed by clinical operations or pathological findings. Hepatic scans and enhanced hepatic double- or triple-phase helical scans were performed to observe and analyze tumors and intrahepatic lesions. CT signs of multiphase dynamic contrast scans of metastatic foci. Results: (1) The density of parenchymal tumors and tumors in the hepatic arterial phase was higher than that in the parenchyma of the hepatic artery. The density of the tumor in the portal vein phase was rapidly decreased until the equilibrium phase was low density; (2) The edge of the tumor was in the hepatic artery phase and the portal vein phase. Ring enhancement was observed; (3) metastatic lesions were only intensified in the hepatic arterial phase, and the total tumor density at the portal vein phase rapidly decreased to isodensity; (4) portal vein involvement was manifested as edge erosion, destruction, disruption of the intrahepatic branches, or Irregular filling defect. Conclusion: Multi-phase spiral CT enhanced scan can show the enhanced characteristics of “fast forward and fast out” of liver cancer, clarify the characteristics of tumor blood supply and portal vein involvement, detect associated intrahepatic metastatic lesions, and provide diagnosis and guidance for treatment. Reliable image basis