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目的 探讨螺旋 CT(SCT)多时相扫描对小肝癌 (SHCC)和微小肝癌 (MHCC)的 CT表现和诊断价值。方法 分析螺旋 CT多时相扫描检查肝脏 5 89例 ,其中经组织学证实 SHCC16例 ,MHCC7例。所有病例先做平扫、对兴趣区再做增强后动脉期和门静脉期及全肝平衡期扫描。层厚 6 .5～ 8m m,进床 5～ 6 .5 m m,图像重建间隔是 3mm或 5 mm;所用造影剂为 6 0 %泛影葡胺或非离子型造影剂 ,用量 80～ 12 0 ml,注射速率为 2 .5～ 3m l/s;扫描时间窗 :动脉期于注射造影剂后 2 0 s进行 ,门静脉期 5 5～ 6 0 s。结果 CT平扫 :低密度 SHCC17例 ,MH CC2例 (82 % ) ,等密度 MHCC4例 (13% )。动脉期 :不均匀的高密度强化 SHCC 16例 ,MH CC 2例 (78% ) ;低密度无强化 SHCC 4例 ,MH CC 1例 (2 1% ) ;供血动脉增多、增粗、僵直13例 (5 6 % ) ,动脉血管迂曲、血管呈斑点状 6例 ,动静脉瘘伴有邻近肝实质异常高灌注区 6例 (高灌注区呈三角形、楔形或不规则形 ,强化程度高于周围肝实质 )。肿瘤内有液化坏死 7例。门静脉期 :低密度 SH CC18例 ,MH CC3例 (91% ) ,稍高密度SHCC 1例 ;肿瘤边缘清楚 SH CC 6例 ,MHCC 2例 ,肿瘤边缘模糊 SHCC 14例 ,MH CC 2例。结论 螺旋 CT增强后动静脉双期或多时相扫描能显著增加 SHCC和 MHCC的检出率 ,提高?
Objective To investigate the CT findings and diagnostic value of spiral CT (SCT) multi-phase scanning in small hepatocellular carcinoma (SHCC) and small hepatocellular carcinoma (MHCC). Methods Five hundred and eighty-nine liver biopsies were analyzed by spiral CT multi-phase scanning. Among them, 16 were SHCC and 7 were MHCC confirmed by histology. All cases to do plain scan, the area of interest to do enhanced arterial and portal venous phase and the whole liver balance scan. Layer thickness of 6.5 ~ 8m m, into the bed 5-6.5mm, image reconstruction interval is 3mm or 5mm; used contrast agent 60% diatrizoate or nonionic contrast agent, the amount of 80 ~ 120 ml, the injection rate was 2.5 ~ 3m l / s; scanning time window: arterial phase after injection of contrast agent 20s, portal vein period 5- 5 ~ 60s. Results CT scan: low density SHCC17 cases, MHCC2 cases (82%), isograde MHCC4 cases (13%). Arterial phase: 16 cases of non-uniform high density enhanced SHCC, 2 cases of MHCC (78%), 4 cases of low density non-enhanced SHCC and 1 case of MHCC (21%). (56%), arteries tortuous and blood vessels speckled in 6 cases. There were 6 cases of arteriovenous fistula with abnormal high perfusion area adjacent to the liver (the perfusion area was triangular, wedge-shaped or irregular shape, the degree of enhancement was higher than that of the surrounding liver substance). Seven cases of liquefaction and necrosis in the tumor. Portal venous phase: 18 cases of low-density SH CC, 3 cases of MHCC (91%), 1 case of slightly high-density SHCC; 6 cases of SHCC clear tumor edge, 2 cases of MHCC, 14 cases of tumor edge fuzzy SHCC, MHCC 2 cases. Conclusion Spiral CT enhanced arteriovenous double or multi-phase scanning can significantly increase the detection rate of SHCC and MHCC?