外生型肝细胞癌及肝血管瘤的CT诊断

目的：探讨外生型肝细胞癌及肝血管瘤的CT表现。方法：回顾性分析7例外生型肝细胞癌及3例外生型肝血管瘤的CT和临床资料,10例均经手术、病理或临床证实。结果：外生型肝细胞癌根据肝内有无肿块将其分为单纯型（4例）和混合型（3例）。2例肿块突出肝外,有蒂与肝相连,5例肿块紧邻肝表面。7例肿块平扫均呈低密度,动脉期不均匀强化,门脉期病变密度降低或呈低密度;其中2例出现动静脉短路征象,2例出现肿瘤周围部分肝实质一过性增强,4例出现门静脉癌栓,3例有肝硬化表现。外生型肝血管瘤中,2例为海绵状血管瘤,病灶平扫呈低密度,增强扫描动脉期肿块边缘强化,门脉期强化范围扩大;1例为纤维性血管瘤,表现为门脉期不均匀强化。结论：CT是诊断外生型肝细胞癌和肝血管瘤的有价值的影像学手段。

CT diagnosis of hepatic extrahepatic growing hepatocellular carcinoma and hemangioma

Objective: To study CT features of the extrahepatic growing hepatocellular carcinoma and hemangioma.Methods: Seven cases of extrahepatic growing hepatocellular carcinoma and 3 cases of extrahepatic growing hemangioma were reviewed retrospectively.All the 10 cases were proved by surgery,pathology or clinical findings.Results:(1) Extrahepatic growing hepatocellular carcinoma could be classified as two types: simple type(4 cases) and mixed type(3 cases).Of the 7 cases of extrahepatic growing hepatocellular carcinoma,the masses of 2 cases seemed to projected out of the liver and had peduncles connected with the liver,the mass of the other 5cases were adjacent to the surface of the liver.The masses appeared as low density on plain CT scanning,heterogeneous enhancement in the arterial phase,and low density in the venous phase.Of the 7 cases,2 cases had artery-portal vein shunt,2 cases appeared transitory enhancement of the parenchyma around the mass,4 cases revealed tumor thrombosis in the portal vein,3 cases had liver cirrhosis.(2) Among 3 cases of extrahepatic growing hemangioma of liver,2 cases appeared as low density on plain CT scanning,marginal nodular enhancement in the arterial phase,and the enhanced area enlarged in the venous phase.1 case appeared as non-homegeneous enhancement in the portal venous phase which contained much fibrous tissue.Conclusion: CT is helpful to make accurate diagnosis of the extrahepatic growing hepatocellular carcinoma and hemangioma.