螺旋CT二维重建对肝肾间肿瘤的定位意义

目的:探讨螺旋CT二维重建对肝肾问占位性病变的诊断价值,提高CT对右上腹占位病变的诊断准确性.方法:对25例经外科手术和病理证实的肝肾间占位病灶的CT资料进行2次阅片分析.第一次仅提供横断位CT图像进行诊断,然后同时提供横断位和二维重建的进行诊断.与手术和病理结果对照,比较分析两次诊断的准确性,并探讨对肝肾间占位病灶CT定位和定性诊断有价值的征象.结果:25例经外科手术和病理证实的肝肾间占位病灶,包括原发性肝细胞肝癌9例、肾上腺腺瘤7例、肾上腺腺癌2例、肾上腺来源的嗜铬细胞瘤3例、肾上腺髓样脂肪瘤1例、肾细胞肾癌2例、后腹膜来源的间质瘤1例,肿瘤直径在5～15cm不等.使用横断位图像定位诊断正确17例(68%),包括肝脏源性6例、肾上腺源性9例、肾源性2例,其中定性诊断正确15例(60%).使用横断位结合二维重建图像诊断正确21例(84%),包括肝脏源性8例、肾上腺源性11例、肾脏源性2例,其中定性诊断正确18例(72%),定位和定性诊断准确率均明显提高.在所有有利于CT定位的征象中,"杯口征"是最直接、最可靠,也是价值最大的定位征象.结论:利用多层螺旋CT扫描速度快、图像分辨率高的特点,采用薄层扫描以及多平面重建,能很好地观察肿瘤的全貌及其与周围脏器的关系,有利于辨别肝肾间占位的来源,明显提高病变的定位和定性诊断准确率.

Clinic Value of Spiral CT 2D - reconstruction in Tumours Located at Hepatorenal Space

Purpose: To evaluate the value of spiral CT 2D reconstruction in localization of massive le-sions located at hepatorenal space, and to improve the diagnosis. Materials: Twenty - five cases of mas-sive lesions in hepatorenal space proved by surgery or pathology were analyzed. All cases were scanned by spiral CT and 2D reconstruction was done. Diagnosis was done by 2 radiologist using axial images only and axial images combined with 2D images, respectively. The results were compared with patholo-gy. Results: Within 25 cases, there were 9 hepatic cellular carcinomas, 7 adrenal adenomas, 2 adrenal carcinomas, 1 adrenal lipoma, 3 pheochromocytomas, 2 renal cellular carcinomas and 1 interstitialoma. The diameter was ranging from 5 to 15 cm. Seventeen lesions(68%) were localized correctly by using axial images only, whereas 21 lesions (84%) were localized correctly by using axial images combined with 2D images. Conclusion: It is useful to diagnose lesions located at hepatorenal space with hi - speed and hi - resolution spiral CT and 2D reconstruction technique.