原发性巨块型肝癌螺旋CT多期增强扫描的临床价值

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。

Practical value of multi-phase helical CT in study of the massive hepatocellular carcinoma

Objective: To analyze the characteristic appearances of massive primary hepatocellular carcinoma(HCC) in multi phase helical study. Methods: Plain scan, dual phase or triple phase enhanced helical scans of liver were done in 49 patients with known hepatocellular carcinoma, The CT findings were reviewed and compared with operations or pathological data. Results: (1) All of HCC were irregular hyperdense in arterial phase companioned with mass and hyperdense tumor vessels. Their density sharply decreased in portal venous phase and became hypodense in balance phase. (2) The periphery of HCC illustrated ring like enhancement both arterial and portal venous phases. (3) Metastatic nodules demonstrated hyperdensity in arterial phase and abruptly turn to be hypodensity in portal venous phase. (4) Portal branches involved by tumor complicated with eroded, destroyed, shut or abnormal contrast medium filling signs. Conclusions: Multi phase helical CT can display the characteristics of massive HCC, make sure the blood supply and involved portal venous conditions as well as detect metastatic nodules. It provides reliable imaging data for the diagnosis and treatment of HCC.