肿瘤性肝灌注异常现象在肝癌中的影像学表现

目的明确肿瘤性肝灌注异常(HPD)在肝细胞癌患者中的发生率、影像学形态特征以及与动-门脉瘘、门脉癌栓之间的关系,探讨其可能发生机制。方法对780例肝细胞癌患者中出现肿瘤性肝灌注异常50例的临床资料、双期CT表现、动态MR增强及肝动脉造影进行回顾性分析,肿瘤性灌注异常的影像诊断标准为:CT、MR增强动脉期表现为病灶周围肝实质楔形或不规则形一过性强化,门静脉期恢复正常,肝动脉造影表现为动脉期病灶周围肝实质一过性染色,门静脉期恢复正常。结果780例肝细胞癌中出现肿瘤性灌注异常50例(6.4%),伴发门脉癌栓者HPD的发生率较不伴发门脉癌栓者高(P<0.01);伴发动-门脉瘘者较不伴者高(P<0.01)。结论肿瘤性灌注异常现象的出现与伴发肝癌动-门脉瘘、门脉癌栓有关。

Imaging findings of tumorous hepatic perfusion disorders in hepatocellular carcinoma

Objective To determine the prevalence of tumorous hepatic perfusion disorders (HPD) in hepatocellular carcinoma (HCC), and study the imaging findings, correlation between portal vein tumor thrombus and arterioportal shunts and explore its mechanism. Methods For fifty patients with tumorous HPD in 780 patients with HCC, the clinical data and imaging findings were retrospectively reviewed. Tumorous HPD was defined as transient triangular, wedge shaped or amorphous hepatic parenchymal hyper-enhancement during hepatic arterial phase and return to normal attenuation/intensity during portal venous phase on CT enhancement, MR dynamic enhancement, and hepatic arteriograms. Results Fifty of the 780 patients (6.4%) had tumorous HPD. The prevalence of tumorous HPD was significantly higher in HCC with portal vein tumor thrombus than in those without portal vein tumor thrombus (P<0.01). The prevalence of tumorous HPD was also significantly higher in HCC with arterioportal shunts than in those without arterioportal shunts (P<0.01). Conclusion Tumorous HPD in HCC is correlated with portal vein tumor thrombus and arterioportal shunts.