MSCT对肝脏占位性病变的鉴别诊断(1)
[摘要] 目的 探讨肝内占位性病变的MSCT鉴别要点。方法 回顾性分析2009.9-2011.9年期间129例肝脏占位性病变的MSCT影像表现。结果 57例肝脏血管瘤中55例平扫为低密度，2例为等密度；其中52例于动脉期边缘呈结节样强化，5例病变呈均匀轻度强化。21例肝细胞癌中平扫19例为低密度，2例为等密度；增强显示动脉期21例病灶明显不均匀强化，门脉期呈明显低密度，低于周围正常肝实质。6例肝内胆管细胞癌，平扫：均表现为肝脏低密度影，边界不清；增强扫描：5例动脉期无明显增强，呈延迟增强；1例早期呈网格状增强，延迟期呈片状增强。30例肝脏转移癌，平扫显示为肝内多发低密度灶，增强扫描显示为不均匀强化。结论 通过控制增强扫描的时间，观察肝脏病变的血供情况，再结合患者各自的临床表现，对肝脏占位性病变做出准确诊断是不难的。
[关键词] 肝脏； 占位性病变； 计算机体层摄影； 鉴别诊断
[中图分类号] R333.4[文献标识码] B[文章编号] 1005-0515(2011)-08-017-02
, http://www.100md.com
The Differential Diagnosis of MSCT for the Liver Space-occupying Lesions
[Abstract] Objective Explore the identify points of Liver space-occupying lesions.Methods Image performance of 129 patients during 2009.9-2011.9 were retrospectively analyzed. Results In 57 cases of liver hemangioma 55 cases is low density in plain CT scan,and the other two cases are equal density.Of which 52 cases are nodular enhanced, and 5 cases are mild enhanced.19 cases of 21 patients with liver cell carcinoma arelow density in plain scan,and the other two cases are equal density;enhance scan showed that 21 cases are obviously uneven enhanced, in portal phase is significantly lower density,lower than normal surrounding liver parenchyma.6 cases are intrahepatics, plain scan show that is low density,boundary is not clear,Enhance scan showed that 5 cases are not obviously enhanced in artery phase,and is delayed enhanced.One case isperiphery enhance in artery phase,and is patchy enhanced in delay phase.30 cases of liver metastatic carcinoma, plain scan show that multiple low density in liver, enhancement show that focal for not even strengthened.Conclusion Through the control of enhanced time, observation of blood to the liver lesions, combine with the different clinical menifestations of liver space-occupying lesions, to make an accurate diagnosis is not difficult.
, http://www.100md.com
[Keywords] Liver; Space-occupying lesions; Computer tomography； Differential diagnosis
肝脏占位性病变在临床上并不少见，多数病变可以依据其典型的影像学特征作出诊断，然而有的病变缺乏典型特征，所以要求影像科医生必须深入了解不同肝脏占位性疾病的病理特征、临床表现，这样才能做出准确诊断。本文笔者搜集129例肝脏占位性病变，分别进行平扫以及增强检查，并对不同病变的影像学表现进行分类、归纳与总结。
1 材料与方法
1.1 临床资料 搜集我院2009.9-2011.9年期间129例肝脏占位性病变，其中血管瘤57例(男24例，女33例，平均年龄41岁)，肝细胞癌21例(男17例，女4例，平均年龄54岁)，肝内胆管细胞癌6例(男4例，女2例，平均年龄52岁)，肝脏转移癌30例(男21例，女9例，平均年龄53岁)。其中9例肝细胞癌，4例肝内胆管细胞癌经手术病理证实。主要症状:21例肝细胞癌患者腹胀15 例，12例有乙肝病史，且甲胎蛋白(AFP)升高；57例肝血管瘤临床均无症状；6例肝内胆管细胞癌中，5例上腹部隐痛、胀痛，5例合并黄疸，5 例合并肝内胆管结石、胆管炎。
, http://www.100md.com
1.2 方法 采用GE lightspeedpro16螺旋CT机进行平扫和增强扫描。扫描参数:层厚10mm,管电压120kv、管电流220mAs。检查前禁食6小时，扫描前30min饮清水500-600mL,检查前即刻饮清水300-400mL。增强扫描采用高压注射器经肘静脉注入碘氟醇(350mgI/mL)90mL,注射速率3.0mL/s,扫描延迟时间分别为动脉期25s、门静脉期65s、延迟期5min。扫描范围自肝顶至胰腺平面下5cm。
2 结果 57例血管瘤中55例平扫为低密度，2例为等密度，52例于动脉期边缘呈结节样强化，其余病例整个瘤体均匀强化；52例于门脉期和延迟期强化逐渐向病灶中心充填，5例于动脉期整个病灶即成明显均匀强化，门脉期强化程度高于肝脏实质，延迟期与周围肝脏呈等密度。
21例肝细胞癌中3例为巨块型，最大者直径约为9cm；2例为弥漫型；16例为多发结节型。平扫19例为低密度，2例为等密度。增强扫描：21例病灶于动脉期明显不均匀强化，门脉期强化撤退，病变呈明显低密度，低于周围正常肝实质；3例巨块型中间坏死灶无强化，呈低密度灶。6例肝内胆管细胞癌，平扫表现为肝脏低密度影。其中5例于肝门部及腹膜后可见多发增大淋巴结，4例合并肝内胆管结石、肝内胆管扩张。增强扫描：6例于动脉期表现为病灶边缘轻度强化，延迟期强化程度逐渐增强,并逐渐向病变内部延伸。30例肝脏转移癌，平扫显示为肝内多发低密度灶，增强扫描显示为不均匀强化。
3 讨论 肝脏占位性病变在CT平扫中多表现为低密度灶，常无明显特征性，由于肝脏双重血供的特殊性, 动态增强扫描对肝脏占位性病变的鉴别诊断起到重要作用，通过控制增强扫描的扫描时间可以反映病变的血供特征，从而为准确诊断提供帮助。, http://www.100md.com(徐新 李国华)
[关键词] 肝脏； 占位性病变； 计算机体层摄影； 鉴别诊断
[中图分类号] R333.4[文献标识码] B[文章编号] 1005-0515(2011)-08-017-02
, http://www.100md.com
The Differential Diagnosis of MSCT for the Liver Space-occupying Lesions
[Abstract] Objective Explore the identify points of Liver space-occupying lesions.Methods Image performance of 129 patients during 2009.9-2011.9 were retrospectively analyzed. Results In 57 cases of liver hemangioma 55 cases is low density in plain CT scan,and the other two cases are equal density.Of which 52 cases are nodular enhanced, and 5 cases are mild enhanced.19 cases of 21 patients with liver cell carcinoma arelow density in plain scan,and the other two cases are equal density;enhance scan showed that 21 cases are obviously uneven enhanced, in portal phase is significantly lower density,lower than normal surrounding liver parenchyma.6 cases are intrahepatics, plain scan show that is low density,boundary is not clear,Enhance scan showed that 5 cases are not obviously enhanced in artery phase,and is delayed enhanced.One case isperiphery enhance in artery phase,and is patchy enhanced in delay phase.30 cases of liver metastatic carcinoma, plain scan show that multiple low density in liver, enhancement show that focal for not even strengthened.Conclusion Through the control of enhanced time, observation of blood to the liver lesions, combine with the different clinical menifestations of liver space-occupying lesions, to make an accurate diagnosis is not difficult.
, http://www.100md.com
[Keywords] Liver; Space-occupying lesions; Computer tomography； Differential diagnosis
肝脏占位性病变在临床上并不少见，多数病变可以依据其典型的影像学特征作出诊断，然而有的病变缺乏典型特征，所以要求影像科医生必须深入了解不同肝脏占位性疾病的病理特征、临床表现，这样才能做出准确诊断。本文笔者搜集129例肝脏占位性病变，分别进行平扫以及增强检查，并对不同病变的影像学表现进行分类、归纳与总结。
1 材料与方法
1.1 临床资料 搜集我院2009.9-2011.9年期间129例肝脏占位性病变，其中血管瘤57例(男24例，女33例，平均年龄41岁)，肝细胞癌21例(男17例，女4例，平均年龄54岁)，肝内胆管细胞癌6例(男4例，女2例，平均年龄52岁)，肝脏转移癌30例(男21例，女9例，平均年龄53岁)。其中9例肝细胞癌，4例肝内胆管细胞癌经手术病理证实。主要症状:21例肝细胞癌患者腹胀15 例，12例有乙肝病史，且甲胎蛋白(AFP)升高；57例肝血管瘤临床均无症状；6例肝内胆管细胞癌中，5例上腹部隐痛、胀痛，5例合并黄疸，5 例合并肝内胆管结石、胆管炎。
, http://www.100md.com
1.2 方法 采用GE lightspeedpro16螺旋CT机进行平扫和增强扫描。扫描参数:层厚10mm,管电压120kv、管电流220mAs。检查前禁食6小时，扫描前30min饮清水500-600mL,检查前即刻饮清水300-400mL。增强扫描采用高压注射器经肘静脉注入碘氟醇(350mgI/mL)90mL,注射速率3.0mL/s,扫描延迟时间分别为动脉期25s、门静脉期65s、延迟期5min。扫描范围自肝顶至胰腺平面下5cm。
2 结果 57例血管瘤中55例平扫为低密度，2例为等密度，52例于动脉期边缘呈结节样强化，其余病例整个瘤体均匀强化；52例于门脉期和延迟期强化逐渐向病灶中心充填，5例于动脉期整个病灶即成明显均匀强化，门脉期强化程度高于肝脏实质，延迟期与周围肝脏呈等密度。
21例肝细胞癌中3例为巨块型，最大者直径约为9cm；2例为弥漫型；16例为多发结节型。平扫19例为低密度，2例为等密度。增强扫描：21例病灶于动脉期明显不均匀强化，门脉期强化撤退，病变呈明显低密度，低于周围正常肝实质；3例巨块型中间坏死灶无强化，呈低密度灶。6例肝内胆管细胞癌，平扫表现为肝脏低密度影。其中5例于肝门部及腹膜后可见多发增大淋巴结，4例合并肝内胆管结石、肝内胆管扩张。增强扫描：6例于动脉期表现为病灶边缘轻度强化，延迟期强化程度逐渐增强,并逐渐向病变内部延伸。30例肝脏转移癌，平扫显示为肝内多发低密度灶，增强扫描显示为不均匀强化。
3 讨论 肝脏占位性病变在CT平扫中多表现为低密度灶，常无明显特征性，由于肝脏双重血供的特殊性, 动态增强扫描对肝脏占位性病变的鉴别诊断起到重要作用，通过控制增强扫描的扫描时间可以反映病变的血供特征，从而为准确诊断提供帮助。, http://www.100md.com(徐新 李国华)