动脉期强化不明显肝脏占位性病变的CT表现及其在鉴别诊断中的意义

doi:10.13481/j.1671-587x.20190131

摘要/Abstract

摘要： 目的：研究在螺旋CT动态增强扫描中动脉期强化不明显肝脏占位性病变的CT表现，分析其特征并进行鉴别。方法：收集118例在CT增强扫描中动脉期强化不明显肝脏占位性病变患者的资料，分析比较其基本CT征象、特征性表现及强化方式。结果：118例肝脏占位性病变患者中，肝转移瘤40例，肝脓肿29例，肝内胆管细胞癌21例，肝细胞癌17例，肝脏炎性假瘤6例，肝淋巴瘤5例；单发54例，多发64例；边缘清晰24例，边缘模糊94例；病变位于肝右叶41例，肝左叶26例，肝左右叶50例，肝尾状叶1例；病变直径0.2~13.4 cm。40例肝转移瘤均呈边缘轻度强化，"牛眼征"出现率为12.50%（5/40）；29例肝脓肿均呈环形、蜂窝样强化，"双环征"和"气泡征"出现率均为13.79%（4/29）；17例肝内胆管细胞癌呈持续渐进强化，肝内胆管扩张、肝包膜凹陷和病灶内钙化出现率分别为57.14%（12/21）、23.81%（5/21）和9.52%（2/21）；17例肝细胞癌强化方式多种多样，肝脏形态轮廓改变、肝动脉扭曲增粗和血管受侵出现率分别为41.18%（7/17）、41.18%（7/17）和35.29%（6/17）；6例肝脏炎性假瘤中4例呈分隔以及结节样强化；5例肝淋巴瘤均呈轻度均匀强化，"血管漂浮征"出现率为40.00%（2/5）。结论：螺旋CT检查动脉期强化不明显肝脏占位性病变时，应结合CT征象及强化方式后进行综合判断，有助于为肝脏病变的定性及鉴别诊断提供重要依据。

关键词: 肝脏, 占位性病变, 电子计算机断层扫描, 动态增强, 鉴别诊断

Abstract: Objective: To study the CT findings of hepatic lesions without obvious enhancement in arterial phase, and to analyze the characteristics of the hepatic lesions.Methods: The clinical materials of 118 cases of hepatic lesions without obvious enhancement in arterial phase scanned by enhanced CT were collected. The basic CT signs, characteristic CT signs and enhancement patterns were analyzed.Results: Among 118 cases, there were 40 hepatic metastases, 29 liver abscesses, 21 intrahepatic cholangiocelloma, 17 hepatocellular carcinoma, 6 inflammatory pseudotumor of liver and 5 hepatic lymphoma; 54 cases showed single lesion and 64 cases showed multiple lesions; 24 cases were sharp and 94 cases were indistinct; 41 cases located in right hepatic lobe, 26 cases located in left hepatic lobe, 50 cases located in left and right hepatic lobe, and 1 case located in hepatic caudate lobe. The diameters of lesions were 0.2-13.4 cm. 40 cases of hepatic metastases showed mild marginal enhancement, while the incidence rate of bull eye sign was 12.50% (5/40); 29 cases of liver abscess showed ring or honeycomb-like enhancement, while the incidence rates of double ring sign and gas bubbles were 13.79% (4/29) and 13.79% (4/29).Seventeen cases of intrahepatic cholangiocelloma showed slow progressive enhancement,while the incidence rates of intrahepatic bile duct dilatation, hepatic capsular depression and calcification were 57.14% (12/21), 23.81% (5/21) and 9.52%(2/21). Seventeen cases of hepatocellular carcinoma showed various enhancement patterns, while the incidence rates of liver contour change, hepatic artery enlargement and vessel invasion were 41.18% (7/17), 41.18% (7/17) and 35.29%(6/17). Four cases of inflammatory pseudotumor of liver showed septal and nodular enhancement; 5 cases of hepatic lymphoma showed internal minimal homogeneous enhancement, while the incidence rate of ‘vascular floating’ sign was 40.00% (2/5).Conclusion: Spiral CT examination of the hepatic lesions without obvious enhancement in arterial phase should be combined with CT signs and enhancement patterns for synthetic judgment, which is helpful to provide an important basis for the qualitative and differential diagnosis of liver lesions.

Key words: liver, lesions, computed tomography, dynamtic contrast enhancement, differential diagnosis

中图分类号:

R814.42

冯晴, 文明. 动脉期强化不明显肝脏占位性病变的CT表现及其在鉴别诊断中的意义[J]. 吉林大学学报(医学版), 2019, 45(01): 163-169.

FENG Qing, WEN Ming. CT manifestations of hepatic lesions without obvious enhancement in arterial phase and their significancs in differential diagnosis[J]. Journal of Jilin University(Medicine Edition), 2019, 45(01): 163-169.

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