外生型肝癌的CT和DSA诊断  

CT and DSA Diagnosis of Pedunculated Hepatocellular Carcinoma

作　　者：夏淦林[1] 冯峰[1] 

机构地区：[1]南通市肿瘤医院放射科

出　　处：《中国医学计算机成像杂志》2007年第6期448-452,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨外生型肝癌的临床表现、CT表现、DSA供血特点。材料和方法:将26例资料完整外生型肝癌的CT表现与其中8例DSA资料、6例手术资料进行回顾性对照分析。结果:26例中23例主诉有上腹疼痛或隐痛,腹胀、乏力,其中4例主要因腹块就诊,4例有突然剧烈腹痛史,3例体检发现。AFP>500ng/ml20例,23例两对半2-3项异常。CT动脉期23例中20例见肿瘤强化征象;静脉期23例中18例肿瘤呈相对低密度,5例肿瘤密度呈相对增高强化。直径>5cm瘤内有低密度坏死区,门脉主干及分支未见癌栓,26例中24例有肝硬化、脾肿大。8例DSA示肿瘤血供丰富,主要由肝动脉供血,其中2例<5cm肿瘤全部为肝动脉供血并显示蒂;5例>10cm肿瘤80%(4/5)有肝外动脉参与供血,其中左叶4例中3例有胃网膜右动脉参与供血。6例手术病例中2例有蒂,所有病例肝外瘤体均有包膜,4例有陈旧性破裂出血并被膈肌或网膜包裹粘连。结论:外生型肝癌有明显的临床及CT、DSA征象特点,运用这些特点能提高外生性肝癌的诊断正确率。Purpose：To investigate the clinical presentation, CT finding and blood - supply characteristic of pedunculated hepatocellniar carcinoma. Materials and Methods： CT finding of 26 patients with complete documents, DSA information of 8 patients （8/26） and surgical intervention documents of 6 patients （6/26） were cross - check analyzed retrospectively. Results： 23 （23/26） patients complained of epigastric pain or vague pain, abdominal distention, debility; 4 （4/26） patients visited for palpable mass; 4 （4/26） cases were evaluated for unexpectedly intense bellyache; 3 cases （3/26） were detected by health examination. AFP 〉 500ng/ml was found in 20 patients, 23 patients were 2 - 3 items abnormal of HB orrhology index. Enhanced tumor tissue was found during hepatic artery - phase in 20（20/ 26） cases; tumor tissue showed relative low density during hepatic portal vein - phase in 18 （18/26） cases. Tumor （diameter 〉 5cm） had low density necrosis region. Portal vein＇ s bole and branch had not found cancer embolus in these patients. 24（24/26） patients had previous history of cirrhosis. Tumor showed abundant blood supply with DSA in 8 patients, mainly supplied with hepatic artery, and two lesions （diameter 〈 5cm） were all blood - supplied with hepatic artery, with well defined peduncle. 4 cases （4/5） （diameter 〉 5cm） had extrahepatic artery to participate blood - supply, where 3 cases located in left lobe blood supplied with axteria gastropiploica dextra. 2 cases had peduncle in 6 patients who had been demonstrated of surgical resection. Extrahepatic growing tumor was found amisnia in all the six patients, 4 lesions had obsolete rupture and were packaged of diaphragmatic muscle or epiploon.Conclusion： Pedunculated hepatocellulax carcinoma had sufficient clinical presentation, CT and DSA imaging characteristic. To use these characteristics we can increase accuracy in diagnosing pedunculated hepatocellniar carcinoma.

关 键 词：癌 肝细胞性 外生型 体层摄影术 X线计算机 数字减影血管造影 

分 类 号：R735.7[医药卫生—肿瘤]