多层螺旋CT双动脉期与门静脉期增强扫描对原发性肝癌检出价值的比较  

Detection of hepatocellular carcinoma with multi-slices sprial CT by using double.arterial phase and portal venous phase enhanced scanning

作　　者：江新青[1,2] 肖湘生[1] 谢琦[2] 吴红珍[2] 汪珍穗[2] 

机构地区：[1]第二军医大学长征医院影像科,上海200003 [2]广州医科大学附属第一人民医院医学影像部,510180

出　　处：《中华放射学杂志》2008年第6期628-631,共4页Chinese Journal of Radiology

基　　金：广东省科技计划项目（2004B36001043）

摘　　要：目的评价多层螺旋CT（MSCT）双动脉期与门静脉期增强扫描对原发性肝癌（HCC）癌灶检出的价值。方法回顾性分析94例经病理证实的HCC患者的MSCT平扫、动脉早期（20～22s）、动脉晚期（34～37s）和门静脉期（60s）资料，并采用χ^2检验分别对≤3cm和〉3cm的病灶在各期相的检出率进行比较。结果94例术中共发现318个病灶，其中≤3cm者86个，〉3cm者232个。动脉早期、动脉晚期和门静脉期检出≤3cm病灶的敏感度分别为39．5％（34个）、67．4％（58个）、44．2％（38个），差异有统计学意义（χ^2=15．38，P〈0．01）。上述3期检出〉3cm病灶的敏感度分别为89．6％（208个）、99．6％（231个）和99．1％（230个），差异有统计学意义（χ^2=39．09，P〈0．01）；阳性预测值均为100％。上述3期检出病灶的总敏感度分别为76．1％（242个）、90．9％（289个）和84．3％（268个），阳性预测值分别为88．3％（242／274）、86．3％（289／335）和93．7％（268／286），差异均有统计学意义（χ^2值分别为25．62和9．29，P值均〈0．05）。结论双动脉期扫描有利于提高病灶的检出率，特别是对于小HCC，动脉晚期的扫描显得尤其重要。Objective To evaluate the double-arterial phase and portal venous phase scanning in the detection of hepatocellular carcinoma with multi-slice sprial CT （MSCT）. Methods Ninety-four patients with hepatocellular carcinoma were examined by abdominal plain CT and early arterial phase （EAP）, late arterial phase （LAP）, portal venous phase （PVP）. Contrast agent of 100 ml （300 mg I/ml） was administrated intravenously by 3 ml/s, for scanning of EAP at 20 to 22 s, LAP at 34 to 37s, and PVP at 60 s. Chi-square test was carried out to compare the sensitivity among various phases. Results A total of 318 lesions was detected pathologically, with 86 lesions less than 3 cm in size and 232 lesions more than 3 cm. For the early arterial phase, late arterial and portal venous phase, the sensitivity was 39. 5% （34）, 67.4% （58）, 44. 2% （38） respectively for the small tumors, which showed significant differences between phases（χ^2 = 15.38,P 〈 0. 01 ）. For the large tumors, the sensitivity was 89. 6% （208）, 99. 6% （231）, 99. 1% （230）, respectively（χ^2 = 39. 09,P 〈 0. 01）. All had positive predictive values of 100%. If the tumors were taken together, the sensitivity was 76. 1% （242）, 90. 9% （289）, 84. 3% （268）, and the positive predictive value was 88. 3% （242/274）, 86. 3% （289/335） , 93.7% （268/286） for the early arterial phase, late arterial and portal venous phase respectively. There was significant difference of sensitivity and positive predictive value between phases （χ^2= 25.62, 9. 29, P 〈 0. 05 ） . Conclusion Double-arterial phase could improve the detection of tumors, especially for small hepatocellular carcinoma, and late arterial phase scanning is particularly important.

关 键 词：癌 肝细胞 体层摄影术 X线计算机 造影剂 

分 类 号：R686[医药卫生—骨科学]