肝脏囊性恶性肿瘤的CT诊断  

CT Diagnosis of Hepatic Cystic Malignancy

作　　者：余日胜[1,2] 傅立平[1,2] 李蓉芬[1,2] 

机构地区：[1]浙江医科大学附属第二医院放射科 [2]浙江省遂昌县人民医院放射科

出　　处：《临床放射学杂志》1999年第3期158-161,共4页Journal of Clinical Radiology

摘　　要：目的：探讨肝脏囊性恶性肿瘤的ＣＴ诊断价值。材料与方法：经手术病理和临床证实的肝脏囊性恶性肿瘤２９例，术前均行ＣＴ检查，其中转移瘤１５例，肝细胞性肝癌４例，肝肉瘤２例，囊腺癌４例（包括囊腺癌肉瘤１例），胆管癌３例和Ｃａｒｏｌｉ病癌变１例。结果：囊性转移瘤远较其他肝囊性恶性肿瘤常见，表现多样化，以多发囊性或囊性实质性病灶共存为其特点，小病灶亦可完全囊变；囊性肝癌表现为单发不均或均匀厚壁型肿块；囊性肝肉瘤为单房或多房囊性肿瘤；囊腺癌或囊腺癌肉瘤则为多房囊样病变或以囊性病变为主的囊实性肿块，有壁结节，周围可有卫星灶及远端胆管扩张；囊性胆管癌为囊实性病变，囊性部分呈较小多发囊性病灶，伴病灶远端胆管明显扩张；Ｃａｒｏｌｉ病癌变在Ｃａｒｏｌｉ病基础上部分扩张胆管癌变（胆管壁软组织肿块）。结论：肝脏囊性恶性肿瘤以转移瘤最常见，各种病理类型的囊性肿瘤有其相似和不同的ＣＴ征象，典型的ＣＴ特征结合临床，大部分肿瘤术前可作出正确诊断。Objective: To evaluate CT scan in the diagnosis of hepatic cystic malignancy.Materials and Methods:CT scan was performed in 29 cases with hepatic cystic malignancy, proved pathologically or clinically, including metastasis (n=15), hepatocellular carcinoma (n=4), sarcoma (n=2), cystadenocarcinoma (n=4), cholangiocarcinoma (n=3) and Caroli's disease with canceration (n=1).Results:Cystic metastasis was seen much more common than other hepatic cystic malignancy, and had a variety of presentations. Typically, it presented as multiple cystic mass, or a mass mixed with cystic and solid lesions. Cystic hepatocellular carcinoma displayed as a single huge cystic mass with even or irregular thick wall. Cystic hepatic sarcoma demonstrated unilocular or multilocular mass without mural nodules. Cystadenocarcinoma appeared as multiloculated cystic tumor (or mixing with solid mass), with mural nodules and satellite lesions, and the biliary duct distal to the tumors was dilated. Cystic cholangiocarcinoma showed a mixed cystic and solid lesion, the cystic part was composed of multiple small cysts, and the biliary duct distal to the tumors was dilated. In Caroli's disease with canceration, soft mass in the dilated biliary duct superimposed upon the background of Caroli's biliary dilatation was seen.Conclusion: Metastasis is the commonest cystic malignancy in the liver. Cystic malignancy of different pathologic nature has different CT findings, sometimes with some similar signs. Typical CT findings, coupled with clinical information, can lead to a correct diagnosis preoperatively in most cases.

关 键 词：肝肿瘤 囊性病变 CT 诊断 

分 类 号：R735.704[医药卫生—肿瘤] R730.44[医药卫生—临床医学]