螺旋CT三期增强扫描误诊漏诊肝细胞癌20例分析  

Analysis of misdiagnosis and missed diagnosis of hepatocellular carcinoma with triple-phase spiral CT enhancement (report of 20 cases)

作　　者：谢品超[1] 练旭辉[1] 叶文钦[1] 文康彦[1] 梁权海[1] 陈忠[1] 

机构地区：[1]南方医科大学附属新会医院放射科

出　　处：《放射学实践》2010年第8期880-883,共4页Radiologic Practice

摘　　要：目的：探讨螺旋CT三期增强扫描误诊或漏诊的20例肝细胞性肝癌（HCC）的原因,以进一步提高HCC的诊断准确性。方法：20例HCC患者行平扫及三期增强扫描,对比剂注射流率为3.0ml/s,然后开始动脉期、门脉期和延迟期的扫描,观察病灶的强化方式和部位。结果：漏诊的5个病灶均〈1cm,其中2个病灶在三期扫描中均未能发现,其余3个病灶因观察分析不仔细而漏诊。16个病灶误诊为其它肝脏病变,肝血管瘤（5个）,肝脓肿（4个）,肝硬化结节（3个）,局灶性结节增生（2个）,肝炎性假瘤（2个）。结论：HCC在三期增强扫描中强化方式不典型是误诊的主要原因,而这种不典型强化方式是HCC的病理基础和生长方式所造成的。了解HCC的病理基础和生长方式及仔细阅片和分析可进一步提高HCC的诊断准确性。Objective：To investigate the causes of misdiagonsis and missed diagnosis of hepatocellular carcinoma （HCC） in triple-phase spiral CT enhancement scanning.Methods：The pre-and post-contrast CT scans of the entire liver in 20 patients with HCC were carried out with a spiral CT scanner.The contrast material was injected at a rate of 3.0ml/s,followed by sequential arterial,portal venous-and delayed phase scans of the liver,during which the location and pattern of all lesions in each phase were observed.Results：Each of the 5 missed lesions was less then 1 cm in diameter.Of the 5 lesions,2 were not detected in triple-phase scanning and the remaining 3 could be found if they had been carefully observed and analyzed.16 lesions were misdiagnosed as other intrahepatic diseases such as hemangioma of the liver （5 lesions）,hepatic abscess （4 lesions）,cirrhotic nodules （3 lesions）,focal nodular hyperplasia （2 lesions） and inflammatory pseudotumor of the liver （2 lesions）.Conclusion：The atypical enhanced CT findings in the triple-phase scanning are the main cause of misdiagnosis,and these atypical enhanced CT findings can result from the pathological basis and growth mode of HCC.Understanding them thoroughly and analyzing them carefully can improve the diagnostic accuracy of HCC.

关 键 词：癌 肝细胞 体层摄影术 X线计算机 诊断显像 

分 类 号：R735.7[医药卫生—肿瘤]