CT对肝血管平滑肌脂肪瘤与肝细胞肝癌的鉴别诊断价值  

CT Features in Differential Diagnosis of Hepatic Angiomyolipoma and Hepatocellular Carcinoma

作　　者：王胜裕[1] 蒯新平[1] 王鹏[2] 刘士远[2] 丘佳明[3] 蒲明明 

机构地区：[1]江苏省常熟市第二人民医院影像科,江苏常熟215500 [2]第二军医大学附属上海长征医院影像科,上海200003 [3]江苏省常熟市第二人民医院病理科,江苏常熟215500

出　　处：《中国医学影像学杂志》2013年第12期924-927,共4页Chinese Journal of Medical Imaging

摘　　要：目的比较肝血管平滑肌脂肪瘤(HAML)与原发性肝细胞肝癌(HCC)的CT征象,提高HAML的CT诊断准确性。资料与方法回顾性分析经病理确诊的9例HAML及20例HCC患者的CT特点,包括病变部位、形态、大小、各期CT值、边缘、肝硬化情况、肿瘤内血管显示情况等。结果 CT平扫及增强扫描动脉期HAML平均CT值明显低于HCC(t=-2.885,P<0.05;t=-3.307,P<0.01),门静脉期CT值差异无统计学意义(t=-0.293,P>0.05)。HAML及HCC动脉期与平扫CT值差值差异无统计学意义(t=1.289,P>0.05),门静脉期与平扫CT值差值差异有统计学意义(t=2.516,P<0.05)。7例HAML显示中心血管影,3例HCC显示中心血管影;1例HAML出现假包膜,13例HCC出现假包膜。HAML与HCC在血管影及假包膜方面差异均有统计学意义(χ2=10.828、7.219,P<0.01)。结论 CT检查可以显示HAML的脂肪成分,增强扫描呈"快进慢出"强化模式,内有粗大血管影,无假包膜,藉此可以与HCC进行鉴别。Purpose To compare the CT features of hepatic angiomyolipoma （HAML） and primary hepatocellular carcinoma （HCC） and improve diagnostic accuracy tbr HAML. Materials and Methods The CT findings of 9 patients with HAML confirmed pathologically and 20 patients with HCC were retrospectively analyzed in terms of lesion location, appearance, size, margin, CT value at each phase, cirrhosis and vessel presence inside tumor. Results Mean CT value on plain scan and at arterial phase on contrast enhanced scan of HAML was significantly lower than that of HCC （t=-- 2.885, P〈0.05; t=- 3.307, P〈0.01）. At portal vein phase, difference in CT value showed no statistic significance （t=-- 0.293,p〉0.05）. CT value on plain scan and at arterial phase of both HAML and HCC was not significantly different （t=-1.289, P〉0.05） whilst that at portal vein phase was significantly different （t=-2.516, P〈0.05）. Central vessels were shown in 7 cases of HAML and 3 cases of HCC, pseudocapsule appeared in 1 case of HAML and 13 cases of HCC with statistical difference （X^2= 10.828, 7.219; P〈0.01 ）. Conclusion CT scan of HAML reveals the component of fat and presents ＂fast in and slow out＂ pattern, large shadow of vessel and absence of capsule on contrast enhanced scan, which can be helpful in the differential diagnosis from HCCs.

关 键 词：肝肿瘤 血管肌脂瘤 癌 肝细胞 体层摄影术 螺旋计算机 诊断 鉴别 

分 类 号：R735.7[医药卫生—肿瘤] R445.3[医药卫生—临床医学]