增强动态CT扫描动脉期肝实质一过性异常强化的临床意义_高回青VIP专享VIP免费

苏州大学学报(医学版)2008；28(5)增强动态CT扫描动脉期肝实质一过性异常强化的临床意义高回青1，范国华2，郭亮3（1.苏州市相城人民医院放射科,江苏苏州215131;2.苏州大学附属第二医院影像科,江苏苏州215004;3.苏州大学附属第一医院影像中心,江苏苏州215006)摘要:目的探讨增强动态CT扫描动脉期肝实质一过性强化(THPE)的病理基础及其临床意义。方法回顾性分析90例THPE患者，均先行CT平扫，分别于注射对比剂后30s、65s、3~5min行动脉期、门静脉期、延迟扫描，分析THPE出现部位、形态、各期强化表现及其与肝内外病变的关系。结果90例中，51例与肝内病变有关，THPE位于病灶周围相应叶段或相邻叶段；39例与肝外病变有关,THPE以门静脉、肝静脉阻塞和肝动脉-门静脉分流多见，常见相应肝动脉不同程度增粗。THPE形态与病变性质的关系：肝细胞癌（HCC）、胆囊炎/癌以多形态型多见；肝血管瘤、肝内胆管细胞癌、胰腺癌/炎、门静脉系栓塞/压迫以扇型多见；肝脓肿以叶/段型、扇型多见；肝转移癌可出现扇型、多型态型和弥漫型；肝内胆管炎、肝硬化、Budd-Chiari综合征多为弥漫型。结论THPE可见于多种病变，根据其出现部位、形态特征对了解病变的病理基础和病变定性具有重要的临床意义，有助于选择合理的治疗方案。关键词：肝脏；体层摄影术；X线计算机；对比增强；动态；局部血流中图分类号：R814.42文献标识码:A文章编号:1673-0399(2008)05-0807-04ClinicalSignificanceofTransientHepaticParenchymalEnhancementinHepaticArterialPhaseDuringDynamicContrast-enhancedCTExaminationGAOHui-qing1,FANGuo-hua2,GUOLiang3(1.DeptofRadiology,People’sHospitalofXiangcheng,SuzhouCity,JiangsuSuzhou215131,China;2.DeptofRadiology,theSecondHospitalAffiliatedtoSoochowUniversity,JiangsuSuzhou215004,China;3.ImagingCenter,theFirstHospitalAffiliatedtoSoochowUniversity,JiangsuSuzhou215006,China)Abstract:ObjectiveToassesstheclinicalsignificanceoftransienthepaticparenchymalen-hancement(THPE)inthehepaticarterialphaseduringdynamiccontrast-enhancedCTexaminationandinvestigatethepathogenesisofTHPE.MethodsNinetycaseswithTHPEwereanalyzedretrospective-ly.AfterplanCTscanwasdone,theenhancedCTscanwasrespectivelyperformedinthehepaticarte-rialphase(30secondsafterthecontrastinjection),theportalvenousphase(65secondsafterthecontrastinjection)anddelayedphase(3~5minutesafterthecontrastinjection).Thelocation,shapeandenhance-mentfeatureofTHPEwereanalyzed,aswellastherelationshipbetweenTHPEandlesionsinliverwas.ResultsIn90patients,THPEswererelatedtohepaticlesionsin51casesinwhichtheTHPEslocatednexttohepaticlesionsandthelesionsoutsideofliverin39cases.THPEwasoftenaccompaniedwithAPSandthethrombosisorcompressionofportalveinanditdemonstratedasdilatationofthehepaticartery.TheshapeofTHPEscausedbyhepatocellularcarcinoma,cholecystitis,cholecystcarcinomawereusuallypolymorphous.TheshapeofTHPEscausedbyhemangioma,cholangiocarcinoma,pancreatitis,ancreatocarcinoma,portalveinthrombosisorcompressionwereusuallysectorial,lobarmultisegmentalorsectorialshapeinhepaticabscesses,sectorial,polymorphousordiffuseshapeinhepaticmetastasis,dif-fusetypeincholangeitis,cirrhosisandBudd-Chiarisyndrome.ConclusionThecauseofTHPEisvar-iousvaried.ThelocationandshapeoftheTHPEarehelpfulintheunderstandingofthepathogenesisoflesionsandthediagnosisofdiseases,whichisofimportantclinicalvalueandwasbeneficialtochoose收稿日期:2008-04-01作者简介:高回青(1970-),男,江苏苏州人,主治医师，医学学士，研究方向为腹部影像诊断学。通讯作者:范国华807SUZHOUUNIVERSITYJOURNALOFMEDICALSCIENCE2008；28(5)表2与THPE相关的异常CT征象及其与病变性质的关系门静脉栓塞/压迫门静脉壁增厚阻塞肝静脉压迫/阻塞APS肝动脉增粗肝异常血管...