摘要
目的 分析肝癌多层螺旋CT血管成像的表现，探讨其临床应用价值。方法 83例经手术病理及临床确诊的肝癌患者行多层螺旋CT检查，经图像处理后获得动脉期、门脉期血管图像：分析肝癌的多层螺旋CT血管成像的表现，并与DSA图像、手术所见以及其临床随访结果相对照。结果MSCTA能够清晰显示肝癌供血动脉形态、起源，并显示瘤体内肿瘤血管和肿瘤染色以及动静脉瘘：能准确评价肝动脉1～2级肿瘤供血血管，但对肝动脉3级分支供血血管显示欠佳；其显示肿瘤供血动脉的敏感度为93.55％，特异度为97.50％，阳性预报值为96.67％，阴性预报值为90.70％。同时MSCTA还显示门静脉血管的形态、变异以及受侵犯的状况，其诊断的敏感度为98.00％，特异度为93.94％，阳性预报值96.09％，阴性预报值为96.67％。结论MSCTA能够提供大量关于肝癌肿瘤供血动脉和血管受累的信息，可作为肝癌治疗前进行准确术前分期和制定手术或者治疗方案的最有效的影像学检查方法。
Objective: To analyze the imaging findings of primary hepatocellar carcinoma. With Multi-slice Spiral CT Angiography(MSCTA) , and to evaluate the clinical application of MSCTA. Methods: 83 cases with hepatocellular carcinoma (HCC) confirmed by pathologic or surgical results or clinical follow up were studied with MSCT. MSCTA images were acquired by post processing of the original data on advanced workstation. The images of MSCTA were analyzed and compared with the findings of DSA, surgery and other imaging modalities. Results: MSCTA clearly showed the tumor vessels and tumor stain as well as hepatic-portal fistula of HCC and easily detect the origin、 shape of tumor supplying arteries. As far as tumor supplying vessels MSCTA illustrated the 1~2 grade branches of hepatic arteries much better than 3 grade branches. The sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV) of MSCTA in detecting the tumor supplying arteries were 93.55% ,97.50%, 96. 67%, 90.70%, respectively. Simultaneously, MSCTA also displayed the variation and invasion situation of portal vein system. The sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV) of MSCTA in evaluating portal vein involved by HCC were 98.00%, 93.94%, 96. 09% and 96. 67%, respectively. Conclusion: MSCTA
引文
[1] 汤钊猷，余业勤．原发性肝癌[M]．上海医科大学出版社．1999．86-112．
[2] Rubin GD, Dake MD, Semba CP. Current status of three-demensional spiral CT scanning for the vasculature[J]. Radiographics. 2002, 22(5): 3-19.
[3] Fishman EK. CT angiography: Clinical applications in the abdomn[J]. Radiographic. 2001, 21(5): 3-16.
[4] 田建明，王飞，叶华，等．肝癌的规则性、变异性供血及其临床意义[J]．中华放射学杂志．1994，28(2)：93-96．
[5] 郭俊渊．现代腹部影像诊断学[M]．北京：科学出版社．2001：547-614．
[6] Miles KA, Leggett DA, Kelley BB, et al. In vivo assessment of neovascularization of liver metastases using perfusion CT[J]. Br J Radiol. 1998, 71: 276-281.
[7] Sahani D, Saini S, Pena C, et al. Using multidetector CT for preperative vascular evaluation of liver neoplasma: technique and results[J]. AJR. 2002, 179(1): 53-59.
[8] Honda H, Tajima T, Taguchi K, et al. Recent developments in imaging diagnosis for HCC: CT arteriography and CT arterioportography evaluation of vascular change in premalignant and malignant hepatic nodules[J]. Hepatobiliary Pancreat Surg. 2000, 7(3): 245-251.
[9] 林贵．肝肿瘤的微血管结构和肿瘤[J]中华放射学杂志．1985，19(5)：257-260．
[10] 陈卫霞，闵鹏秋，宋彬，等．肝细胞性肝癌螺旋CT同层动态扫描与肿瘤血管生成的相关性[J]．中华放射学杂志，2001，35(3)247-252．[1] 汤钊猷，余业勤．原发性肝癌[M]．上海：上海医科大学出版社．1999．86-112．
[2] Rubin GD, Dake MD, Semba CP. Current status of three-demensional spiral CT scanning for the vasculature[J]. Radiographics. 2002: 22(5): 3-19.
[3] 燕霞．肝癌的血管生成与螺旋CT和动态MRI的强化[J]．医学影像学杂志．2005．15(1)：56-58．
[4] 程红岩，徐爱民，陈栋，等．多层螺旋CT薄层增强3期扫描在诊断小肝癌中的作用[J]．中华放射学杂志，2002．36(11)．
[5] 周康荣．螺旋CT[M]．上海医科大学出版社．1998：126-127．
[6] 林亿兵，吴泽新，文明，等．螺旋CT双期扫描对伴肝硬化的小肝癌的诊断价值[J]．中华放射学杂志．1999，33：255-257．
[7] 严福华，曾蒙苏，周康荣．螺旋CT双期动态扫描在小肝癌诊断中的价值[J]．中华放射学杂志．1996，30：829 832．
[8] 赵虹，周康荣，严福华，等．小肝癌多排螺旋计算机X线体层扫描多期扫描价值的探讨[J]．中华肝脏病杂志．2003，11：530 532．
[9] Lim JH, Kim CK, Lee WJ, et al. Detection of hepatocellar carcinomas and dysplastic nodles in cirrhotic livers: accuracy of helical CT in transplant patients[J]. AJR. 2000, 175: 693-698.
[10] Jang HL, Lim Jh, Lee SJ, et al. hapatocellar carcinoma: are combined CTduring arterial portography and CT hepatic arteriography in addition to triple-phase helical CT all necessary for preoperative evaluation? [J] Radiology. 2000, 215: 373-380.
[11] Hwang GJ, Kim MJ, Yoo HS, et al. Nodular cellarcarcinomas: detection with arterial-, portal-, and delayed-phase images at spiral CT[J]. Radiology. 1997, 202: 383.[12] Loyer EM, Chin H, Dubrow RA, et al. Hepatocellular carcinoma and intrahepatic peripheral cholangicarcinoma: enhancement patterns with quadruple phase helical CT: a comparative study[J]. Radiology. 1999, 212: 866-875.
[13] Kim T, Federle MP, Baron RL, et al. Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller 3cm weth three-phase helical CT[J]. Radiology. 2001, 219: 699-706.
[14] Horigome H, Nomura T, Saso K, et al. Diagnosis of small hepatocellular Carcinoma: imaging diagnosis and significance of tumor biopsy[J]. Hepatogastroenterology. 2000, 47: 1659: 1662.
[15] 黄娟，周祥平，刘荣波，等．原发性肝癌血供特点的螺旋CT表现及其与病理学特征的相关性研究[J]．中华放射学杂志．2000，11：753-765．
[16] 朱月莉，王滨，史英红．肝细胞癌肿瘤血管生成与螺旋CT增强特征探讨[J]．临床放射学杂志．2004，23：57-61．
[17] 郭晓娟，郭佑民，陈敏，等．螺旋CT不同动态增强扫描方式对小肝癌诊断价值的比较[J]．第四军医大学学报．2005，25(4)：355-359
[18] Kim SK, Lim JH, Lee WJ, et al. Detection of hepatocellular carcinoma: Comparison of dynamic three phase computed tomography images and four phase computed tomography images using multidetector row helical-computed-tomography[J]. J Comput Assist Tomogr. 2002; 26(5): 691-698.
[19] Kopp AF, Heuschmid M, Claussen CD. Multi-detector helical CT of the liver for tumor detection and characterization[J]. Eur. Radiol. 2002, 12: 745.
[20] Wong K, Paulson EK, Nelson RC. Breath-hold three-dimensional CT of the liver with multi-detector row helical CT[J].??Radiology．2001．219：75．
[21] 曹永胜，顾缙，周康荣等．螺旋CT血管造影及三维重建的临床应用[J]．中华放射学杂志．1997，31(2)：96-99．
[22] Uchida M, Ishibashi M, Abe T, et al. Three-dimentional imaging of liver tumors using helical CT during intravenous injection of contrast medium[J]. J Compute Assist Tomogr, 1999,23:435.
[23] Fishman EK. CT angiography: Clinical applications in the abdomen[J]. Radiographics.2000,21:3.
[24] Byun JH, Kim TK, Lee SS, et al. Evaluation of the hepatic artery in potential donors for living donor liver transplantation by computed tomography angiography using multidetector-row computed tomography: comparison of volume rendering and maximum intensity projection techniques[J]. J Comput Assist Tomogr. 2003.27(2): 125-131.
[25] 李小兵，田建明，王培军，等．多层CT胰腺双期血管成像研究[J]．中国医学影像技术．2002，18(5)：428-430．
[26] Kuszyk BS, Fishman EK, Technical aspects of CT angiography [J]. Semin Ultrasound CT MR. 1998,19(5):383-393.
[27] Prokop M. Multislice CT angiography[J]. European Journal of Radiology.2000,36: 86.
[28] 田建明，王飞，叶华，等．肝癌的规则性、变异性供血及其临床意义[J]．中华放射学杂志．1994，28(2)：93-96．
[29] Sahani D, Saini S, Pena C, et al. Using multidetector CT for preperative vascular evaluation of liver neoplasma:technique and results[J].A JR.2002,179(1): 53-59.
[30] Murakami T, Kim T, Takamura M, et al. Hypervascular hepatocellular carcinoma:detection with double arterial phase multi-detector row helical CT[J].Radiology.2001,218(3): 73-767.
[31] 谭理连，李杨彬，李树欣，等．螺旋CT肝动脉期及三维重建对原发性肝癌供血血管及血供情况的评价[J]．中国医学影像技??术．2002，18(2)：157-159．
[32] Takahashi S, Murakami T, Takamura M, et al. Multi-detector row helical CT angiograph of hepatic vessels: depiction weth dual-arterial phase acquisition during single breath hold[J]. Radiology. 2002,222(1):81-88.
[33] 唐秉航，李良才，何亚奇，等．中晚期肝癌动脉早期MSCT血管造影[J]．放射学实践．2004，19(3)：194-198．
[34] 张龙江，马宁，宋光义，等．原发性肝细胞癌多层螺旋CT血管造影表现及其临床应用价值[J]．中国医学影像技术．2004，20(7)1084-1087．
[35] 谭理连，李杨彬，梁彤杰，等．螺旋CT肝动脉期原发性巨块型肝癌增强血管形态分析[J]．中国医学影像技术，2001，9(3)：193-198．
[36] 于频．系统解剖学[M]．第4版．北京：人民卫生出版社．1997：129．
[37] 郭俊渊．现代腹部影像诊断学[M]．北京：科学出版社，2001，547-614．
[38] Veda K, Matsui O, Kawamori Y, et al. Hypervascular Hepatocellular carcinoma: Evaluation of Hemodynamics with Dynamic CT during hepatic arteiriography[J]. Radiology. 1998,206(1): 161-166.
[39] Toyosaka, Okamato E,Mitsunobu M, et al. Intrahepatic Metastases in Hepaticellular Carcinoma:Evidence for Spread Via the portal vein as an efferent vessel[J]. Amj Gastroenterol. 1996,91 (8): 1610-1615.
[40] 张红丽，郭启勇，廖伟，等．对比分析多层CT门静脉三维成像技术与DSA评价肝细胞癌合并门静脉受累情况[J]．肝胆外科杂志．2003，11(2)：51-53．
[41] 王东，张挽时，熊明辉．螺旋CT门静脉血管造影的临床应用价值[J]．中国医学影像学杂志．2002，10：276 278．
[42] 王东，张挽时，熊明辉，等．门静脉癌栓CT及CT门静脉造影的诊??断价值[J]．放射学实践．2003，17(4)：345 347．
[43] 陈卫霞，宋彬，闵鹏秋，等．肝细胞癌门静脉癌栓致肝脏灌注异常CT表现[J]．临床放射学杂志．2001，20(7)：510 513．
[44] 齐丽萍，赖声远，张秀丽，等．肝癌伴门静脉癌栓血流动力学变化的CT表现[J]．放射学实践．2005，20(4)：308-311．
[45] 吴东，周康荣，陈祖望，等．螺旋CT门静脉成像诊断门脉受侵的价值[J]．临床放射学杂志．2001，20(12)：920-923．
[46] 肖文莲，罗光华，李丹，等．肝细胞癌合并门静脉癌栓的多层螺旋CT诊断及临床意义[J]．中国介入影像与治疗学．2005，2(3)：193-196．
[47] Takahashi S, Murakami T, Takamura M, et al. Multi-detector row helical CT angiograph of hepatic vessels:depiction weth dual-arterial phase acquisition during single breath hold[J].Radiology. 2002,222(1):81-88.
[48] Ngan H, Peh WCG. Arteriovenous shunting in hepatocellular carcinoma:its prevalence and clinical significance[J].Clinical Radiology. 1997,52(1):36-40.
[49] 朱顺康，单鸿，关守海，等。肝细胞癌合并近端动脉门静脉分流的多层螺旋CT诊断及临床意义[J]．中华放射学杂志．2003，37(5)：408-412．
[50] 徐宏伟，晁明，徐风峰，等．多层螺旋CT肝癌合并动静脉瘘的价值[J]．中国医学影像技术．2003，19(4)：432-434．
[51] Quirga S, Sebastis MC,Moreiras M, et al. Intrahepatic arterioportal shunt:Helical CT findings[J]. Euro radiol. 1999,9:1126-1130.
[52] Winter TC, Freeny PC, Nghiem HV, et al. Hapatic arterial anatomy intransplantation candidates:evaluation with three-dimensional CT arteriography[J]. Radiology. 1995,195:363-370.
[53] Copel L, Sosnal J, Weeks D, et al. Use of three dimensional CT in the abdomen: a useful preoperative planning tool[J]. Surg Technol Int. 2003,11:71-78.[54] Erbay N, Ra[tppoulos V, Pomfret EA, et al. Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients[J].Amj Roentgenol. 2003,181 (1): 109-114.
[55] Geng YF, Chen CL, Jawan B, et al. Multi-slice computed tomography angiography in pediatric liver transplantation[J]. Radiology. 2003,76(2): 353-357.
[56] Iroshige S, Shimada M, Harada N, et al. Accurate preoperative estimation of liver graft volume try to using three dimensional computed tomography[J]. Transplantation.2003, 75 (9): 1561-1564.
[57] 于静红．螺旋CT血管成像[J]．实用放射学杂志．1999，15：431-432．
[58] 王爽．多层螺旋CT在肝脏肿瘤诊断中的应用[J]．临床放射学杂志．2003，3：248-250．
[59] 李智岗，赵俊京，时高峰，等．多层螺旋CT在肝癌介入治疗中的价值[J]．中国介入影像与治疗学．2005，2(2)：93-96．
[60] 郑金龙，孔建，冯敢生，等．肝癌介入治疗的影像评估价值[J]，介入放射学．2000，19(2)：110-113．
[61] 曹永胜，顾缙，周康荣等．螺旋CT血管造影及三维重建的临床应用[J]．中华放射学杂志．1997，31(2)：96-99．
[62] Foley W D, Mallisee TA, Hohenwalter MD, et al. Multiphase hepatic CT with a multi-row detector CT scanner [J]. AJR. 2000,175:679.