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目的 探讨肝细胞癌螺旋CT增强表现及其随时间延迟所致的CT征象的变化过程。材料与方法 41例肝细胞癌患者 ,其中 13例经手术病理标本证实 ,其余患者由临床表现和实验室检查诊断。采用SiemensSomatomPlus 4A螺旋CT设备 ,先作平扫 ,然后在肿瘤靶平面进行动脉期同层面动态扫描 (延迟 14～ 2 1s)、全肝门静脉期扫描 (延迟 80～ 85s)及病变靶平面平衡期扫描 (延迟 170～ 2 85s)。着重观察、分析不同CT扫描时相肝细胞癌CT表现特征的动态变化过程及其病理学基础。结果 在CT扫描时间窗优化条件下 ,肝细胞癌可显示以下CT表现特征 :肿瘤供血血管及瘤区异常血管增强 (35 /41,85 .37% ,包括供血血管增多、僵直 ,瘤区异常血管、动静脉瘘等 ) ;大血管癌栓 (2 2 /41,5 3 .6 6 % ) ;肿瘤实质强化 (4 1/41,10 0 % ) ;肿瘤与肝实质界面改变 (境界清楚 2 6 /41,6 3 .40 % ;境界不清 15 /41,36 .6 0 % ) ;肿瘤相关肝段改变 (17/41,41.46 % )等。肿瘤供血动脉及瘤内血管显示最早、最佳及消退时间分别为18.37s、31.5 2s、5 2 .2 5s。肿瘤实质和包膜强化在不同时相也有一定规律。结论 不同CT征象随时间延迟有一定的演变过程 ,可反映该时间段肿瘤血流动力学特点和相关病理变化
Objective To investigate the enhancement of spiral CT in hepatocellular carcinoma and the changes of CT signs due to the time delay. Materials and Methods Among the 41 patients with hepatocellular carcinoma, 13 were confirmed by pathological specimens, and the remaining patients were diagnosed by clinical manifestations and laboratory examinations. Using SiemensSomatomPlus 4A Spiral CT equipment, firstly perform plain scan, then carry out arterial phase isolayer dynamic scan (14-2 1s delay), whole portal vein phase scan (delay 80-85s) and target plane balance phase scan in tumor target plane. (delay 170 ~ 2 85s). Observe and analyze the dynamic changes of CT features of hepatocellular carcinoma in different CT scans and their pathological basis. Results Under CT scanning time window optimization, hepatocellular carcinoma can show the following CT features: Abnormal blood vessels in tumor blood vessels and tumor areas (35/41, 85.37%), including increased blood supply, vascular rigidity, and abnormal blood vessels in the tumor area. , arteriovenous fistula, etc.); large vascular tumor emboli (2 2 /41, 5 3. 6 6 %); tumor parenchymal enhancement (4 1/4 1, 10%); tumor and liver parenchymal interface changes (demarcation clearly 2 6 /41,6 3. 40%; unclear borders 15/41, 36.60%;) tumor-related liver changes (17/41, 41.46%) and so on. The earliest, best, and extinction time of tumor blood supply artery and intratumoral blood vessels were 18.37s, 31.5 2s, and 52.25s, respectively. Tumor parenchyma and envelope enhancement also have certain rules at different phases. Conclusion There is a certain evolution of different CT signs with time delay, which can reflect the characteristics of tumor hemodynamics and related pathological changes during this time period.