Spiral CT of hepatocarcinoma displays and differential diagnosis _'s symptom

Spiral CT of hepatocarcinoma displays and differential diagnosis _'s symptom
Spiral CT of hepatocarcinoma displays and differential diagnosis

Chinese tumour magazine Vol. 22 of number 2 of 2000 Clinical practice

Author: It is built that Joe's tip horse sets up common tight good fortune China five the beginning

Unit: Qiao Ying (dept. of radiology of the People's Hospital of Taishan of Guangdong Province, 529200) ; Ma LiGong ( Dept. of radiology of affiliated hospital of medical college of Qinghai) ; Yan FuHua ( Subsidiary dept. of radiology of hospital of Zhongshan of medical university of Shanghai) ; Wu JianChu (dept. of radiology of the People's Hospital of Taishan of Guangdong Province, 529200)

Keyword: Liver tumour radiation photography; Spiral CT; Diagnose, distinguish

[Summary]PurposeScan, behave to analyze spiral CT each of 54 cases of liver cellulous hepatocarcinoma, canvass its value in diagnosis of hepatocarcinoma and differential diagnosis.MethodSweep and strengthen and scan while being flat to all the intersection of case and competent the whole liver. 25 s begins a scanning of liver artery after injecting radiography pharmaceutical, 70 s begins a scanning of pulse of door. Observe all focuses and strengthen manifestation in scanning in each.ResultThe liver artery one scans and finds 72 focuses together, 28 focuses among them are shown as and strengthened evenly, 40 strengthen (4 among them and can also see blood supply artery for irregularity) ,4 have not been obviously strengthened. Door the intersection of pulse and issue find 62 focus scan, low density, 8 among them can see the pulse cancer bolt of the door form, 7 focuses can see the membrane of false bag taking shape.ConclusionSpiral CT each strengthens and scans the characteristic that can fully reflect cellulous hepatocarcinoma of the liver, favorable to diagnosis and differential diagnosis.

Spiral CT features of hepatocellular caicinoma

QIAO Ying, YAN Fuhua, WU Jianchu, et al.

( Department of Radiology, Taishan Hospital, Taishan 529200, China)

[Abstract]ObjectiveTo analyze the features of two-phase spiral scanning in 54 cases of hepatocellular carcinoma and to e valuate its usefulness in diagnosis and differential diagnosis.MethodsPrecontrast and postcontrast CT scans of the whole liver in all cases were carried out with GE-Hispee d Advantage spiral CT scanner. The arterial phase scanning was strarted at 25 sec after injection of contrast medium and the portal venous phase scanning at 70 sec.ResultsIn the 54 cases examined, 72 lesions were found in the arterial phase. In 28 of these lesions, it was enhanced homogeneously, while in 40 lesions, the enhancement was not homogeneous. Supplying artery could be seen in 4 of them. The remaining 4 lesions had no enhancement. There were 62 lesiosns with low density in portal venous phase. Portal vein tumor thrombus was seen in 8 cases, and pseudocapsule was observed in 7 lesions.ConclusionTow-phase spiral CT scanning is of value in the diagnosis and differential diagnosis of hepatocellula r carcinoma.

[Subject words]Liver neoplasms/ridiography; Spiral CT; Diagdosis, differential

CT scans and plays an important role in the diagnosis of hepatocarcinoma, especially spiral CT appearing in recent years, it is extremely fast to scan, has overcome a great deal of shortcomings of regular CT, has improved the accuracy that hepatocarcinoma diagnoses[1,2]. Each strengthen, scan, display, go on, analyze dynamically to 54 the intersection of liver and cellulous spiral CT of hepatocarcinoma now, canvass its value in diagnosis of hepatocarcinoma and differential diagnosis.

Material and method

54 cases of hepatocarcinoma patient, 38 men, 16 women, 32-78 years old, 51 average years olds. The operation or living to examine 40 verified, the others are by the clinical materials (first child protein is positive) Combine many kinds of images, learn, check ' Supersound, angiography,etc.) And followed up a case by regular visits to one year the above verifieded.

All cases are checked, scans cycle for one second, scan the condition 120- 140 KV by GE-Hispeed Advantage spiral scanning machine, 230- 250 mA, 512* 512 matrix, pitch is 1, one layer of thick intervals 5 mm or 10 mm. A patient prohibited to eat 4 h before checking, 0.5 h took 2% orally and is suffused with the shadow Portugal amine 800 ml and full of the gastrointestinal tract before scanning. Patient competent the whole liver make and strengthen the scanning sweep, while being flat. The intersection of radiography and for being excellent to link apparent pharmaceutical (the intersection of 300 mg/ml and iodine, first clever Germany) ,Total amount 90 ml, injects the speed 3 ml/s, 25 s begins a scanning of liver artery after injecting radiography pharmaceutical, 70 s begins the whole liver scanning of the door pulse one, scan time 15- 28 s each time, let the patient hold one's breath while scanning.

Result

54 find 72 focuses together, size is 2- 6 cm, average 3.8 cm. Its CT behaves as follows.

1.It is flat to sweep: Find 42 focuses, 34 are low density (Fig. 1, 4) ,Or irregularity that the density is even, the irregularity person can see the necrosis district or fat of lower density changing the sex among them. 2 focuses can see the high density calcification cooking stove, there are 8 focuses besides because with fatty liver and is shown as the high density.

2.Liver artery is a scanning, find 72 focuses, its CT displays multi-type: (1)The focus strengthens the irregularity, the low density district in the centre can not strengthen obviously (Fig. 2) ,There are 40; (2)The focus strengthens and presents high density (Fig. 5, 6) evenly ,There are 28; (3)Can see blood supply artery (Fig. 7) in the centre or perimeter in focus ,There are 4. In addition 4 focuses have not been obviously strengthened, it is still low density (Fig. 8) .

3.Pulse of door is a scanning, find 62 focuses, the low density cooking stove where it is even or uneven, clear at the border (Fig. 3) . In that can see the pulse cancer bolt of the door taking shape, is shown as the pulse backbone of the door or branch increases thickly in 8 examples, whether full of defect or not; 7 focuses can see the membrane of false bag, are shown as the intact or incomplete high density in the perimeter is taken (Fig. 9) .



Fig. 1~3 is the same case. Fig. 1: It is flat to sweep illustrationally showing a low density of right frontal lobe of liver takes the location cooking stove, the moderate yield can be seen in my district of platelet lower density, still can see a calcification shadow (blood fluke due to liver cirrhosis) in the liver essence . Fig. 2: The liver artery one scans the focus perimeter to obviously strengthen, the necrosis area in the centre has not strengthened. Fig. drop at 3 pieces of pulse and a focus density, present the low density picture 4 of irregularity, 5 is the same case. Fig. 4: It is flat to sweep a oval low density cooking stove of leaf in the left of liver, is clear, the density is even at the border. Fig. 5: Artery issues of focus strengthen, present even high the intersection of density and the intersection of picture and 6 little the intersection of HCC and the intersection of artery and issues of the whole tumour strengthen 7 Fig. the visible blood supply artery is developed in the the intersection of liver and the intersection of artery and a focus obviously, lump strengthens the uneven picture 8, 9 is the same case. Fig. 8: A focus of artery has not been obviously strengthened. Fig. 9: Door the intersection of pulse and issue make membrane, strengthen, take the form of ring high density lead.

Discussion

Learn to check the constant development of technology and improve with the image, focal detection and qualitative rate of accuracy to hepatocarcinoma are improving constantly. CT scanning in the past, it is slow to scan, can't finish the scanning in the peak value of the intensification of liver during this period, some focuses are shown as the low density, difficult and other pathological changes are distinguished, and some little focuses are even omitted. Check and bring the qualitative leap to the liver in appearance of spiral CT. Its scanning is extremely fast, hold one's breath once (about 15- 25 seconds) It becomes the whole liver scanning that over. Its greatest advantage can be strengthening different periods scanning and carrying on the scanning in addition, fully utilize double blood of liver to be for the characteristic and cellulous hepatocarcinoma of the liver to mainly fully reflect the focal CT characteristic by the characteristic of the artery blood supply of liver, and focus have two chance of detection, therefore make the intersection of hepatocarcinoma and focal detection rate and determine the nature the accuracy rate of diagnosis is obviously improved[3]. This group of results show, there are 68 that can see, strengthen, behave while scanning in the liver artery one in 72 hepatocarcinoma focuses, this sufficient explanation spiral CT can reflect the blood of hepatocarcinoma supports the characteristic, and 4 focuses can see blood supply artery while scanning, this is different to see in regular CT. In door in the intersection of pulse and issue scan, have 62 focus low density, reflect hepatocyte hepatocarcinoma soon stock the characteristic that produce soon too. So each scans can reflect the blood of hepatocarcinoma supports the characteristic, helps to diagnose.

According to the literature, it only had 37% of the focuses that can see in the liver artery during this period and strengthen behaving that regular CT scanned dynamically in the past[4]. However, focuses of the intensification are not all cellulous hepatocarcinoma of liver during this period in the liver artery, need to further distinguish: (1)Hemangioma: Model of hemangioma show as, strengthen, scan focus, begin, take the form of the intersection of tubercle and form, strengthen from perimeter in early days, expand to the centre until totally packing gradually[5]. Have some angiomatous wall thin focus too, it in charge ofs to be old, artery issue scan, see, strengthen, present high density evenly obviously right away, its value keeps time relatively long, it is generally about 1- 4 minutes, therefore is still high density in the door pulse one, so as to distinguish with hepatocarcinoma. (2)Cooking stove hyperplasia of tubercle or adenoma of the office: Rare benign pathological change, easy to take place on young women. Two CT of pathological change these display same, difficult difference, can also obviously strengthen and present high density while scanning in the liver artery one, and its focus is strengthened even and unanimously ' Except that the scar is organized) ; Scan generally still door pulse issue is to be slightly density high or,etc. density,know border, the diagnosis substantially as having the centre scar to support office cooking stove tubercle to be outgrowth, the diagnosis substantially as seeing the membrane of bag or focus centre and bleeding to support adenoma. (3)Transformation tumour that the rich blood supports: For instance sarcoma, one kind of cancers, endocrine tumour, melanin tumour, gastrointestinal mucus gland cancer,etc. were supported for the rich blood too while transferring to the liver, the liver artery one can also be obviously strengthened while scanning, need to distinguish with cellulous hepatocarcinoma of the liver. On condition that define and send the medical history of tumour originally, it is easy to diagnose; On condition that send tumour with indeterminate position originally, differential diagnosis has certain difficulty. Generally speaking, shifting tumours are mostly the cooking stove of the frequently-occurring disease, can spread all over the whole liver; In addition, can see and strengthen behaving when pulse one scan on the door in the transformation cooking stove where most rich blood supports, it strengthens duration is longer than cellulous hepatocarcinoma of the liver, but what different from hemangioma is and does not totally fill with all the time, it is annular to be shown as more and strengthen, so all right this is distinguished.

In sum, spiral CT each can fully reflect to strengthen and scan the blood of hepatocarcinoma supports the characteristic, especially liver artery one scans here. Slip-ring and conventional dynamic hepatic CT, contrast material and timing considerations. Radiology, 1995, 195: 1-8.

[3]Zhou KangRong, edit. Spiral CT. 1st. Shanghai: The publishing house of medical university of Shanghai, 1998.104.

[4]Zhou KangRong, edit. Belly CT. 11th. Shanghai: The publishing house of medical university of Shanghai, 1993.39.

[5]reeny PC, Marks WM. Hepatic hemangioma: dynamic bolus CT. Am J Radiol, 1986, 147: 711-719.

Accept draft date: 1999-05-11
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