Loyer E M, Chin H, DuBrow R A, David C L, Eftekhari F, Charnsangavej C
Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Radiology. 1999 Sep;212(3):866-75. doi: 10.1148/radiology.212.3.r99se32866.
To define the hemodynamic features of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma by using quadruple phase helical computed tomography (CT) and determine the value of this information in characterizing tumors.
Helical CT of the liver was performed in 45 patients with newly diagnosed HCC or peripheral cholangiocarcinoma. Scans were obtained before and 25 seconds, 70 seconds, and 2-6 minutes after the start of the contrast material injection. The intensity and spatial distribution of contrast material uptake were evaluated during all phases. Time-attenuation curves were established for each lesion. Relative attenuation and lesion conspicuity were assessed. A diagnostic confidence level was assigned to each lesion.
In the majority of HCC lesions, a single, early peak of enhancement followed by a continuous decrease in tumor attenuation over time was seen. The greatest tumor conspicuity occurred during the delayed phase. In cholangiocarcinoma, tumor attenuation increased during the delayed phase. In the majority of lesions, the greatest tumor conspicuity was seen during the portal venous phase. In both tumor types, the diagnostic confidence level improved when the delayed phase was used.
The variation over time in the intensity of contrast enhancement in HCC and cholangiocarcinoma differs sufficiently to make this a useful diagnostic criterion. The delayed phase is particularly important because it amplifies this difference.
通过使用四期螺旋计算机断层扫描（CT）来确定肝细胞癌（HCC）和肝内胆管癌的血流动力学特征，并确定该信息在肿瘤特征描述中的价值。
对45例新诊断为HCC或周围胆管癌的患者进行肝脏螺旋CT检查。在开始注射造影剂前以及注射后25秒、70秒和2 - 6分钟进行扫描。在所有阶段评估造影剂摄取的强度和空间分布。为每个病变建立时间 - 衰减曲线。评估相对衰减和病变清晰度。为每个病变指定诊断置信度水平。
在大多数HCC病变中，可见单个早期强化峰值，随后肿瘤衰减随时间持续下降。最大的肿瘤清晰度出现在延迟期。在胆管癌中，肿瘤衰减在延迟期增加。在大多数病变中，最大的肿瘤清晰度出现在门静脉期。在两种肿瘤类型中，使用延迟期时诊断置信度水平均有所提高。
HCC和胆管癌中造影剂强化强度随时间的变化差异足够大，使其成为一个有用的诊断标准。延迟期尤为重要，因为它放大了这种差异。
