Ferrucci J T
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Keio J Med. 1991 Dec;40(4):194-205. doi: 10.2302/kjm.40.194.
With the increasing availability of curative surgical techniques for primary and secondary hepatic neoplasms, the tasks for clinical imaging of liver cancer suspects have become more exacting. Detection of tumor, differential diagnosis of individual nodules, and mapping the anatomic extensions of malignant disease are now routinely required. Related and unrelated liver substrate abnormalities such as cavernous hemangioma and focal fatty deposits are often discovered in liver cancer suspects and must be differentiated from metastatic deposits. Moreover, modern imaging methods frequently display tiny subcentimeter nodules which often prove difficult to adequately characterize (micrometastases vs other). The most sensitive imaging techniques are CT after arterial portography and intraoperative ultrasound, but because of their invasiveness, these are reserved exclusively for staging. For primary screening MR imaging is increasingly preferred over CT because of its superiority in discriminating hemangiomas and cysts from metastases without the need for iodinated contrast material.
随着用于原发性和继发性肝脏肿瘤的根治性外科手术技术越来越普及，对疑似肝癌患者进行临床成像的任务变得更加严格。现在常规需要检测肿瘤、对单个结节进行鉴别诊断以及描绘恶性疾病的解剖学扩展范围。在疑似肝癌患者中经常会发现诸如海绵状血管瘤和局灶性脂肪沉积等相关和不相关的肝脏基质异常，并且必须将其与转移性沉积物区分开来。此外，现代成像方法经常显示出小于1厘米的微小结节，这些结节往往难以充分定性（微转移瘤与其他情况）。最敏感的成像技术是动脉门静脉造影后的CT和术中超声，但由于它们具有侵入性，仅用于分期。对于初次筛查，由于磁共振成像（MR成像）在无需使用碘化造影剂的情况下就能将血管瘤和囊肿与转移瘤区分开来，其优越性日益凸显，越来越多地被优先选用，而非CT。
