多期 MDCT 下肝血管瘤的增强表现：我们能否通过与血池的增强比较来诊断肝血管瘤？

Contrast enhancement of hepatic hemangiomas on multiphase MDCT: Can we diagnose hepatic hemangiomas by comparing enhancement with blood pool?

机构信息

Department of Radiology, The University of Chicago, IL 60637, USA.

出版信息

AJR Am J Roentgenol. 2010 Aug;195(2):381-6. doi: 10.2214/AJR.09.3324.

DOI:10.2214/AJR.09.3324

PMID:20651193

Abstract

OBJECTIVE

The purpose of this article is to determine whether enhancement of nodular foci within hemangiomas is homogeneous and matches blood vessels at different phases on contrast-enhanced MDCT.

MATERIALS AND METHODS

Multiphase (unenhanced, arterial, portal venous, and delayed phases) MDCT images of 58 hemangiomas were reviewed by two radiologists. Nodular-enhancing foci within hemangiomas were evaluated for enhancement pattern and were subjectively compared with enhancement of the aorta, inferior vena cava, hepatic vein, and portal vein for each contrast-enhanced phase. Both readers measured CT attenuation of enhancing nodules and vessels at each phase, and enhancement of nodules and vessels was compared.

RESULTS

Qualitative analysis showed heterogeneously enhancing nodules in 79.3% and 65.5% of hemangiomas in the arterial phase and in 74.1% and 53.4% of hemangiomas in the portal venous phase, according to readers 1 and 2, respectively. In the arterial phase, 3.8% and 12.3% of nodules showed enhancement similar to that in the aorta. In the portal venous phase, 15.4% and 21.7%, 16.8% and 18.2%, 14.1% and 23.8%, and 19.5% and 25.9% of nodules were scored with enhancement similar to that in the aorta, inferior vena cava, hepatic vein, and portal vein by readers 1 and 2, respectively. Differences between attenuation of nodules and all vessels in the arterial, portal venous, and delayed phases were statistically significant. Statistically significant differences were also noted between attenuation among blood vessels in the arterial and portal venous phases but not in the delayed phase.

CONCLUSION

Attenuation of enhancing foci within hemangiomas does not match vessel density qualitatively or quantitatively. No common blood pool density exists in the arterial or portal venous phase. Although persistent enhancement without washout is a useful CT criterion, specific criteria to match the blood pool cannot be used to confirm a diagnosis of hemangioma.

摘要

目的

本文旨在确定肝血管瘤内结节性强化灶在不同时相的 MDCT 多期增强扫描中的强化方式是否均匀，是否与血管强化方式一致。

材料与方法

对 58 例肝血管瘤患者的多期（平扫、动脉期、门静脉期及延迟期） MDCT 图像进行回顾性分析。由两位放射科医生评估肝血管瘤内结节性强化灶的强化方式，并对各期增强扫描中肝血管瘤结节强化方式与主动脉、下腔静脉、肝静脉及门静脉强化方式进行主观对比。两位观察者分别测量各期增强结节及血管的 CT 值，并对两者的强化程度进行对比。

结果

定性分析结果显示，在动脉期，两位观察者分别有 79.3%和 65.5%的肝血管瘤内结节呈不均匀强化，在门静脉期，分别有 74.1%和 53.4%的肝血管瘤内结节呈不均匀强化。在动脉期，3.8%和 12.3%的结节强化程度与主动脉相似。在门静脉期，分别有 15.4%和 21.7%、16.8%和 18.2%、14.1%和 23.8%、19.5%和 25.9%的结节强化程度与主动脉、下腔静脉、肝静脉及门静脉相似。肝血管瘤结节在动脉期、门静脉期及延迟期的 CT 值与各血管 CT 值差异均有统计学意义（P＜0.05）。动脉期与门静脉期各血管之间的 CT 值差异亦有统计学意义（P＜0.05），但延迟期各血管之间的 CT 值差异无统计学意义（P＞0.05）。