Choi B I, Han J K, Cho J M, Choi D S, Han M C, Lee H S, Kim C Y
Department of Radiology, Seoul National University College of Medicine, Korea.
Cancer. 1995 Dec 15;76(12):2434-42. doi: 10.1002/1097-0142(19951215)76:12<2434::aid-cncr2820761206>3.0.co;2-g.
Spiral computed tomography (CT) allows imaging of the liver during the peak contrast material levels due to the capability of fast data acquisition. The objective of this study was to evaluate the usefulness of two-phase spiral CT in the differential diagnosis of focal hepatic tumors.
One hundred two patients who had hepatic tumors (211 nodules; 149 hepatocellular carcinomas [HCCs], 36 metastases, and 26 hemangiomas) underwent two-phase spiral CT with 10-mm collimation at 10 mm/second table speed and 120 mL of contrast material injected at the rate of 3 mL/second. Computed tomography images of the hepatic arterial phase and late (equilibrium) phase were obtained at 35-second and 180-second delays, respectively. The enhancement patterns of tumors were divided into six types and were compared with the attenuation of surrounding liver parenchyma: totally high, peripherally high, centrally high, mixed, iso, and low.
The common enhancement patterns of HCC in two-phase spiral CT were totally high in the arterial phase and low (n = 63, 42%) or iso (n = 28, 19%) in the late phase. Metastasis showed peripherally nonnodular high attenuation (n = 9, 25%) or low attenuation (n = 9, 25%) in the arterial phase and low attenuation in the late phase, followed by totally high attenuation in the arterial phase and iso in the late phase (n = 6, 17%). Hemangiomas showed totally or peripherally nodular enhancement in the arterial and late phases (n = 23, 89%). In distinguishing hemangiomas from malignant tumors, totally high or peripherally nodular high attenuation in the late phase was the most useful contrast enhancement pattern (96% of hemangioma vs. 0% of malignant tumors). In distinguishing HCCs from metastases, a combination of contrast enhancement pattern of totally high attenuation in the arterial phase and low in the late phase was the most useful contrast enhancement pattern (42% of HCCs vs. 0% of metastases). The predictability of differentiation between hemangiomas and malignant tumors and between HCCs and metastases was 99% and 90% with spiral CT, respectively.
Two-phase spiral CT is useful in the differential diagnosis of focal hepatic tumors with evaluation of contrast enhancement patterns.
螺旋计算机断层扫描（CT）由于具备快速数据采集能力，能够在对比剂浓度达到峰值时对肝脏进行成像。本研究的目的是评估双期螺旋CT在肝脏局灶性肿瘤鉴别诊断中的应用价值。
102例患有肝脏肿瘤（211个结节；149例肝细胞癌[HCC]、36例转移瘤和26例血管瘤）的患者接受了双期螺旋CT检查，准直器宽度为10mm，检查床速度为10mm/秒，以3ml/秒的速率注入120ml对比剂。分别在延迟35秒和180秒时获得肝脏动脉期和延迟（平衡）期的CT图像。将肿瘤的强化模式分为六种类型，并与周围肝实质的衰减情况进行比较：全高、周边高、中心高、混合、等密度和低密度。
HCC在双期螺旋CT中的常见强化模式为动脉期全高，延迟期为低密度（n = 63，42%）或等密度（n = 28，19%）。转移瘤在动脉期表现为周边非结节状高衰减（n = 9，25%）或低衰减（n = 9，25%），延迟期为低衰减，其次为动脉期全高，延迟期等密度（n = 6，17%）。血管瘤在动脉期和延迟期表现为全或周边结节状强化（n = 23，89%）。在鉴别血管瘤与恶性肿瘤时，延迟期全高或周边结节状高衰减是最有用的对比增强模式（96%的血管瘤与0%的恶性肿瘤）。在鉴别HCC与转移瘤时，动脉期全高衰减且延迟期低衰减的对比增强模式组合是最有用的对比增强模式（42%的HCC与0%的转移瘤）。螺旋CT对血管瘤与恶性肿瘤以及HCC与转移瘤的鉴别预测准确率分别为99%和90%。
双期螺旋CT通过评估对比增强模式，在肝脏局灶性肿瘤的鉴别诊断中具有重要价值。
