Young N, Sing T, Wong K P, Hollands M, Tait N
Department of Radiology, Westmead Hospital, New South Wales, Australia.
J Gastroenterol Hepatol. 1997 May;12(5):385-91. doi: 10.1111/j.1440-1746.1997.tb00448.x.
The present study assesses the usefulness of computed tomography (CT) arterial portography (CTAP) in detecting and defining the number and anatomy of potentially malignant liver lesions. One hundred and one adults studied in 1993 and 1994 were retrospectively reviewed, including patients with primary or secondary tumours for possible resection and patients with non-hepatic malignancies in whom the detection of liver metastases would preclude surgery. Twenty-three patients underwent non-spiral CT studies and 78 had studies on a spiral unit, with 22 of these having single phase and 56 having dual phase studies to overcome artefact problems. The relationship between lesion size and detection sensitivity is critical. On non-spiral studies, the overall lesion detection sensitivity and positive predictive value was 69 and 90%, respectively. Detection sensitivity was 100 and 20% for lesions > 1 cm and < 1 cm, respectively. On single phase spiral CTAP the overall detection sensitivity and positive predictive value was 80 and 66%, respectively. Detection sensitivity for lesions > 1 cm and < 1 cm was 100 and 0%, respectively. On dual phase spiral CTAP the overall detection sensitivity and positive predictive value was 76 and 71%, respectively. For lesions > 1 cm and < 1 cm the sensitivity was 81 and 55%, respectively. Eighteen patients with non-hepatic malignancies with unsuspected metastatic spread did not proceed to major surgery because of liver metastases detected on CTAP. Perfusion artefacts occurred in 30 and 64% of non-spiral and of initial portal venous spiral CTAP studies, respectively. By using the double-phase technique, these artefacts were substantially diminished. In conclusion, CTAP is a valuable tool for assessing the presence, site and size of possible liver tumours and confers a benefit even when previous ultrasound and conventional CT have already been used. In addition, CTAP has a lower limit of useful resolution of approximately 1 cm. Perfusion artefacts can be reduced by a dual phase protocol.
本研究评估了计算机断层扫描（CT）动脉门静脉造影（CTAP）在检测和确定潜在恶性肝病变的数量及解剖结构方面的实用性。回顾性分析了1993年和1994年研究的101例成年人，包括可能接受手术切除的原发性或继发性肿瘤患者以及肝脏转移瘤的检测会排除手术的非肝脏恶性肿瘤患者。23例患者接受了非螺旋CT检查，78例进行了螺旋CT检查，其中22例进行单相检查，56例进行双相检查以克服伪影问题。病变大小与检测灵敏度之间的关系至关重要。在非螺旋检查中，总体病变检测灵敏度和阳性预测值分别为69%和90%。对于大于1 cm和小于1 cm的病变，检测灵敏度分别为100%和20%。在单相螺旋CTAP上，总体检测灵敏度和阳性预测值分别为80%和66%。对于大于1 cm和小于1 cm的病变，检测灵敏度分别为100%和0%。在双相螺旋CTAP上，总体检测灵敏度和阳性预测值分别为76%和71%。对于大于1 cm和小于1 cm的病变，灵敏度分别为81%和55%。18例非肝脏恶性肿瘤且未怀疑有转移扩散的患者因CTAP检测到肝脏转移而未进行大手术。非螺旋CTAP和门静脉期初始螺旋CTAP检查分别有30%和64%出现灌注伪影。通过使用双相技术，这些伪影明显减少。总之，CTAP是评估可能存在的肝脏肿瘤的位置和大小的有价值工具，即使之前已经使用过超声和传统CT，它也能带来益处。此外，CTAP的有效分辨率下限约为1 cm。双相方案可减少灌注伪影。
