Miller F H, Butler R S, Hoff F L, Fitzgerald S W, Nemcek A A, Gore R M
Department of Radiology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, IL 60611, USA.
AJR Am J Roentgenol. 1998 Sep;171(3):643-9. doi: 10.2214/ajr.171.3.9725290.
Our purpose was to determine the value of triphasic helical CT (unenhanced, hepatic arterial, and portal venous phases) in the detection and characterization of focal hepatic lesions due to hepatomas or metastases.
One hundred two patients with known or suspected hepatomas or liver metastases underwent triphasic CT. The number and conspicuity of lesions were evaluated on each phase.
Five hundred eighty-four lesions were detected in 102 patients. Patients with hypovascular malignancies had more lesions detected on the portal venous phase with increased conspicuity than on the other phases. Patients with hypervascular malignancies had lesions best detected on the hepatic arterial phase, which revealed small lesions that were not seen on the other phases in seven (21%) of the 33 patients with hypervascular metastases and hepatomas. No lesions were detected on the unenhanced phase that were not seen on the other phases. However, arterial phase images introduced new diagnostic dilemmas because not all lesions seen on the arterial phase alone were caused by hepatomas or metastases, even in patients with known malignancies; several lesions represented benign abnormalities that included focal nodular hyperplasia.
The unenhanced phase is not routinely necessary for the detection of metastases or hepatomas. Hypovascular malignancies are best evaluated during the portal venous phase. Small lesions due to hypervascular metastases and hepatomas are best evaluated and may be detected only during the hepatic arterial phase, which should be used routinely in these patients. New dilemmas may develop from the increased sensitivity of the hepatic arterial phase for lesions. However, the hepatic arterial phase is of limited value with hypovascular malignancies.
我们的目的是确定三相螺旋CT（平扫、肝动脉期和门静脉期）在检测和鉴别肝癌或转移瘤所致肝脏局灶性病变中的价值。
102例已知或疑似肝癌或肝转移瘤的患者接受了三相CT检查。评估每个期相病变的数量和清晰度。
102例患者共检测到584个病变。乏血供恶性肿瘤患者在门静脉期检测到的病变更多，且清晰度高于其他期相。富血供恶性肿瘤患者的病变在肝动脉期显示最佳，在33例富血供转移瘤和肝癌患者中，有7例（21%）在肝动脉期发现了其他期相未显示的小病变。平扫期未检测到其他期相未显示的病变。然而，动脉期图像带来了新的诊断难题，因为即使在已知恶性肿瘤的患者中，并非所有仅在动脉期可见的病变都是由肝癌或转移瘤引起的；一些病变代表良性异常，包括局灶性结节性增生。
对于检测转移瘤或肝癌，平扫期并非常规必需。乏血供恶性肿瘤在门静脉期评估最佳。富血供转移瘤和肝癌所致的小病变在肝动脉期评估最佳，且可能仅在肝动脉期才能检测到，这些患者应常规使用肝动脉期。肝动脉期对病变的敏感性增加可能会带来新的难题。然而，肝动脉期对乏血供恶性肿瘤的价值有限。
