Hünerbein R, Reuter P, Skutta B, Kuhn F P
Institut für Diagnostische und Interventionelle Radiologie, Städtische Kliniken Kassel.
Aktuelle Radiol. 1998 Jul;8(4):176-82.
To assess the value of noncontrast, arterial and portal venous phase of triphasic helical CT in detecting and characterising focal liver lesions.
120 patients with focal liver disease underwent triphasic helical CT examinations with a collimation of 6.5 mm at a table feed of 6.5 mm/s. The liver scans were obtained before the administration of 120 ml of non-ionic contrast material (flow 2 or 3 ml/s), at the arterial phase, and at the portal venous phase (20 s, respectively 60 s after injection). Patients were divided into four groups according to the underlying disease and enhancement pattern. The studies were evaluated retrospectively.
A total of 269 lesions was seen. The noncontrast phase (NCP) revealed 86% of lesions, the arterial phase (AP) 95% and the portal venous phase (PVP) 91%. In the first group of hypovascular lesions (colorectal carcinoma) all lesions (73/73) were detected in the PVP. In the second group of hypervascular lesions (breast cancer, melanoma) the combination of AP and PVP revealed 73 of 74 lesions. In the third group of patients with unknown primary and detected lesions by sonography all 89 lesions were detected with the combination of AP and PVP. In the fourth group of patients with cirrhosis 3 of 33 lesions were detected exclusively during the AP and 3 other lesions exclusively during the NCP. To make a definitive diagnosis of focal liver lesions the value of the three phases was as follows: to characterise lesions the PVP was sufficient in 62%, the combination of PVP and AP in 27%, and the combination of all three phases in 11%.
If hypovascular lesions are suspected examination during PVP is sufficient. In cases of hypervascular lesions and lesions of unknown primary AP and PVP should be combined. Unenhanced scans are of additional diagnostic value only in patients with liver cirrhosis.
评估螺旋CT三期扫描（平扫、动脉期、门静脉期）对肝脏局灶性病变的检测及定性价值。
120例肝脏局灶性病变患者接受螺旋CT三期扫描，扫描准直6.5mm，床速6.5mm/s。扫描在静脉注射120ml非离子型对比剂（流率2或3ml/s）前、动脉期（注射后20s）及门静脉期（注射后60s）进行。根据基础疾病及强化方式将患者分为四组，对研究进行回顾性分析。
共发现269个病灶。平扫期（NCP）显示86%的病灶，动脉期（AP）显示95%，门静脉期（PVP）显示91%。第一组乏血供病变（结直肠癌）所有病灶（73/73）均在门静脉期显示。第二组富血供病变（乳腺癌、黑色素瘤），动脉期与门静脉期联合显示74个病灶中的73个。第三组原发灶不明但超声发现病灶的患者，动脉期与门静脉期联合显示所有89个病灶。第四组肝硬化患者，33个病灶中3个仅在动脉期显示，3个仅在平扫期显示。对于肝脏局灶性病变的确诊，三期扫描的价值如下：仅门静脉期足以定性病灶的占62%，门静脉期与动脉期联合的占27%，三期联合的占11%。
怀疑乏血供病变时，门静脉期检查即可。怀疑富血供病变及原发灶不明的病变时，应联合动脉期与门静脉期扫描。平扫扫描仅对肝硬化患者有额外诊断价值。
