Gualdi G F, Casciani E, D'Agostino A, Polettini E
Servizio TC-RM, I Clinica Medica, Università La Sapienza, Roma.
Radiol Med. 1998 Oct;96(4):344-52.
The purpose of this study was to investigate if Triphasic Spiral CT (arterial, portal and equilibrium phases) can improve the characterization of noncystic focal lesions.
Sixty-six patients with suspected focal liver disease underwent Triphasic Spiral CT. After the injection of 120-140 ml contrast material at 3 ml/s the liver was imaged in the arterial (scanning delay: 20-27 s), portal (scanning delay: 45-80 s) and equilibrium (scanning delay: 5-8 min) phases. The enhancement of each lesion was evaluated in each phase and the lesions were grouped by enhancement pattern (11 patterns in all). The reference standards in our 66 patients were surgery (12), biopsy (43), MRI (9), follow-up (9), somatostatin receptor scintigraphy (6).
One hundred and twenty-six liver lesions were detected in 66 patients, four of 11 enhancement patterns (hypo/hyper/hyper, hyper/iso/iso, hyper/hyper/iso, hyper/hyper/hyper) were always referrable to benign disease (hemangioma, focal nodular hyperplasia-FNH-adenoma). Four of 11 enhancement patterns (iso/hypo/hypo, iso/iso/hypo, hyper/hypo/hypo, hyper/hyper/hypo) were always referrable to malignant disease (hepatocellular carcinoma-HCC-metastases). The other two patterns (hypo/hypo/hypo, hypo/hypo/hyper) were seen in both benign and malignant diseases.
Triphasic Spiral CT improves the characterization of HCC, FNH, adenoma and hemangioma. The arterial and the equilibrium phases add no information to the yield of the portal venous phase in metastases, except for those from pancreas neuroendocrine tumors in the arterial phase. In our experience, patients with unclassified lesions at US or conventional CT, suspected HCC and metastases from pancreas neuroendocrine tumors should be submitted to Triphasic CT of the liver. This technique however does not appear to be indicated in the study of liver metastases from hypovascular tumors, while it improves the detection of FNH and adenoma.
本研究旨在探讨三相螺旋CT（动脉期、门静脉期和平衡期）是否能改善非囊性局灶性病变的特征描述。
66例疑似局灶性肝病患者接受了三相螺旋CT检查。以3ml/s的速度注射120 - 140ml造影剂后，在动脉期（扫描延迟：20 - 27秒）、门静脉期（扫描延迟：45 - 80秒）和平衡期（扫描延迟：5 - 8分钟）对肝脏进行成像。评估每个病变在各期的强化情况，并根据强化模式将病变分组（共11种模式）。我们66例患者的参考标准为手术（12例）、活检（43例）、MRI（9例）、随访（9例）、生长抑素受体闪烁显像（6例）。
66例患者共检测到126个肝脏病变，11种强化模式中的4种（低/高/高、高/等/等、高/高/等、高/高/高）总是提示良性疾病（血管瘤、局灶性结节性增生 - FNH - 腺瘤）。11种强化模式中的4种（等/低/低、等/等/低、高/低/低、高/高/低）总是提示恶性疾病（肝细胞癌 - HCC - 转移瘤）。另外两种模式（低/低/低、低/低/高）在良性和恶性疾病中均可见。
三相螺旋CT改善了对HCC、FNH、腺瘤和血管瘤的特征描述。除了动脉期来自胰腺神经内分泌肿瘤的转移瘤外，动脉期和平衡期对转移瘤门静脉期的诊断价值无额外贡献。根据我们的经验，超声或传统CT检查发现病变未分类、疑似HCC以及胰腺神经内分泌肿瘤转移瘤的患者应接受肝脏三相CT检查。然而，这项技术似乎不适用于乏血供肿瘤肝转移的研究，而它能提高FNH和腺瘤的检出率。
