CAJ | 학술논문

目的：探讨128层螺旋CT三期动态增强在鉴别高分化肝癌（WHCC）和局灶性结节增生（FNH）中的诊断价值。方法分析41例肝脏占位病变患者（其中20例 WHCC为 WHCC组、21例 FNH 为 FNH 组）128层螺旋CT三期动态增强扫描图像，观察有无假包膜、有无肝硬化、有无肿块纤维瘢痕；测量病灶大小、病灶平扫 CT值、平扫值与正常肝脏的 CT比值、动态增强的峰值、动态峰值与肝脏比值、动脉期 CT值（AP 值）、静脉期 CT 值（VP值）、延时期CT值（DP值）。结果假包膜：WHCC组12例，FNH组0例；中央纤维瘢痕：WHCC组0例，FNH组8例；肝硬化：WHCC组7例，FNH组1例。WHCC组年龄大于 FNH 组[（58．40±0．29）岁比（41．20±0．46）岁， P＜0．01]。WHCC组较 FNH 组的平扫 CT值（42．90±1．76比51．33±1．26）、动态增强峰值（94．74±4．49比116．74±4．25）、峰值与肝脏比值（1．30±0．72比1．63±0．59，）、AP值（74．10±4．15比102．71±4．10）、VP 值（84．05±4．62比107．05±3．76）、DP值（78．70±2．99比95．24±3．35）显著降低（均P＜0．01）。结论假包膜为WHCC固有特征，中央纤维瘢痕为 FNH 常见特征。三期动态增强扫描年龄、平扫 CT 值、动态增强的峰值、AP值、VP值、DP值对 WHCC和 FNH的检出和鉴别诊断有一定价值。
목적：탐토128층라선CT삼기동태증강재감별고분화간암（WHCC）화국조성결절증생（FNH）중적진단개치。방법분석41례간장점위병변환자（기중20례 WHCC위 WHCC조、21례 FNH 위 FNH 조）128층라선CT삼기동태증강소묘도상，관찰유무가포막、유무간경화、유무종괴섬유반흔；측량병조대소、병조평소 CT치、평소치여정상간장적 CT비치、동태증강적봉치、동태봉치여간장비치、동맥기 CT치（AP 치）、정맥기 CT 치（VP치）、연시기CT치（DP치）。결과가포막：WHCC조12례，FNH조0례；중앙섬유반흔：WHCC조0례，FNH조8례；간경화：WHCC조7례，FNH조1례。WHCC조년령대우 FNH 조[（58．40±0．29）세비（41．20±0．46）세， P＜0．01]。WHCC조교 FNH 조적평소 CT치（42．90±1．76비51．33±1．26）、동태증강봉치（94．74±4．49비116．74±4．25）、봉치여간장비치（1．30±0．72비1．63±0．59，）、AP치（74．10±4．15비102．71±4．10）、VP 치（84．05±4．62비107．05±3．76）、DP치（78．70±2．99비95．24±3．35）현저강저（균P＜0．01）。결론가포막위WHCC고유특정，중앙섬유반흔위 FNH 상견특정。삼기동태증강소묘년령、평소 CT 치、동태증강적봉치、AP치、VP치、DP치대 WHCC화 FNH적검출화감별진단유일정개치。
Objective To explore the value of three-phase dynamic contrast-enhanced 128-slice spiral CT in the differential diagnosis of well-differentiated hepatocellular carcinoma(WHCC)and focal nodular hyperplasia(FNH).Methods Three-phase dynamic contrast-enhanced 128-slice spi-ral CT was performed in 20 patients with WHCC(WHCC group)and 21 patients with FNH (FNH group).The pseudocapsule,cirrhosis and fibrous scar were observed.In addition,lesion size,nonenhanced CT value,average CT value,average lesion-to-normal liver CT ratio,dynamic contrast-enhanced peak value,dynamic peak-to-liver ratio,arterial phase CT value(AP value),ve-nous phase CT value(VP value)and delay period CT value(DP value)were measured.Results In WHCC group,pseudocapsule,central fibrous scar and cirrhosis were observed in 12,0 and 7 pa-tients,respectively.In FNH group,pseudocapsule,central fibrous scar and cirrhosis were observed in 0,8 and 1 patients,respectively.Compared with FNH group,age,nonenhanced CT value,dy-namic contrast-enhanced peak value,dynamic peak-to-liver ratio,AP value,VP value and DP value significantly decreased in WHCC group[(58.40±0.29)years vs (41.20±0.46)years,42.90± 1.76 vs 51.33±1.26,94.74±4.49 vs 116.74±4.25,1.30±0.72 vs 1.63±0.59,74.10±4.15 vs 102.71±4.10,84.05±4.62 vs 107.05±3.76 and 78.70±2.99 vs 95.24±3.35,respectively;P<0.01].Conclusion The pseudocapsules and central fibrous scar are the inherent features of WH-CC and FNH,respectively.Three-phase dynamic contrast-enhanced 128-slice spiral CT is valuable for the detection and differential diagnosis of WHCC and FNH.