CAJ | 학술논문

目的在肝癌高发人群中对CT动脉增强期所发现的小结节(5～10 mm) (SAENs)进行随访观察,以确定肝细胞癌(HCC)发生率和危险因素.方法研究对象包括112例患者(男∶女=100∶12;年龄36 ～ 92岁),通过最初的CT检查中共发现175个SAENs.在随访期间(1.4 ～41.8个月,平均35.7个月)对CT检查结果进行观察分析,以最终阐明结节为肝癌的危险因素和比例.结果随访期间的175结节中,有101 (57.7％)消失,34个(19.4％)持续存在,40个(22.9％)结节最终确诊为肝癌(33例患者).其中患者有肝癌治疗史(P =0.005,风险比=7.429),较大尺寸的SAEN(P=0.003,风险比=1.630),肝内有同时发现的HCC(P=0.021,风险比=3.777)和缺乏共存的典型的动静脉分流(P=0.003,风险比=4.459)是在CT影响学上肝内结节可能为HCC的风险因素.结论在肝癌高发人群中经常能发现SAEN,其中有22.9％的硬结节有可能为肝癌,特别是当有下列因素存在包括合并有肝癌病史,有同时存在的肝癌、结节较大以及没有发现共存的典型动静脉分流时,肝癌发生率会明显升高.
목적 재간암고발인군중대CT동맥증강기소발현적소결절(5～10 mm) (SAENs)진행수방관찰,이학정간세포암(HCC)발생솔화위험인소.방법 연구대상포괄112례환자(남∶녀=100∶12;년령36 ～ 92세),통과최초적CT검사중공발현175개SAENs.재수방기간(1.4 ～41.8개월,평균35.7개월)대CT검사결과진행관찰분석,이최종천명결절위간암적위험인소화비례.결과 수방기간적175결절중,유101 (57.7％)소실,34개(19.4％)지속존재,40개(22.9％)결절최종학진위간암(33례환자).기중환자유간암치료사(P =0.005,풍험비=7.429),교대척촌적SAEN(P=0.003,풍험비=1.630),간내유동시발현적HCC(P=0.021,풍험비=3.777)화결핍공존적전형적동정맥분류(P=0.003,풍험비=4.459)시재CT영향학상간내결절가능위HCC적풍험인소.결론 재간암고발인군중경상능발현SAEN,기중유22.9％적경결절유가능위간암,특별시당유하렬인소존재포괄합병유간암병사,유동시존재적간암、결절교대이급몰유발현공존적전형동정맥분류시,간암발생솔회명현승고.
Objective To evaluate the outcomes of small (5 ～ 10mm),arterially enhancing nodules (SAENs)shown exclusively at the hepatic arterial phase of CT in a hepatocellular carcinoma(HCC) surveillance population and to determine risk factors for developing HCC.Methods The study population included 112 patients (maleifemale =100 ∶ 12 ; aged 36 ～ 92 years) with 1 7 5 SAENs who were at risk of HCC.We evaluated serial changes during follow-up(1.4 ～41.8 months,mean 35.7 months) and analysed the initial CT findings of SAENs and the accompanying lesions to elucidate the risk factors for HCC development.Results Of 175 SAENs,101 (57.7％) disappeared and 34(19.4％) persisted.Forty SAENs(22.9％) became HCC in 33 patients(29.5％).Presence of HCC treatment history(P =0.005,risk ratio =7.429),a larger size of SAEN(P =0.003,risk ratio =1.630),presence of coexistent HCC(P =0.021,risk ratio =3.777) and absence of coexistent typical arterioportal shunts (P =0.003,risk ratio =4.459) turned out to be independently significant risk factors for future development of HCC.Conclusion SAENs are frequently seen in an HCC surveillance population and have a 22.9％ probability of becoming HCC on a per-lesion basis.Risk increased particularly when the lesion is associated with a previous or concurrent HCC,a large size or found without a coexistent typical arterioportal shunt.