CAJ | 학술논문

目的：探讨320层螺旋CT在影像学表现不典型的转移性肝癌诊断中的临床价值。方法回顾性分析2010年8月至2014年8月在广州市第一人民医院行320层螺旋CT平扫和增强扫描，并经病理学检查确诊的62例CT表现不典型转移性肝癌患者临床资料。其中男45例，女17例；年龄37～83岁，中位年龄63岁。所有患者均签署知情同意书，符合医学伦理学规定。观察320层螺旋CT平扫和增强扫描病灶的显像特点，包括病灶的密度、数目、边界、增强方式。结果62例不典型转移性肝癌CT平扫，94%（58/62）表现为低或稍低密度，6%（4/62）表现为高低混杂密度；病灶多发型占77%（48/62），单发型占23%（14/62）；边界模糊占79%（49/62），边界清晰占21%（13/62）。CT增强扫描渐进性强化型占50%（31/62），无明显强化型占21%（13/62），边缘花环样强化型占11%（7/62），快进快出型占5%（3/62），多种强化方式混合型占13%（8/62）。结论采用320层螺旋CT动态增强扫描可以较好地评估影像学表现不典型转移性肝癌的组织学和血供特征，为临床治疗方案的制定提供更为准确的影像学依据。
목적：탐토320층라선CT재영상학표현불전형적전이성간암진단중적림상개치。방법회고성분석2010년8월지2014년8월재엄주시제일인민의원행320층라선CT평소화증강소묘，병경병이학검사학진적62례CT표현불전형전이성간암환자림상자료。기중남45례，녀17례；년령37～83세，중위년령63세。소유환자균첨서지정동의서，부합의학윤리학규정。관찰320층라선CT평소화증강소묘병조적현상특점，포괄병조적밀도、수목、변계、증강방식。결과62례불전형전이성간암CT평소，94%（58/62）표현위저혹초저밀도，6%（4/62）표현위고저혼잡밀도；병조다발형점77%（48/62），단발형점23%（14/62）；변계모호점79%（49/62），변계청석점21%（13/62）。CT증강소묘점진성강화형점50%（31/62），무명현강화형점21%（13/62），변연화배양강화형점11%（7/62），쾌진쾌출형점5%（3/62），다충강화방식혼합형점13%（8/62）。결론채용320층라선CT동태증강소묘가이교호지평고영상학표현불전형전이성간암적조직학화혈공특정，위림상치료방안적제정제공경위준학적영상학의거。
ObjectiveTo investigate the clinical value of 320-slice spiral CT in diagnosis of metastatic liver cancer with atypical CT manifestations.MethodsClinical data of 62 patients with metastatic liver cancer with atypical CT manifestations who were conifrmed by the pathological examination and underwent 320-slice CT plain scan and enhanced scan in the First People's Hospital of Guangzhou from August 2010 to August 2014 were studied retrospectively. Of the 62 patients, 45 were males and 17 were females with the age ranging from 37 to 83 years old and the median of 63 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The imaging characteristics of the lesions by spiral CT plain scan and enhanced scan were observed, including density, number, boundary and enhancement pattern of the lesions.ResultsOn CT plain scan of the 62 cases, 94% (58/62) displayed low or slightly low density and 6% (4/62) displayed mixed high and low density, 77% (48/62) were with multiple lesions and 23% (14/62) were with single lesion; 79% (49/62) were with obscure boundary and 21%(13/62)were with well-deifned boundary. On CT enhanced scan, 50% (31/62) were with progressive enhancement, 21% (13/62) were without obvious enhancement, 11% (7/62) were with wreath-like edge enhancement, 5% (3/62) were with fast in fast out enhancement and 13% (8/62) were with multiple patterns enhancement.Conclusions320-slice dynamic contrast enhanced spiral CT may better relfect the histological and blood supply characteristics of metastatic liver cancer with atypical imaging manifestations and provide more accurate imaging evidences for the formulation of clinical therapeutic regimen.