肝脏占位性病变的影像学检查周康荣 摘要:肝脏占位性病变的影像学检查,近年来取得了很大进展,无论是病灶的检出率和定性诊断准确率都有很大提高,对肝脏和肝脏病变的血供研究进一步深入。
US和C T在肝脏占位病变的检测中应用最为普遍,敏感性也相仿,但螺旋CT双期或多期增强扫描的定性能力更强,动脉期扫描的价值得到充分肯定,但动脉期的标准、起始时间、持续时间,以及与造影剂注射计划的关系,文献报道比较混乱,作者根据多年的临床和科研资料积累,作了较详细的讨论。
磁共振成像SE T1W、T2W加上快速梯度回波序列动态增强对肝脏占位病灶的诊断尤其定性能力略优于SCT,尤其对小的血管瘤、RN、DN的鉴别意义更大。
作者把肝内占位病变分成多血供和少血供两大类,并对常见病变的CT、M R表现与特征作了扼要介绍。
最后还对肝脏特异性M R造影剂的发展前景以及多层螺旋CT的临床应用价值作了论述。
Imaging Examination of Hepatic Space Occupying LesionsZhou K angrongDepartment of Radiology,ZhongS han Hospital,Shanghai200032Abstract:I n recent years,imag ing examina tio n of the liver,mainly focused on the space occupying or focal le-sions has been developing very fast.W hatever the detectability o r the accuracy of the preo perative diagnosis of the fo-cal liver lesion were sig nificantly improved.T he study on the bloo d supply to the liver and hepatic lesions w as further deepened.U S and the most commonly applied imaging modalities in the examnina tio n of the liver,bo th have similar sensitivity in the detection of the lesions,but dual phase dy namic enhancement SCT is better in the characterization of the lesions,and particularly,its arterial phase is approved to be very valuble.How ever,it is still and quite confus-ing problem as to what is the criteria,initial time,ending time and duration of the enhancement of the arterial phase, as well as the relation w ith the contrast injection protocol.The author discussed it in detail on the basis of his o wn clinical and research data collected in a few years.It is also considered by the author that M RI including SE T1W, T2W and dynamic enhancement with F M PSPGR sequence mig ht be superior to SCT in the diagnosis of the focal liv er lesions,especially small hemangioma,RN and DN.A ccording to the deg ree of the blood supply,the lesio ns can be divided into tw o catego ries:hy pervascular and hypov ascular.T ha t may be helpful fo r differentiation of the diseases on the images.CT findings and features of some co mmon diseases of the liver were presented briefly in this series.Final-ly,the futute development of specific liver M R contrast agents such as M n-DPDP,SPIO,and the present or future applicatio n of the new CT scanner,namely multislice SCT were also involved in the discussion and evaluation. 随着U S、CT和M RI等影像学检查技术的不断发展,以及临床经验的积累,肝脏占位性病变尤其小病灶的检出率明显提高,术前诊断准确性也得以提高。
