【作者】 王春业；

【导师】 张志远；

【作者基本信息】 宁夏医科大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的评价双源64排螺旋CT三期增强扫描及3D后处理重建对肝脏血管瘤容积测定的诊断价值;动脉期强化的分组分型对临床的应用价值。方法回顾性分析300例肝血管瘤的CT资料;所有病例均应用SIEMENS双源64排螺旋CT进行三期动态增强扫描,全部测定了患者的不同时相的CT值。其中有185例根据瘤体最大直径(d)分成三组(4cm<d≦10cm、d>10cm及d<4cm三组),应用容积测定软件测定不同时相的强化容积,进行分型。结果①300例病例中,共有452个病灶,有415个病灶(91.82%)在平扫时为低密度,37个(8.18%)病灶为等或高密度;动脉期385个病灶边缘点状、斑片状强化,67个未出现强化;门脉期及延迟期相继出行强化,最终都强化至等密度。3D后处理后,可从不同角度、不同时相肿瘤强化容积的改变看到不同的瘤体整体形态学改变及肿瘤与肝动脉之间的关系。②直径小于4cm的肝血管瘤动脉期强化比率均大于28%,平均为53.68±13.25%; 4cm<d≦10cm的肝血管瘤动脉期强化容积比率为22.25%±3.25%;d>10cm的肝血管瘤动脉期强化容积比率均小于18.50%,平均为13.28%±4.26%。双源64排螺旋CT三期动态增强扫描可了解肝脏血管瘤的血供情况,从而为肝脏血管瘤的动脉栓塞治疗提供依据。结论(1)双源64排螺旋CT三期增强扫描及3D后处理可清楚显示肝血管瘤的CT表现,对血管瘤的诊断及鉴别诊断有明显的优势。(2)对于4cm<d≦10cm的肝血管瘤,动脉期强化比率大于22.25%的病灶,可认为其动脉期血供丰富(富血供型);小于22.25%的病灶,可认为其缺乏动脉供血(乏血供型);直径小于4cm的肝血管瘤多为富血供型;大于10cm的肝血管瘤多为乏血供型。目的分析介入栓塞治疗对不同类型肝血管瘤的影响及疗效评价。方法搜集32例经过动脉栓塞治疗的肝血管瘤患者,术前均行三期动态增强扫描,并测量术前的瘤体容积及动脉期强化比率;应用平阳霉素-碘乳剂行动脉栓塞治疗,术后6个月随访复查CT,测量瘤体体积,计算体积缩小率,进行统计分析评价疗效。结果全部病例经动脉栓塞治疗前后瘤体体积缩小有统计学意义;富、乏血供组间瘤体缩小率差异有统计学意义(P<0.05);4例d>10cm的血管瘤患者行动脉栓塞后瘤体容积均较术前缩小,但效果不明显,需要二次栓塞。结论1)动脉栓塞治疗直径4-10cm的肝血管瘤,不论富血供还是乏血供的患者都有很好的疗效,但是以富血供肿瘤效果更明显;2)双源64排螺旋CT评价肝血管瘤栓塞治疗后的疗效评价有很大的应用价值。更多还原

【Abstract】 Objective Evaluation of dual-source 64-slice spiral CT 3-phase contrast-enhanced scanning and 3D post-processing of volume determination of liver hemangioma diagnosis; arterial phase enhancement the groups and types effect on the value of Clinical application.Methods 1)Retrospective analysis of clinical pathology by the 300 confirmed cases of hepatic hemangioma CT data.All cases applied for three dynamic enhanced scan and 3D-reprocessing. Determine the CT value of all cases of hepatic hemangioma in patients at different phases. 185 cases,according to the biggest diameter,we fall into 3 groups (4cm<d≦10cm、d>10cm、d<4cm),and using 3D software to determine enhanced capacity at different phases. Results 1)300 cases,452 lesions.In plain,91.82% of the lesions show low density lesions;8.18% lesions appear high or identical density leisons. And after enhanced scan, in the arterial phase, 92.78% of lesions appear nodular or patchy edge enhancement, 14.82% leisons have no enhancement; in the portal and the extension phase, the scope of the lesions increased gradually expanded,and the last appear epual density lesions。After 3D post-processing,in different angles and different phases,tumor volume changes that different morphological changes in the overall tumor and the relation of between liver hemangioma and liver artery。2) The diameter is less than 4.00cm of hepatic hemangioma in the arterial phase enhancement ratios are more than 28.00% with an average of 53.68±13.25%;4.0cm <d≦10.0cm hepatic arterial vascular tumor volume ratio of the enhanced 22.25%±3.25%;d>10.0cm hepatic arterial vascular tumor volume ratio of enhancement was less than 18.50%,,an average of 13.28%±4.26%。Conclusions①Dual-source 64-slice spiral CT CT 3-phase contrast-enhanced scanning and 3D post-processing clearly shows the typical CT hepatic hemangioma performance,and great value of vascular diagnosis and differential diagnosis。②For 4.0cm <d≦ 10.0cm hepatic hemangioma,arterial phase enhancement ratio of greater than 22.25% of the lesions,can be considered on its arterial blood supply (the rich blood supply type);less than 22.25% of the lesions,,can be considered its lack of arterial blood supply (lack of blood supply type);diameter of less than 4.00cm of hepatic hemangiomas are mostly rich blood supply type;d> 10.0cm hepatic hemangiomas mostly for lack of blood type。Dual-source 64-slice spiral CT three dynamic enhanced understanding of hepatic hemangioma scan the blood supply to the liver hemangioma embolization therapy。 Objective Analyze interventional treatment of liver hemangioma effect of different types。Methods Collected 32 patients of hepatic hemangioma undergo properative three dynamic contrast-enhanced scan.Measure tumor volume and ratio of arterial phase enhancement;apply the same density pingyangmycin-Iodine lotion to treat hepatic hemangioma in arterial embolization and follow-up and recheck CT after operation,measure the tumor volume,calculate the ratio of volume reducement and evaluate curative effect by statistical analysis. Results The difference of the tumor volume of all the cases before and after treatment by TAE were showed statistical significance. The difference of minification of tumor between the rich and lack blood-supply groups were showed statistical significance (P<0.05).But at d>10cm group,all 4 cases only undertake summary,effect is not very clear by arterial embolization.And for d<4cm group,because the patient choose follow-up observation. Conclusions 1)For 4cm <d≦10cm group,by arterial embolization,all kinds of hepatic haemangiomas have a good effect,and rich blood-supply is better.2)Dual-source 64-slice spiral CT has great value of effect assessment of after hepatic haemangiomas arterial embolization.更多还原