肝細胞癌和肝臟轉移腫瘤在電腦斷層影像上的鑑別診斷

DIFFERENTIAL DIAGNOSIS OF HEPATOCDLLULAR CARCINOMA AND LIVER METASTASES ON COMPUTED TOMOGRAPHIC IMAGES

吳志順(Chih-Shun Wu) ； 姜仁惠(Jen-Huey Chiang) ； 潘慧本(Huay-Ben Pan) ； 楊建芳(Chien-Fang Yang) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 14卷2期 (1989/06) Pp. 133-139

摘要

電腦斷層掃描在肝腫瘤的偵測和診斷上可提供甚多資料，本文收集了1983年2月至1986年10月93例肝臟轉移及1985年6月至1986年10月93例肝細胞癌的病例，在電腦斷層的影像上作一鑑別診斷。肝細胞癌較典型的電腦斷層影像包括：1.單一病灶.2.未作對比劑顯像前，可見到圍繞在病灶邊緣的薄層低吸收區。3.注射對比劑後，可見到龐雜的顯影增強。4.對於較大塊腫瘤，內緣常見一層厚的未壞死腫瘤。5.腫瘤向肝表面外形成有莖突垂的現象。6.腫瘤易破裂。7.肝硬化及門靜脈被侵犯。肝臟轉移的電腦斷層影像包括：1.多發性病灶。2.即使3-5 cm較小型腫瘤，便有明顯中央性壞死。3.對於較大腫瘤，具有清晰外緣，而內部部密度均匀且明顯偏低者。4.多發性，界限清晰，大小相似且均匀分佈在肝內的病灶。5.腹腔內有淋巴節腫大現象。當電腦斷層影像難以區分肝轉移和肝細胞癌的時候，臨床症狀和數據則有助於鑑別診斷。

關鍵字

肝細胞癌（hepatocellular carcinoma） ； 肝臟轉移（liver metastasis）

並列摘要

Computed tomography may offer valuable information in detection and diagnosis of hepatic tumor; We collected 93 cases of liver metastases from Feb. 1983 to Oct. 1986, and compared with 93 cases of hepatocellular carcinomas from June, 1985 to Oct. 1986, based on computed tomographic images. Hepatocellular carcinoma was suggested by a solitary lesion, a narrow circular hypodense zone surrounding the mass on the plain CT, heterogeneous enhancement after injection of contrast medium, larger tumor size with a thick layer of non-necrotic tumor, pedunculation of the mass from liver surface, rupture of the tumor, presence of liver cirrhosis and portal vein involvement. Liver metastases were favored by multiple lesions, tumor size between 3 to 5 cm with central necrosis, larger tumor size with well-defined sharp margin and homogeneous extremely hypodense interiorly, multiple, sharp margin, same size of lesions with even distribution in the liver and presence of lymphadenopathy in the abdomen. Clinical information will be very helpful in differential diagnosis when CT image is contraversal.