肝細胞癌之電腦斷層掃描－延時顯影技術之探討

CT of Hepatocellular Carcinoma: Delayed Hepatic Computed Tomography on the Detectability of Hepatic Lesions

孔慶惠(Ching-Huei Kung) ； 曾旭明(Yuk-Ming Tsang) ； 陳嘉美(Margaret Chia-Mei Chen) ； 徐劍耀(Jane Chien-Yau Hsu) ； 蘇誠道(Cheng-Tau Su) ； 賴明陽(Ming-Yang Lai) ； 許金川(Jin-Chuan Sheu) ； 陳定信(Ding-Shinn Chen) ； 魏達成(Ta-Cheng Wei)

《中華放射線醫學雜誌》 17卷4期 (1992/12) Pp. 369-376

摘要

在肝藏之電腦斷層掃描技術中，延時電腦斷層掃描(Delay CT, DECT)較動態電腦斷層掃描(Dynamic CT, DYCT)能偵測出較多之轉移性肝腫瘤。為瞭解電腦斷層掃描對肝細胞癌之偵測，我們對49例被證實為肝細胞癌之病患，施予未經造影劑之電腦斷層掃描(Non-contrast CT, NCT)、DYCT和DECT，利用主觀之目測，將各種顯像技術所偵測出之腫瘤數及偵測腫瘤之顯著性(conspicuity)之結果加以比較，同時並比較在各種顯影技術所測之腫瘤與正常肝實質密度差(Tumor-Liver density difference)之變化。結果為在28例小型（直徑≦4公分，平均大小為2.93±0.9公分）未具有中心壞死之肝細胞癌病患，DECT可明顯地偵測出病灶之存在者有27例，佔96%，而其中又偵測病灶之顯著性之能力最好者有13例，佔46%。在14例大型（直徑＞4公分，平均大小為9.25±2.65公分）具有中心壞死之肝細胞癌病患，DEC丁可明顯地偵測出病灶之存在者有13例，佔93%，而其中又偵測病灶之顯著性之能力最好者有2例，佔14%。在7例浸潤性之肝細胞癌病患，DECT可將所有病灶明顯地偵測出來，而其中偵測病灶之顯著性的能力最好者有5例，佔71%。
故建議對疑似肝內腫瘤之病患，除一般未予造影劑前之電腦建議斷層掃描外，應加上動態及延時電腦斷層掃描，以期得到較高之偵測率(detectability)。而針對經治療後為追蹤目的者，僅施予延時電腦斷層掃描即可。

關鍵字

肝臟腫瘤 ； 肝臟電腦斷層掃描

並列摘要

Dynamic sequential hepatic computed tomography (DYCT) is claimed to be less useful than delayed hepatic computed tomography (DECT) in defining and detecting metastatic hepatic tumors. A study was conducted on 49 patients wih suspicious hepatic lesions, which were subsquently proven to be hepatocellular carcinoma, to subjectively evaluate the lesion detectability and conspicuity by NCT、DYCT and DECT. In addition, the liver-tumor density difference was also analysed among these three techniques. Our results showed that DECT detected 27/28 13/14 and 7/7 cases in small large and infiltrative HCCs, respectivly. Among these detected cases, DECT was visually superior to NCT and DYCT in 12/28、2/24 and 5/7 of small、large and infiltrative HCCs. However, DECT was inferior to NCT in 3 cases, all were of poor liver function. In conclusion to evaluate patients with suspicious hepatic lesions, all three techniques-NCT、DYCT and DECT are necessary, whereas only DECT may be necessary for the patient with HCC undergoing treatment.

並列關鍵字

Liver, neoplasm ； Liver, computed tomography