Role of Triphasic Computed Tomography during Arterial Portography in Distinguishing Pseudolesion and Hepatocellular Carcinoma

三相性經動脈門靜脈肝臟電腦斷層造影在辨別肝細胞癌和假性病灶的角色

林勝彥(Shen-Yen Lin) ； 黃培青(Pei-Ching Huang) ； 吳冠群(Koon-Kwan Ng) ； 洪建福(Chein-Fu Hung) ； 張啟仁(Chee-Jen Chang) ； 吳樹鏗(Shu-Hang Ng) ； 萬永亮(Yung-Liang Wan) ； 呂嘉偉(Kar-Wai Lui)

《Journal of Radiological Science》 37卷1期 (2012/03) Pp. 1-10+54

https://doi.org/10.6698/JRS.201203_3701.01

摘要

本研究回顧性評估在疑似患有肝細胞癌的患者，三相性經動脈門靜脈肝臟電腦斷層造影的臨床功效。我們同時分析肝癌腫瘤及假性病灶在影像學上的表現。從2007年5月至2010年9月間，在本院有129位已知或疑似肝癌的病人接受肝臟電腦斷層掃描和三相性經動脈門靜脈肝臟電腦斷層造。我們分析了肝細胞癌和假性病灶的大小、形狀、位置以及在影像學上的表現，同時也計算並比較三相性經動脈門靜脈肝臟電腦斷層造影的敏感度、陽性預測率和接受者操作型曲線下面積。在103例患者中，發現184個肝細胞癌腫瘤和134個假性病灶。陽性預測率在三相和單相性經動脈門靜脈肝臟電腦斷層造影分別90.2％和53.9％（P＜0.01）。在未顯影的電腦斷層造影中，低密度的表現在肝細胞癌和假性病灶中分別為96.3％和3％（P＜0.01）。在給予對比劑後，原本低密度的133個假性病灶（99.3％）分別有66個（49.3％）在第二相，和121個（90.3％）在第三相的動脈門靜脈肝臟電腦斷層造影中顯影等同肝臟實質的密度。肝細胞癌腫瘤在第一相。第二相和第三相的動脈門靜脈肝臟電腦斷層造影中出現低密度的表現的比例分別100％，97.5％和97.5％。在第三相的動脈門靜脈肝臟電腦斷層造影。低密度表現的病灶比較偏向肝細胞癌大於假性病灶（97.5％和9.7％P＜0.05）。三相性經動脈門靜脈肝臟電腦斷層造影的陽性預測值明顯高於單相性經動脈門靜脈肝臟電腦斷層造影，其影像上的變化也同時讓我們可以辨別肝細胞癌和假性病灶。

並列摘要

To retrospectively evaluate the clinical efficacy of triphasic computed tomography during arterial portography (CTAP) for a pretreatment survey of patients with suspected hepatocellular carcinoma (HCC) and to compare the dynamic image features of HCCs and pseudolesions during triphasic CTAP.Between May 2007 and September 2010, 129 patients with known or suspected HCC underwent triphasic helical computed tomography (THCT) and triphasic CTAP at our institution. The HCC image characteristics and pseudolesion dynamic changes in enhancement, size, shape, and location were reviewed. The sensitivity, positive predictive rate (PPV), and area under the receiver operating characteristic curve of triphasic CTAP were calculated and compared.Of 129 patients, 103 with 184 HCCs and 134 pseudolesions were enrolled. The PPVs for triphasic CTAP and monophasic CTAP were 90.2% and 53.9%, respectively (P＜0.05). During the precontrast phase of triphasic CTAP, low attenuation of HCCs and pseudolesions occurred in 96.3% and 3% of the cases, respectively (P＜0.05). After contrast administration, 133 (99.3%) low-attenuation pseudolesions that appeared during the first phase of CTAP, 66 (49.3%) during the second phase, and 121 (90.3%) during the third phase because iso-attenuated to normal liver parenchyma. The proportion of HCCs with low attenuation during the first, second, and third CTAP phases was 100%, 97.5%, and 97.5%, respectively. During the third phase of triphasic CTAP, low attenuation was more likely associated with HCC than pseudolesions (97.5% vs. 9.7%, P＜0.05).The PPV was significantly increased by triphasic CTAP compared to monophasic CTAP. The dynamic image features of triphasic CTAP are useful for distinguishing pseudolesions from HCC.