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目的探讨CT诊断早期肝癌(HCC)时易忽略的几点重要的间接征象及其临床意义。方法回顾分析12例HCC患者的早期CT检查直接征象呈阴性(无明显肿块及异常强化)时的表现,对照现有病灶,利用薄层重组、窗宽调节等技术重点观察前次扫描图像的血管形态、局部密度及轮廓等间接征象。所有病例均经随访、手术或穿刺病理证实为HCC。结果 (1)直接征象:12例HCC患者早期扫描时的平扫及增强后门静脉期均未见明显异常密度灶,增强后动脉期共发现1例病灶呈轻度强化改变,1例可疑稍低密度,境界均不清楚。(2)间接征象:12例中共1个病灶见异常扭曲增粗的供血动脉,2例表现为肝局部轮廓向外膨隆及增粗动脉,2例表现为血管推移征,6例表现血管推移征及增粗的供血动脉,1例同时表现增粗动脉、血管推移及轮廓改变。结论早期HCC直接征象不明显,血管推移、异常供血动脉及局部轮廓改变等间接征象的CT表现对诊断早期HCC具有重要的临床意义。
Objective To explore some important indirect signs that may be neglected in the diagnosis of early hepatocellular carcinoma (HCC) by CT and its clinical significance. Methods Retrospective analysis of 12 cases of HCC patients with early signs of CT examination was negative (no significant mass and abnormal enhancement) when the performance of the control of existing lesions, the use of thin-layer reorganization, window width adjustment and other techniques focus on the previous scan of the blood vessels Shape, local density and contour indirect signs. All cases were followed up, pathology confirmed by surgery or HCC. Results (1) The direct signs: 12 cases of HCC patients with early scan scan and enhanced portal vein after no significant abnormal density lesions were enhanced artery phase was found in 1 case mild enhancement, 1 case slightly lower Density, realm are not clear. (2) Indirect signs: Twelve cases of one common lesion in China showed an abnormally tortuous and thickening donor artery, two cases showed outward bulging and thickening of the local outline of the liver, two cases of vascular patency and six cases of vascular patency And thickening of the feeding arteries, 1 case also showed thickening arteries, vascular transition and contour changes. Conclusions The early signs of HCC are not obvious. The CT findings of indirect signs such as vascular transition, abnormal feeding arteries and local contour changes have important clinical significance in the diagnosis of early HCC.