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目的 探讨螺旋CT肝脏双期扫描及门静脉血管三维重建在小肝癌诊断中临床应用价值。方法 25例直径≤3cm小肝癌行螺旋CT肝脏双期扫描及门静脉血管三维重建。三维重建方法采用最大强度投影(MIP)。结果 (1)CT平扫,18例病灶呈低密度,7例病灶呈等密度。肝动脉期,25例病灶强化呈高密度,强化类型分为均匀一致性,斑点状及环状强化。门静脉期25例病灶均呈低密度。(2)门静脉血管MIP三维重建能较好显示小肝癌病灶与肝内门静脉血管关系,肝内门静脉血管分支于病灶处稀少,部分中断或被轻度推移,肿瘤内无门静脉分支血管。结论 螺旋CT肝脏双期扫描及门静脉血管三维重建是诊断和评价小肝癌的有效方法,提高了小肝癌的检出率及诊断正确率,可较好显示病灶与门静脉的关系,为其外科手术提供导向。
Objective To investigate the value of spiral CT liver biphasic scanning and three-dimensional reconstruction of portal vein vessels in the diagnosis of small hepatocellular carcinoma. Methods Twenty-five cases of small hepatocellular carcinoma with diameter ≤3 cm were scanned with helical CT and three-dimensional reconstruction of portal vein. The three-dimensional reconstruction method uses maximum intensity projection (MIP). RESULTS: (1) On plain CT scans, 18 lesions showed low density, and 7 lesions showed equal density. In the hepatic arterial phase, lesions were enhanced in high density in 25 cases, and the types of enhancement were uniform, dot-like and ring-shaped. In the portal venous phase, lesions showed low density in 25 cases. (2) MIP three-dimensional reconstruction of portal vein blood vessels can better show the relationship between small hepatocellular carcinoma lesions and intrahepatic portal vein blood vessels. Branches of intrahepatic portal vein blood vessels are sparse at the lesions, partially interrupted or slightly displaced, and there are no portal vein branch vessels within the tumor. Conclusion Spiral CT liver dual-phase scanning and three-dimensional reconstruction of portal vein vessels are effective methods for diagnosis and evaluation of small hepatocellular carcinoma, improve the detection rate and diagnostic accuracy of small hepatocellular carcinoma, and can better show the relationship between the lesion and the portal vein, providing a surgical operation guide.