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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (01) : 41 -45. doi: 10.3877/cma.j.issn.2095-3224.2017.01.009

所属专题： 文献；

论著

不同来源肝转移瘤多层螺旋CT影像学特征的分析
姜昊1, 姜慧杰1,†(), 潘文彬1, 李鑫1, 王奕乔1   
  1. 1. 150086　哈尔滨医科大学附属第二医院影像中心；黑龙江省医学科学院；中俄医学影像研究中心
  • 收稿日期:2016-11-20 出版日期:2017-02-25
  • 通信作者: 姜慧杰
  • 基金资助:
    国家"十二五"科技支撑计划课题(No.2015BAI01B09); 国家自然科学基金面上项目(No.81471736、81671760); 哈尔滨市科技创新人才研究专项资金(No.2016RAXYJ063)

The analysis of imaging features of liver metastases by multi-slice spiral CT

Hao Jiang1, Huijie Jiang1,†(), Wenbin Pan1, Xin Li1, Yiqiao Wang1   

  1. 1. Medical Imaging Center, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Academy of Medical Sciences, Sino-Russian Medical Research Center, Harbin 150086, China
  • Received:2016-11-20 Published:2017-02-25
  • Corresponding author: Huijie Jiang
  • About author:
    Corresponding author: Jiang Huijie, Email:
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引用本文：

姜昊, 姜慧杰, 潘文彬, 李鑫, 王奕乔. 不同来源肝转移瘤多层螺旋CT影像学特征的分析[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(01): 41-45.

Hao Jiang, Huijie Jiang, Wenbin Pan, Xin Li, Yiqiao Wang. The analysis of imaging features of liver metastases by multi-slice spiral CT[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(01): 41-45.

目的

探讨不同来源肝转移瘤多层螺旋CT的增强特点，分析肝转移瘤少见的影像学表现，以提高对不同来源肝转移瘤患者的诊断及鉴别诊断能力。

方法

收集94例不同来源肝转移患者的临床资料，包括原发灶部位、肝转移瘤的数目以及不同时相的CT值变化。

结果

（1）不同来源肝转移瘤三期强化特点表现为胃癌呈慢升慢降型；结直肠癌及肺癌则为持续上升型；（2）本研究94例肝转移瘤患者，其中囊变36例：结直肠癌17例，胃癌17例，肺癌2例；出现钙化21例：结直肠癌16例，胃癌4例，肺癌1例。门静脉来源的消化系统恶性肿瘤（结直肠癌及胃癌）肝转移瘤的囊变率和钙化率明显高于经肝动脉转移的肺癌患者。两种不同血行途径、不同来源的肝转移瘤的囊变（χ2=5.17，P=0.023；χ2=11.79，P=0.001）、钙化（Fisher检验，P=0.038）出现率不同，差异具有统计学意义。

结论

（1）不同来源肝转移瘤三期强化特点不同，一种慢升慢降型，主要表现在胃癌；另一种持续上升型，主要为结直肠癌、肺癌；（2）囊变和钙化常见于门静脉来源的消化系统恶性肿瘤引发的肝转移瘤，此征象对确定肝转移瘤的来源有一定的指导作用。

关键词: 肿瘤转移, 结直肠肿瘤, 多层螺旋CT, 肝转移
Objective

To investigate the characteristics of multi-slice spiral CT (MSCT) of liver metastases from different sources, and to explore the characteristics of rare type of liver metastases in order to improve the diagnosis and differential diagnosis of liver metastases from different sources.

Methods

Clinical data of 94 cases of liver metastases was recorded, including the site of the primary tumor, metastasis number, the CT values of different phase time.

Results

(1) The Three enhanced phases of liver metastasis can be divided into two types : the gastric cancer showed a type of time densitycurve (TDC) of gradual rise–gradual fall, and colorectal cancer and lung cancer showed continued going-up. (2) In this study, 94 patients with liver metastases had 36 cases of cystic changes,including 17 cases of colorectal cancer, 17 cases of gastric cancer and 2 cases of lung cancer. Calcification occurred in 21 cases, including 16 cases of colorectal cancer, 4 cases of gastric cancer and 1 case of lung cancer. The rate of cystic degeneration and calcification of the digestive system of malignant tumors from portal vein (colorectal cancer and gastric cancer)was significantly higher than that of patients with the hepatic artery metastasis of lung cancer . There were significant differences in the rate of cystic degeneration (χ2=5.17, P=0.023; χ2=11.79, P=0.001)and calcification(Fisher?s exact test, P=0.038) between the two kinds of liver metastases from different hematogenous pathways and different sources.

Conclusions

(1) The three enhanced phases of liver metastasis from three different sources can be divided into two types: the gastric showed a TDC type of gradual rise–gradual fall, colon and lung showed continued going-up. (2) Cystic degeneration and calcification common in the portal vein of the digestive system of malignant tumors caused by liver metastases, this phenomenon to determine the source of liver metastases have a certain role in guiding.

Key words: Neoplasm Metastasis, Colorectal neoplasms, Multi-slice spiral CT, Liver metastases
表1 94例不同原发灶肝转移瘤增强扫描三期CT值（例，±s）
原发灶 例数 动脉期 门静脉期 延迟期
结直肠癌 45 47.01±12.03 52.78±14.09 56.24±12.09
胃癌 29 46.01±8.03 54.18±13.01 52.24±11.98
肺癌 20 50.01±9.03 58.88±11.09 61.24±8.09
图1 三种不同来源肝转移瘤增强扫描CT值变化情况对比
表2 不同原发灶肝转移瘤囊变的出现比较（例）
组别 例数 原发灶
肺癌 结直肠癌 胃癌
囊变 36 2 17 17
非囊变 58 18 28 12
X2值 ? ? 5.17 11.79
P值 ? ? 0.023* 0.001*
表3 不同原发灶肝转移瘤钙化出现比较（例）
组别 例数 原发灶
消化道肿瘤 肺癌
钙化 21 20 1
非钙化 73 54 19
P值 ? ? 0.038
图2 结直肠癌肝转移：肝内见类圆形囊变，壁薄
图3 结肠癌肝转移：平扫肝右叶不规则低密度影，边界欠清晰，其内可见多发点状、片状高密度钙化影
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