摘要
目的分析放射性核素显像和常规CT诊断肝局灶性结节增生（FNH）的各自优势，探讨二者结合对FNH的诊断价值。方法回顾性分析32例（男15例，女17例，年龄22～59岁）FNH患者的病理及影像资料。32例患者均行常规CT（平扫及增强）检查。其中24例行放射性核素显像，在肝胶体显像时加做融合图像采集，经计算机处理后得到SPECT及定位CT的融合图像。对显像发现病灶的患者行肝胆动态显像，包括血流灌注相、早期相及延迟相。检查结果的比较采用四格表∥检验或四格表Fisher确切概率法检验。结果32例患者共切除32个病灶，均为单发。病理均为FNH，其中25个为病理经典型，7个为病理非经典型；大病灶（最大径〉3cm）20个，小病灶（最大径≤3cm）12个。32例患者常规CT检出所有病灶，确诊病理经典型FNH15个，其中大病灶10个，小病灶5个；其余病灶均误诊或诊断不明确。24例患者进行放射性核素显像，结果示大病灶11个，其中病理经典型7个，病理非经典型4个；其余病灶诊断不明确或未检出。常规CT与放射性核素显像对病理经典型病灶确诊率分别为60．0％（15／25）和38．9％（7／18），病理非经典型为0／7和4／6；大病灶为50．O％（10／20）和73．3％（11／15），小病灶为41．7％（5／12）和0／9；对FNH的总确诊率为46．9％（15／32）和45．8％（11／24）。24例行放射性核素显像患者同时行常规CT检查，2种方法结合共确诊FNH18个，总确诊率75．0％（18／24）。在病理非经典型、小病灶FNH的诊断方面，常规CT与放射性核素显像比较，差异有统计学意义（P=0．02，0．04）；2种方法结合对FNH的总确诊率与单种方法的确诊率比较，差异均有统计学意义（χ2=4．48和4．27，P均〈0．05）。结论常规CT与放射性核素显像对FNH的诊断各有优势；二者结合可提高对FNH的总确诊率。
Objective To investigate radionuclide imaging and routine CT in diagnosing hepatic focal nodular hyperplasia （FNH） and the combined diagnostic value of the two modalities. Methods Thirty- two patients with hepatic FNH were retrospectively studied. All patients underwent routine CT scan. Twenty-four patients were examined by ^99Tc^m-sulfur colloid （SC） hepatic planar scintigraphy and SPECT/CT imaging, and then patients who had abnormal foci underwent ^99Tc^m-diethyl iminodiacetic acid （EHIDA） tri- ple-phase hepatobiliary imaging. X2 -test of four-table or Fisher exact probabilities in 2 × 2 table was applied for statistical analysis. Results Of all 32 patients pathologically diagnosed as FNH with single solitary nodule, 25 were classified as classic type and the rest 7 as non-classic type. Although routine CT found all hepatic lesions, only 15 cases were diagnosed pathologically as FNH classic type but the rest were either misdiagnosed or left as indeterminate. On radionuclide imaging （hepatic colloid scintigraphy plus triple-phase hepatobiliary images）, 11 patients with big foci （ with maximal diameter 〉 3 cm） out of 24 patients were correctly diagnosed as FNH, with 7 diagnosed as classic type FNH and 4 as non-classic. Other 13 patients were either misdiagnosed or simply missed. The diagnosing rates of routine CT and radionuclide imaging were 60.0% （ 15/25 ） and 38.9% （7/18） for FNH classic type, 0/7 and 4/6 for non-classic type, 50. 0% （10/20） and 73.3% （11/15） for big foci, 41.7% （5/12） and 0/9 for small foci （with maximal diameter ≤ 3 cm）, respectively. The total diagnosing rate of radionuclide imaging combined with routine CT was significantly higher than that of routine CT or radionuclide imaging alone （ χ2 = 4.48, P 〈 0.05 ;χ2 =4.27, P 〈 0.05 ）. Conclusion Radionuclide imaging in combination with routine CT may improve the diagnostic accuracy for hepatic FNH patients.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2011年第4期250-254,共5页
Chinese Journal of Nuclear Medicine
