Imaging Diagnosis And Disposal Strategy Of Liver Small Mass

Objective:To improve the diagnostic and disposal competence of small liver tumors.Methods:161 cases of liver tumor from our hospital's in-patient and out patient were collected in the duration from December 2005 to December 2008. Medical data,liver ultrasonography and AFP blood test were collected and analyzed.Diagnoses were made by two senior doctors and complicated cases followed discussion.Diagnosis of micro HCC made by the combination with results of MRI,ultrasonograpy,AFP and/or the clinical outcome.All cases were performed CT examination using GE Lightspeed spiral CT machine.Follow plain scan,Iodine contrast media Lopamiro 300mgI/ml in 1.5ml/ kg dosage of which usually about 95mi was intravenous injected in the injection speed of 3ml/s.Early arterial phase,late arterial phase and portal venous phase scan were done in the 25,45 and 70 seconds.Some cases were performed delayed scan in 3 and/or 5 minutes.32 cases of the total were performed MRI examination using GE 1.5T Signa MRI machine.Plain scan sequences including axial T2WI fat suppressed and T1WI positive and opposes phase,coronary T2WI fat suppressed.Axial and coronary enhanced scan follow the intravenous administration of Gd-DTPA 20ml.We usually recommend lipiodol CT in the patient with suspected small nodules with significantly increased AFP.CT scan is performed one month after lipiodol trancathether injected.If we see lipiodol deposition,we recommend further interventional therapy.If no lipiol deposition is found,follow up of CT examination and AFP blood test in three months time would be suggested. In the follow up if we observed the lesion significantly enlarged,we then recommend further surgery or interventional therapy.If the lesion doesn't grow up,then 3 to 6 months follow up suggested.We use the above procedure in liver cancer screening.Results:In the total 161 case,the diagnosis of which include 125 cases of HCC(including micro HCC),26 cases of hemangioma,9 cases of FNH and 1 case of aneurysms.In 124 cases,the diagnosis can be confirmed by CT examination.Another 37 case were diagnosed by combination of MRI,AFP and iodine contrast CT examination,lipiodol CT examination were performed in 11 patients(7 cases of micro HCC and 4 cases of small HCC),all the 11 cases were further interventional therapy.125 of 161 patients diagnosed liver carcinoma,102 males and 23 females, male vs.female ratio is about 4.43:1,with the average age of 56.2 in male and 61.0 in female.The high onset age is usually in 40 to 70 years in male and 50 to 80 years in female with the peak age of 60 to 70 years.In our study,one cases has undergone several times of CT,MRI and AFP blood test,the results clearly show the process from liver regenerative nodule to dysplastic nodule to small hepatocellular carcinoma,it also well display the lesion supply blood changes from mainly portal blood in earlier to mainly arterial blood in later.In our study,early arterial phase and late arterial phase scans can detect all hypervascular lesions,portal phase scan can help qualitation diagnosis, but cannot find more lesions.Conclusion:As for liver small and micro lesions,three phases spiral CT examination and MRI examination can help to identify benign and malignancy lesion and is of great value in liver carcinoma screening.In three phases spiral CT scan,dual arterial phase CT scan can sensitively detect hypervascular lesions and show the arterial blood supply feature.It helps differential diagnosis.Portal phase scan can help qualitation diagnosis. Combine use of various imaging examination can improve the diagnostic accuracy of small liver carcinoma.Standardized screening process can instruct routine clinical works.