Atilla ARSLANOĞLU, Turan ILICA, Zeki YEŞİLOVA, Okan KUZHAN

Hepatoselüler karsinomların saptanmasında ve karakterizasyonunda trifazik spiral bilgisayarlı tomografinin tanı değeri

Amaç: Hepatoselüler karsinomların (HK) saptanmasında ve karakterizasyonunda, trifazik spiral Bilgisayarlı Tomografinin (BT) tanı değerini araştırmak. Gereç ve yöntem: 31 HK’lı hasta (18 erkek, 13 kadın, 15 -76 yaş aralığında, ortalama 60.3 ± 11.3) ile karaciğerinde fokal lezyonu olan 7 hasta trifazik spiral BT protokolü ile incelendi. 150 ml kontrast madde, 3 ml/s hız, unifazik uygulama, hepatik arteriyel faz (HAF) için 20-40 s gecikme zamanı, portal venöz faz (PVF) için 60-90 s gecikme zamanı, geç faz (GF) için 3-8 dk gecikme zamanı ile tüm hastalarda, HAF’da iyi bir vasküler kontrastlanma, PVF’da yeterince parankimal kontrastlanma, GF’da da ekstravasküler boşlukta kontrastlanma sağlandı. Bulgular: 31 HK ile birlikte, 3 kist, 3 hemanjom, 1 fokal nodüler hiperplazi saptandı. HK olguları HAF’da % 58 (n=18) hiperattenuasyon, % 32 (n=10) hipoattenuasyon, % 10 (n=3) izoattenuasyon, PVF’da % 54 (n=17) hipoattenuasyon, % 32 (n=10) hiperattenuasyon, % 14 (n=4) izoattenuasyon, GF’da ise % 74 (n=23) hipoattenuasyon, % 19 (n=6) hiperattenuasyon ve % 7 (n=2) izoattenuasyon gösterdi. (HAF+ PVF+GF)’da (trifazik) incelemenin sensitivitesi (% 90.3), sadece (HAF+ PVF)’da (dual faz) incelemenin sensitivitesinden (% 88.7) yüksek olarak saptandı. Sonuç: Trifazik spiral BT, HK ve diğer KC’deki fokal lezyonların saptanmasında ve karakterizasyonunda standart BT tekniği olarak hızla kabul görmüştür. İleride otomatik bilgisayar programları ile kullanılan parametreler optimize edilerek daha iyi sonuçlar elde edilebilecektir.

Anahtar Kelimeler:

Tomografi, x-ışınlı bilgisayarlı, Tanı, Karsinom, hepatosellüler

The value of triphasic computed tomography in the detection and characterization of hepatocellular carcinomas

Objective: To evaluate the value of triphasic computed tomography (CT) in the detection and characterization of hepatocellular carcinomas (HCC). Materials and methods: Thirty-one HCC cases (18 male, 13 female, range 15-76 years, mean 60.3 ± 11.3) and 7 cases with focal liver lesions evaluated with triphasic spiral CT. We got optimum vascular contrast in hepatic arterial phase (HAP), paranchymal contrast in portal venous phase (PVP), and extravascular space contrast in late phase (LP) with 150 ml of non-ionic contrast material containing 300 mg/ml iodine, and 3 ml/sec monophasic injection rate, 20-40 second delay time for HAP, 60-90 second delay time for PVP and 3-8 minutes delay time for LP respectively. Results: With 31 HCC patients we detected 3 cysts, 3 hemangiomas and focal nodular hiperplasia. HCCs were hyperattenuated 58% (n=18), hypoattenuated 32% (n=10), and isoattenuated 10% (n=3) in HAP; hypoattenuated 54% (n=17), hyperattenuated 32% (n=10), isoattenuated 14% (n=4) in PVP; hypoattenuated 74% (n=23), hyperattenuated 19% (n=6), isoattenuated 7% (n=2) in LP. Sensitivity of HAP+PVP+LP (triphasic) CT (90.3%) was significantly higher than that of PVP+LP (dual phase) CT (88.7%). Conclusion: Triphasic spiral CT accepted as a standart CT technique for detection and characterization of HCC and focal liver lesions. We realized that we could get good results by automatic computer programs optimization in future.

Keywords:

Tomography, X-Ray Computed, Diagnosis, Carcinoma, Hepatocellular,

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