请帮忙看下我妈妈的CT报告。

yetian324

我妈妈是08年10月28日接受的CT检查，之前超声报告中发现肝脏占位，所以后来进行了CT增强扫描。我把报告贴在下面希望各位高手能给点意见。！
   超声报告。 肝大小形态正常，包膜光滑，肝内结构清晰。肝静脉行走自然，实质回声尚均匀。 于肝左内叶见一个异常回声，大小约18*14mm，其边界不清楚，外形欠规则，以低回声为主，内回声欠均质，内见少许点状中强回声，加彩后异常回声内及周边未见血流信号。门脉主干内径11mm，门脉腔内彩色血流信号充填好。胆囊大小正常，壁光滑，胆囊内透声好，胆总管内径4mm。胰腺显示清楚，胰头厚24mm，胰体厚12mm，胰尾厚15mm，回声均匀，主胰管未见扩张。脾脏回声均匀。
    CT报告。肝脏形态，大小正常，边缘清晰，右后叶下缘与右肾间散在斑点状高密度影；右前叶实质两个类圆形低密度，较大者大小约1.5*0.8cm，边缘清晰，增强后动脉期呈不均匀强化，静脉期强化程度低于正常肝实质，延迟期（延迟2min）扫描显示强化降低；余肝实质密度均等，并呈均匀强化。胆囊形态、大小正常，囊内密度均等，壁不厚，无强化；肝内外胆管未见明显扩张。脾脏不大，实质密度均等并均质强化。胰腺形态、大小及实质未见明显异常，强化均匀等，胰周间隙显示清晰。两侧肾脏形态、大小、实质未见明显异常，强化均等，胰周间隙显示清晰。两侧肾脏形态、大小、实质未见明显异常，强化均匀，肾周间隙显示清晰。腹膜后未见确切肿大淋巴结影。
    甲胎蛋白 3.2 ng/ml
    癌胚抗原 2.2 ng/ml
    肝功正常，没得过肝炎。目前医院还是判断不太清楚，只是让家中修养，经常复查。不知各位大大有什么意见。谢谢了！

liver_GZ

年龄？
乙肝、丙肝等都查过？
CT影像：“右前叶实质两个类圆形低密度，较大者大小约1.5*0.8cm，边缘清晰，增强后动脉期呈不均匀强化，静脉期强化程度低于正常肝实质，......”
特点类似“快进快出”（类似特点的病变良恶性都有，我未见CT片，不想妄加评论），可以把CT片发我邮箱[email protected]，但如此小病灶应该很难明确性质。

处理：
1. 密切观察、随访，每2－3个月复查超声和AFP，每6－12个月复查增强CT/或MRI；
2. 如果心理负担过大，经过一段时间随访复查后，选择射频消融直接毁损该病灶（宁可错杀一万，不可放过一个）。
3. 当然肝穿活检是不错选择；如为恶性，无法绝对排除针道转移的风险。

yetian324

谢谢版主的回复！
我妈妈53岁。这次查了肝功的，正常。 另外妈妈还做了选择性肝脏造影，提示血管瘤？
另外我应该怎么把片发到你邮箱呢？照下来还是怎么 或者扫描吗？

liver_GZ

DSA血管造影提示血管瘤？
血管瘤往往提示为“慢进慢出”或“快进慢出”特点。基本和你描述的CT特征不完全吻合。
能扫描CT片当然最好。也可以发在这个帖子里，让大家分析一下。

liver_GZ

原帖由 liver_GZ 于 2008-10-31 21:24 发表
3. 当然肝穿活检是不错选择；如为恶性，无法绝对排除针道转移的风险。

刚好看到Gut最新的一篇文献（今年11月发表）：肝穿活检的针道转移发生率2.7％。

Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis
M A Silva1, B Hegab1, C Hyde2, B Guo2, J A C Buckels1, D F Mirza1
1 The Liver Unit, University Hospital Birmingham NHS Trust – Queen Elizabeth, Birmingham, UK
2 Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK


Correspondence to:
Mr D F Mirza, Nuffield House, University Hospital Birmingham NHS Trust – Queen Elizabeth, Edgbaston, Birmingham B15 2TH, UK; [email protected]

Background: Needle biopsy of a suspicious liver lesion could guide management in the setting of equivocal imaging and serology, although it is not recommended generally because there is the possibility of tumour dissemination outside the liver. The incidence of needle track seeding following biopsy of a suspicious liver lesion is ill-defined, however.

Methods: A systematic review and meta-analysis of observational studies published before March 2007 was performed. Studies that reported on needle tract seeding following biopsy of suspicious liver lesions were identified. Lesions suspected of being hepatocelleular cancer (HCC) were considered. Data on the type of needle biopsy, diagnosis, incidence of needle track seeding duration to seeding, follow-up and impact on outcome were tabulated.

Results: Eight studies identified by systematic review on biopsy of HCC were included in a meta-analysis. The pooled estimate of a patient with seeding per 100 patients with HCC was 0.027 (95% confidence interval (CI) 0.018 to 0.040). There was no difference whether a fixed or random effects model was used. Q was 4.802 with 7 degrees of freedom, p = 0.684; thus the observed heterogeneity was compatible with variation by chance alone. The pooled estimate of a patient with seeding per 100 patients per year was 0.009 (95% CI 0.006 to 0.013), p = 0.686.

Conclusions: In this systematic review we have shown that the incidence of needle tract tumour seeding following biopsy of a HCC is 2.7% overall, or 0.9% per year.

[ 本帖最后由 liver_GZ 于 2008-11-1 21:20 编辑 ]