目的 探讨多层螺旋CT(MSCT)对 肝转移瘤、原发性肝癌的鉴别诊断价值。 方法 对38例原发性肝癌、30例肝转移瘤 患者行MSCT、全肝CT灌注成像检查，观察 不同病灶影像学表现，并比较不同病灶CT 增强时间、肝脏不同区域CT灌注参数。结 果 影像学表现方面，38例原发性肝癌患 者单发28例，多发10例，以圆形或类圆 形、膨胀性生长为主，增强扫描后不均匀 强化22例，均匀强化11例，无强化5例； 30例肝转移瘤患者单发10例，多发19例， 弥漫型(“雨打沙滩”状)1例，以圆形或 椭圆形为主，增强扫描后不均匀强化18 例，均匀强化10例，无强化2例。CT增强 时间方面，原发性肝癌始增时间、峰值时 间、始消时间均显著短于、持续时间显著 长于肝转移瘤(P＜0.05)。CT灌注参数方 面，原发性肝癌肿瘤组织肝动脉灌注量 (HAP)、肝动脉灌注指数(HPI)均显著高 于、门静脉灌注量(PVP)显著低于瘤周组 织、正常肝脏组织(P＜0.05)；肝转移瘤 肿瘤组织HAP、HPI均显著高于、PVP显著 低于正常肝脏组织(P＜0.05)；原发性肝 癌患者瘤周组织PVP显著高于、HPI显著低 于肝转移瘤瘤周组织（P＜0.05）。结论 MSCT动态增强扫描、CT灌注参数等对原发 性肝癌、肝转移瘤诊断鉴别有重要价值。

Objective To investigate the value of multi-slice spiral CT (MSCT) in the differential diagnosis of liver metastases and primary liver cancer. Methods 38 patients with primary liver cancer and 30 patients with liver metastases were examined by MSCT and whole-liver CT perfusion imaging, and imaging findings of different lesions were observed. The CT enhancement time and CT perfusion parameters of different regions of the liver were compared between different lesions. Results The imaging findings of 38 patients with primary liver cancer showed that there were 28 patients with single lesion and 10 patients with multiple lesions, lesions were round or quasi-circular, showing an expansive growth. After enhanced scan, there was inhomogeneous enhancement in 22 cases, homogeneous enhancement in 11 cases and no enhancement in 5 cases. Among 30 patients with liver metastases, there were 10 patients with single lesion and 19 patients with multiple lesions, the lesion was diffuse type (rain pattering on sand beach type) in 1 case, most of lesions were round or oval. Enhanced scan showed inhomogeneous enhancement in 18 cases, homogeneous enhancement in 10 cases and no enhancement in 2 cases. In terms of CT enhancement time, the initial time of enhancement, time to peak and initial disappearance time of primary liver cancer were significantly shorter than those of liver metastases, while the duration was significantly longer than that of liver metastases (P<0.05). For CT perfusion parameters, the hepatic artery perfusion (HAP) and hepatic perfusion index (HPI) of primary liver cancer were significantly higher than while the portal vein perfusion (PVP) was significantly lower than those of peritumoral tissues and normal liver tissues (P<0.05). The HAP and HPI of liver metastases were significantly higher than those of normal liver tissues while PVP was significantly lower than that of normal liver tissues (P<0.05). The PVP of peritumoral tissues in patients with promary liver cancer was significantly higher than while the HPI was significantly lower than that of the peritumoral tissues in patients with liver metastases (P<0.05). Conclusion MSCT dynamic contrastenhanced scan and CT perfusion parameters are of great value in the differential diagnosis of primary liver cancer and liver metastasis.