역동적 CT에서 간세포암의 경동맥 화학색전술 후 새로 발생하여 조영증강되는 소결절(≤20 mm)의 평가 = Evaluation of Newly Developed Small (≤20 mm) Enhancing Nodules on the Arterial Phase CT after Transcatheter Arterial Cheomoembolization in Patients with Hepatocellular Carcinoma

다국어 초록 (Multilingual Abstract)

Purpose: We assessed the clinical significance of newly developed small (≤20 mm) early-enhancing hepatic nodules on arterial phase CT after performing transcatheter arterial cheomoembolization (TACE) in patients suffering with hepatocellular carcinoma (HCC).
Materials and Methods: We searched for the radiologic reports that showed small early enhancing nodule (≤ 20 mm) on the arterial phase imaging of follow-up CT after performing TACE. Thirty-seven lesions in 30 patients had round or oval shaped nodules and the numbers of nodule for one patient was less than five. We classified the nodules by size, location and the decreased attenuation seen on the portal venous phase. The latest follow-up CTs were reviewed to assess the nodules for the final diagnosis. All the follow-up CTs were twophase spiral CT scans.
Results: Twenty-five (67%) of the 37 nodules were recurred HCC, as was determined on the basis of their interval growth and lipiodol uptake after TACE. Among the 37 nodules, seven (18%) disappeared on the latest follow-up CT and they were considered as definite pseudolesions. The remaining five (15%) were stable in size or they decreased in size, and they were considered as probable pseudolesions. The mean size of the nodules on initial CT was 11 mm. The mean size of the malignant nodules was 11±4.2 mm and that of the benign pseudolesions was 9±4.9 mm. The nodules located on the hepatic surface were possible to definite benign pseudolesions (p<0.05). All ten low attenuated nodules seen on the portal phase were HCCs.
Conclusion: When seen on the follow-up CT scans of HCC patients after performing TACE, the newly developed small early-enhancing nodules were considered to have high potential of being HCC by their locations and enhancing patterns.

국문 초록 (Abstract)

목적: 간세포암의 경동맥 화학색전술 후 추적CT 검사에서 새로이 관찰되는 20 mm 이하의 결절성 동맥기 조영증강의 임상적 의의에 대하여 알아보았다.
대상과 방법: 최근 3년간 간세포암으로 경동맥 화학색전술을 시행 받은 환자의 추적 이중시기 역동적 CT에서 새로 발생한 20 mm 이하의 동맥기 조영증강을 보이는 소결절을 가진 환자 중, 최소 6개월 이상 추적 관찰이 가능하고, 5개 이하의 원형 또는 타원형의 소결절을 가지고 있는 30명 환자의 37개 소결절을 대상으로 위치, 크기, 문맥기의 감쇄밀도 등을 분류한 후 이후의 추적검사로 확인된 최종진단에 따라 비교 분석 하였다.
결과: 소결절 37개중 25개(67%)는 추적검사에서 크기가 커지거나 리피오돌이 침착되어 재발된 간세포암으로 진단되었다. 추적검사에서 사라진 경우 7개(18%)는 양성 위병소로 판정하였다. 리피오돌이 침착이 안되거나 크기 변화가 없는 3개(9%)와 크기가 감소한 2개(6%)는 잠정적인 양성 위병소로 판정하였다. 소결절들의 평균 크기는 11 mm 였고, 이중 악성 소결절의 평균 크기는 11±4.2 mm이고 양성 위병소로 판명된 크기는 9±4.9 mm이었다. 결절의 위치가 표면일수록 양성 위병소일 가능성이 높았다(p < 0.05). 간문맥기에서 저음영을 보이는 소결절 10개는 모두 재발된 간세포암으로 진단되었다.
결론: 간세포암의 경동맥 화학색전술 후 추적 CT에서 나타나는 소결절들에서 결절의 위치와 조영증강 양상이 악성도를 판단하는데 도움을 줄 수 있다.

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