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간 혈관종의 진단과정에서 임상적 및 방사선 형태학적 특징에 대한 연구
천기태,송정선,이수택,김대곤,안득수 의과학연구소 1996 全北醫大論文集 Vol.20 No.2
Objective : Hemangioma is the most common benign neoplasm of the liver and the second most common hepatic tumor, exceeded only by metastatic tumor. Fifty to 20 per cent of patients with hemagiomas are asymptomatic, and the lesions are discovered incidentally, usually by ultrasonography or CT performed for some other reason. Despite their usual benign behavior, hepatic hemagiomas frequently cause difficult diagnostic problems because they can be confused with a malignant neoplasm. Numerous methods are commonly applied to making this decision, including CT, ultrasound, MRI, radionuclide scintigram, angiography, and percutaneous fine needle biopsy. But, the specific diagnostic criteria for hemangioma cannot be reliably demonstrated in every classes. This study was done to evaluate the characteristics and problems of each clinical and radiological method for identifying hemangioma. We can find occasionally very huge sized hemangioma, so has to differenciate from hepatocellular carcinoma. Methods : We considered for symptoms, laboratory results, characteristic findings and problems of above diagnostic methods in 26 patients diagnosed as hepatic hemangioma between March, 1990 and October, 1994 at Chonbuk and Chonnam National University. Results : Hemangiomas occur predominantly in women and seen more commonly in forth and fifth decade. For the most cases the liver function tests are within normal limit or mildly increased. Especially the value of alpha-fetoprotein(AFP) is normal except for one case. Although ultrasound has low sensitivity, it has many advantages as screening test. We can discover that ^(99m)Tc-RBC SPECT and the fine needle aspiration biopsy are safe diagnostic method but has risks such as bleeding and shock. Conclusion : IF the lesion is well marginated and hyperechoic and the patient has normal liver function costs and normal AFP, we recommend only a follow-up sonogram in 3 to 6 months to assess lesion Patients with an atypical sonographic pattern(hypoechoic or mixed) or those with abnormal liver function test or elevated AFP, should have a technetium ^(99m)Tc erythrocyte scan. If the radionuclide scan is negative, MRI should be performed. Needle biopsy of hemangioma should be reserved for those cases in which a confident diagnosis cannot be reached by other means. (Key Words : Hepatic Hemangioma, Radiology)