原发性肝癌与肝局灶性结节性增生MRI平扫及强化特征研究

doi:10.3969/j.issn.1672-5069.2017.03.019

摘要/Abstract

摘要： 目的分析原发性肝癌（PLC）和肝局灶性结节性增生（FNH）磁共振成像（MRI）平扫及强化特征的差异,以探讨应用MRI鉴别诊断两者的方法。方法 2014年7月~2016年6月我院诊治的26例FNH和36例PLC患者,使用SuperMark 1.5 T磁共振成像仪行MRI平扫和动态增强扫描。比较两组病灶分布情况和影像学表现特征。结果 FNH病灶在左叶和右叶的比例分别为30.8%和69.2%,与PLC病灶（38.9%和61.1%）比,差异无统计学意义（均P>0.05）,但FNH病灶位于肝包膜下的比例为46.2%,显著高于PLC组的16.7%（P<0.05）;FNH病灶直径为（4.8±0.8） cm,与PLC病灶的（5.1±0.8） cm比,差异无统计学意义（P>0.05）;平扫结果显示FNH病灶T1低信号和等信号比例分别为84.6%和15.4%,与PLC病灶（88.9%和11.1%）比,差异无统计学意义（P>0.05）;FNH病灶T2高信号和等信号比例分别为88.5%和11.5%,与PLC病灶（91.7%和8.3%）比,差异无统计学意义（P>0.05）;PLC病灶内往往显示长T1和长T2两个信号的坏死区,还出现短T1和混杂T2的出血信号,而部分FNH病灶中心处可见星芒状的结构,呈现出长T1和长T2信号。FNH显示中心瘢痕和供血动脉的比例分别为65.4%和46.2%,均显著高于PLC病灶（8.3%和8.3%,P<0.05）,存在门静脉栓子和肝硬化的比例分别为0.0%和7.7%,均显著低于PLC病灶（分别为25.0%和55.6%,P<0.05）,快进快出强化和淋巴结肿大的比例分别为88.5%和0.0%,与PLC病灶的86.1%和11.1%比,差异均无统计学意义（P>0.05）。结论使用MRI检查可清晰地区分PLC与FNH的影像学特征,有助于两者的判别和鉴别诊断。

关键词: 原发性肝癌, 肝局灶性结节性增生, 磁共振成像, 强化特征

Abstract: Objective To study the difference of magnetic resonance imaging（MRI） scan and enhanced features of patients with primary liver cancer （PLC） and focal nodular hyperplasia （FNH）. Methods 26 patients with FNH and 36 patients with PLC between July 2014 and June 2016 were enrolled in this study,and all of them finished MRI check-up. Lesion distribution and imaging manifestation were compared between the two lesions. Results The proportion of lesions in the left lobe and right lobe in FNH foci were 30.8% and 69.2%）,not statistically different as compared with PLC foci（38.9% and 61.1%,P>0.05）,while the foci under hepatic capsule in FNH was 46.2%,much higher than in PLC（16.7%,P<0.05）;the lesion diameters in FNH foci was （4.8±0.8） cm,not statistically different compared to PLC foci[（5.1±0.8）cm,P>0.05];plain scan results showed that the proportion of low and equal signal in T1 in FNH foci were 84.6% and 15.4%,no significant difference compared with PLC foci（88.9% and 11.1%,P>0.05）;the proportion of high and equal signal in T2 in FNH foci were 88.5% and 11.5%,not statistically significantly different as compared with PLC foci（91.7% and 8.3%,respectively,P>0.05）;Tumor lesions often showed long T1 and long T2 signals in necrotic area in PLC foci,while FNH exhibited a central stellate structure and a signal of long T1 and long T2;the proportion of central scar and feeding arteries in FNH foci were radiologically 65.4% and 46.2%,much higher than 8.3% and 8.3% in PLC foci （P<0.05）;the proportion thrombus in portal vein and cirrhosis in FNH foci were 0.0% and 7.7%,much lower than 25.0% and 55.6% in PLC foci（P<0.05）;the proportion of fast-in and fast-out enhancement and swollen lymph nodes in FNH were 88.5% and 0.0%,not significant different as compared with PLC foci （86.1%and 11.1%,respectively,P>0.05）. Conclusion MRI can clearly distinguish PLC and FNH,which can help the diagnosis in clinical practice.

Key words: Primary liver cancer, Focal nodular hyperplasia, Magnetic resonance imaging, Enhanced features

徐安波, 侯激流, 徐茜. 原发性肝癌与肝局灶性结节性增生MRI平扫及强化特征研究[J]. 实用肝脏病杂志, 2017, 20(3): 333-336.

Xu Anbo, Hou Jiliu, Xu Qian. MRI scan and enhanced features of primary liver cancer and focal nodular hyperplasia[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(3): 333-336.

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