MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究*

doi:10.3969/j.issn.1672-5069.2019.06.031

实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (6): 900-903.doi: 10.3969/j.issn.1672-5069.2019.06.031

MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究^*

曾艳妮, 张灿, 毕俊英, 刘良进, 孟俊, 秦涛

430033武汉市湖北省第三人民医院/湖北省中山医院放射科（曾艳妮,毕俊英,刘良进,孟俊,秦涛）; 华中科技大学同济医学院附属协和医院放射科（张灿）

收稿日期:2018-11-22 出版日期:2019-11-13 发布日期:2019-11-13
通讯作者: 秦涛,E-mail:qyypiano@163.com
作者简介:曾艳妮,女,43岁,大学本科,副主任医师。主要从事影像学诊断与治疗学研究。E-mail:521034549@qq.com
基金资助:
*湖北省自然科学基金资助项目（编号：3689272）

Value of long-time delayed enhancement scan of MRI in the diagnosis of solitary necrotic nodule of liver

Zeng Yanni, Zhang Can, Bi Junying, et al.

Department of Radiology,Third People's Hospital,Wuhan 430033,Hubei Province

Received:2018-11-22 Online:2019-11-13 Published:2019-11-13

摘要/Abstract

摘要： 目的探讨磁共振成像（MRI）长时间延迟增强扫描诊断肝脏孤立性坏死性结节（SNNL）的价值。方法 2013年5月~2018年5月我院就诊的17例SNNL患者和15例肝脏恶性肿瘤患者（其中10例为肝细胞癌和5例为肝转移癌）,所有患者均行常规CT/MRI增强扫描及MRI多期长时间延迟至120 min扫描,分别比较两组病灶影像学特征,如病灶密度、强化类型,探讨长时间延迟扫描在鉴别SNNL与肝脏恶性肿瘤中的作用。结果在SNNL患者,CT和MRI共检出17个病灶,均位于肝右叶,且均为单发病灶,直径为（2.1±0.4） cm;在10例HCC患者,MRI检查发现11个病灶,位于肝右叶者8个,位于肝左叶者3个。单发病灶9例,多发病灶1例,直径为（5.4±1.6） cm;在5例肝脏转移癌患者中,共检出12个病灶,位于肝右叶者9个,位于肝左叶者3个,直径为（3.1±0.9）cm;在SNNL病灶中有4个病灶在T2WI上表现为“靶征”,与肝转移癌病灶的影像学表现类似;在延迟期（DP）3/5 min扫描,HCC和肝转移癌病灶边缘多呈中度-重度环形强化,SNNL病灶边缘强化水平随着延迟时间延长而逐渐增强。在DP 1 h时,17个病灶均表现为中度-重度环形强化,病灶中心无强化,而肝脏恶性肿瘤病变边缘强化均已消失。结论 MRI 长时间延迟增强扫描能有效区分SNNL与肝脏恶性肿瘤,主要表现为在延迟扫描时呈病灶边缘和间隔环形强化,且病变中心无强化。

关键词: 肝孤立性坏死性结节, 磁共振成像, 延迟扫描, 诊断

Abstract: Objective To evaluate the value of long-time delayed contrast-enhanced scan of magnetic resonance imaging （MRI） in the diagnosis of patients with solitary necrotic nodules of the liver （SNNL）. Methods 17 patients with SNNL and 15 patients with malignant liver tumors（including 10 with hepatocellular carcinomas and 5 with hepatic metastases） were admitted to our hospital between May 2013 and May 2018,and all patients underwent conventional CT/MRI enhanced scan and multi-phase long-delayed to 120 minute MRI scanning. The imaging characteristics,such as density and enhancement type of the lesions were compared between the two groups. Result Out of 17 patients with SNNL,17 single foci were found by CT and MRI scan,all localized in right lobe with the diameters of（2.1±0.4） cm;out of 10 patients with HCC,MRI scan demonstrated 11 foci,8 localized in right and 3 in left lobe with the diameters of（5.4±1.6） cm;out of 5 patients with metastases,12 foci were found,9 localized in right,and 3 in left lobe,with the diameters of （3.1±0.9） cm;four SNNL lesions showed “target sign” on T2WI and the imaging manifestation of liver metastases were similar to those of SNNL;at delayed phase （DP）3/5 min,the edge of HCC and liver metastasis foci showed moderate to severe circular enhancement,and the enhancement in SNNL was intensified as the scan time prolonged;at DP 1 hour,17 SNNL foci showed moderate to severe circular enhancement and no enhancement in the centre of each lesion,while all enhancement in tumors disappeared. Conclusion Long-time delayed contrast-enhanced MRI might effectively distinguish SNNL from malignant hepatic tumors,which needs further investigation.

Key words: Solitary necrotic nodules, liver, Delayed MRI scanning, Diagnosis

曾艳妮, 张灿, 毕俊英, 刘良进, 孟俊, 秦涛. MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 900-903.

Zeng Yanni, Zhang Can, Bi Junying, et al.. Value of long-time delayed enhancement scan of MRI in the diagnosis of solitary necrotic nodule of liver[J]. Journal of Practical Hepatology, 2019, 22(6): 900-903.

参考文献

[1] Yang WM,Yu XL,Jie TM, et al.Solitary necrotic nodule of the liver:Contrast-enhanced sonography. J Clin Ultrasound,2010,35(4):177-181.
[2] Chang SC,Cho EY,Jin SJ,et al.Spontaneous regression of a solitary necrotic nodule of the liver. Hepat Int,2010,4(3):649-652.
[3] 钟武宁,康巍,胡雪莹,等. 钆塞酸二钠增强MRI对小肝癌诊断效果的Meta分析. 中国CT和MRI杂志,2014,12(6):54-57.
[4] 黄召弟,向颖,孟祥水,等. 肝细胞癌MRI延迟强化特征与纤维组织分布的关系. 中华放射学杂志,2017,51(3):183-187.
[5] Fang J,Ma X,Yu D,et al.Specific imaging characteristic of solitary necrotic nodule of the liver:Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI. Eur Radiol,2017,27(9):1-11.
[6] Cirillo M,Scomazzoni F,Cirillo L,et al.Comparison of 3D TOF-MRA and 3D CE-MRA at 3T for imaging of intracranial aneurysms. Eur J Radiol,2013,82(12):E853-E859.
[7] Qian H,Li S,Ming J,et al.MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules. Eur J Gastroenterol Hepatol,2016,28(7):749-756.
[8] Endo Y,Hikita H,Hamada A,et al.A case of solitary necrotic nodule of the liver with acute liver dysfunction:The imaging appearance correlated with pathological findings. J Med Ultrason,2003,30(3):193-198.
[9] Kang MW,Tay TKY,Poh WT,et al.Solitary necrotic nodule of the liver:Radiologic-pathologic correlation in a case with unusual imaging features. Jpn J Radiol,2013,31(4):277-281.
[10] De LM,Luigi B,Formisano C,et al.Solitary necrotic nodule of the liver misinterpreted as malignant lesion:considerations on two cases. J Surg Oncol,2015,74(3):219-222.
[11] 彭爱琴,李全卫,宋淮,等. 多排螺旋CT 对肝脏孤立性坏死结节的诊断价值. 医学影像学杂志,2015,25(2):283-285.
[12] Wang LX,Liu K,Lin GW,et al.Solitary necrotic nodules of the liver:Histology and diagnosis with CT and MRI. Hepat Mon,2012,12(8):e6212.
[13] Colagrande S,Politi LS,Messerini L,et al.Solitary necrotic nodule of the liver:Imaging and correlation with pathologic features. Abdom Imaging,2003,28(1):41-44.
[14] Kanematsu M,Kondo H,Goshima S,et al.Imaging liver metastases:review and update. Eur J Radiol,2006,58(2):217-228.
[15] 李晶,唐少珊,于宏伟. 超声造影在单发转移性肝癌与肝脏孤立性坏死结节鉴别诊断中的价值. 临床肝胆病杂志,2016,32(7):1338-1341.
[16] Li G.Solitary necrotic nodule of the liver:MR findings in 33 pathologically proved lesions. Eur J Radiol,2012,81(4):623-629.
[17] Nicolau C,Catalá V,Vilana R,et al.Evaluation of hepatocellular carcinoma using SonoVue,a second generation ultrasound contrast agent:correlation with cellular differentiation. Eur Radiol,2004,40(6):1092-1099.
[18] Bartolotta TV,Taibbi A,Midiri M,et al.Focal liver lesions:contrast-enhanced ultrasound. Abdom Imaging,2009,34(2):193-209.
[19] Kim YK,Park G,Kim CS,et al.Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterization of liver metastases:comparison with multidetector-row CT. Brit J Radiol,2012,85(1013):539-547.
[20] Namasivayam S,Martin DR,Saini S.Imaging of liver metastases:MRI. Cancer Imaging,2007,7(1):2-9.
[21] 刘立国,王黎明,荣维淇,等. 肝脏孤立性坏死结节10例. 中华普通外科杂志,2011,26(10):853-855.

MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究^*

Value of long-time delayed enhancement scan of MRI in the diagnosis of solitary necrotic nodule of liver

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会. 脂肪性肝病诊疗规范化的专家建议（2019年修订版）[J]. 实用肝脏病杂志, 2019, 22(6): 787-792.
[2]	. 肝纤维化诊断及治疗共识（2019年）[J]. 实用肝脏病杂志, 2019, 22(6): 793-803.
[3]	吴海义, 陈建新. 四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 832-835.
[4]	曹策, 郁义星, 王贝贝, 赵卫峰. 增强磁共振成像联合血清甲胎蛋白和脱-γ-羧基凝血酶原诊断肝细胞癌临床价值探讨[J]. 实用肝脏病杂志, 2019, 22(6): 896-899.
[5]	邢昊, 韩骏, 杨田. 应用血清PIVKA-II诊断肝细胞癌研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 934-937.
[6]	梁巨波, 苗琪, 马雄. 胆管细胞型胆汁淤积诊治进展[J]. 实用肝脏病杂志, 2019, 22(6): 941-943.
[7]	高伟, 侯勇. 肝脏硬度值检测诊断慢性乙型肝炎患者肝组织纤维化的效能分析*[J]. 实用肝脏病杂志, 2019, 22(5): 652-655.
[8]	黄汉军, 鲁凤荣, 张灿. 基于Exchange血流动力学模型的MRI扫描参数诊断肝硬化临床价值分析*[J]. 实用肝脏病杂志, 2019, 22(5): 696-699.
[9]	金良红, 李兴杰, 关红博, 麻少辉. 双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学和肝功能临床价值研究*[J]. 实用肝脏病杂志, 2019, 22(5): 712-715.
[10]	洪佳, 吴晓宁, 尤红. 胆汁淤积性肝病的规范化诊断[J]. 实用肝脏病杂志, 2019, 22(5): 758-760.
[11]	程华, 鞠辉, 宋德顺, 李伟. 慢性乙型肝炎患者血清血管生成素样蛋白2和高尔基体蛋白73水平变化及其诊断显著肝纤维化的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 494-497.
[12]	余英芳, 温生宝. 应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎患者肝纤维化程度效能研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 502-505.
[13]	张亚飞, 叶珺, 谢琴秀, 邹桂舟, 李家斌, 李旭, 张振华. 不同医院无创性肝纤维化指标预测慢性乙型肝炎患者肝纤维化效能差异分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 510-513.
[14]	谢晓, 刘婷, 董志霞, 夏幼辰, 张启迪, 曲颖, 蔡晓波, 徐铭益, 陆伦根. FibroTouch检测肝脏受控衰减参数对肝脂肪变的诊断价值分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 526-529.
[15]	张骏飞, 许何明, 宋海燕, 董静, 潘劲劲, 陈照林, 徐军, 陈从新, 刘波. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征：巴黎标准诊断中国患者灵敏度低[J]. 实用肝脏病杂志, 2019, 22(4): 537-540.