磁共振成像鉴别诊断肝硬化背景下不典型增生结节与小肝癌临床价值研究*

doi:10.3969/j.issn.1672-5069.2026.01.034

摘要/Abstract

摘要： 目的探讨增强磁共振成像(MRI)在肝硬化背景下鉴别诊断不典型增生结节(DN)与小肝细胞癌(sHCC)的价值。方法 2022年7月~2025年7月我院诊治的104例存在肝脏结节性病变的肝硬化患者,均接受钆塞酸二钠增强MRI检查,经手术后或穿刺组织行病理学检查诊断。结果本组经病理学检查诊断DN者46例,诊断sHCC者58例;DN病灶结节直径为(0.9±0.2)cm,sHCC病灶直径为(1.1±0.2)cm;DN病灶T1WI多表现为高信号或等信号,T2WI和DWI多表现为低信号,而sHCC病灶T1WI多表现为低信号或等信号,T2WI和DWI多表现为高信号。sHCC病灶动脉期强化、门静脉期廓清、肝胆期呈低信号和“快进快出”模式,其相对ADC值显著小于DN组;增强MRI鉴别诊断的灵敏度为89.7%,特异度为91.3%,准确度为90.4%。与病理学诊断的Kappa值为0.81。结论增强MRI可鉴别诊断DN与sHCC,两种病灶在信号强度和强化方式等方面有明显的区别,可帮助鉴别。

关键词: 肝肿瘤, 肝硬化, 不典型增生结节, 增强磁共振成像, 钆塞酸二钠, 鉴别诊断

Abstract: Objective The aim of this study was to investigate differential diagnosis of dysplastic nodule (DN) and small hepatocellular carcinoma (sHCC) under background of liver cirrhosis (LC) by enhanced magnetic resonance imaging (MRI). Methods A total of 104 patients with LC and intrahepatic nodular lesions were encountered in our hospital between July 2022 and July 2025, and all underwent Gd-EOB-DTPA enhancement of 3.0 T MR. The diagnosis was proven by histo-pathological examination. Results The histo-pathological examination diagnosed DN with dimeter of (0.9±0.2)cm in 46 cases and sHCC with diameter of (1.1±0.2)cm in 58 cases in our series; DN lesions presented with high or equal signals on T1WI mostly, and with low signals on T2WI and DWI mostly, while sHCC lesions showed with low or equal signals on T1WI mostly, and with high signals on T2WI and DWI mostly; sHCC lesions demonstrated with enhancement at arterial phase, clearance at portal vein phase, low signals at hepatobiliary phase and "fast-in and fast-out" mode, and their relative apparent diffusion coefficient (ADC)was much lower than ADC lesions; the differential diagnosis by MRI was excellent with sensitivity of 89.7%, the specificity of 91.3% and the accuracy of 90.4%, and the Kappa was 0.81 as compared to histo-pathological diagnosis. Conclusion MRI by Gd-EOB-DTPA enhancement could provide differential diagnosis of DN and sHCC, and the signal intensity and enhancement mode between the two lesions were mostly different.

Key words: Hepatoma, Liver cirrhosis, Enhanced magnetic resonance imaging, Gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid, Dysplastic nodule, Differential diagnosis

王威, 孟云, 冀鹏. 磁共振成像鉴别诊断肝硬化背景下不典型增生结节与小肝癌临床价值研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 133-136.

Wang Wei, Meng Yun, Ji Peng. Differential diagnosis of dysplastic nodule and small hepatocellular carcinoma under background of liver cirrhosis by enhanced magnetic resonance imaging[J]. Journal of Practical Hepatology, 2026, 29(1): 133-136.

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磁共振成像鉴别诊断肝硬化背景下不典型增生结节与小肝癌临床价值研究^*

Differential diagnosis of dysplastic nodule and small hepatocellular carcinoma under background of liver cirrhosis by enhanced magnetic resonance imaging

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