Kanematsu Masayuki, Semelka Richard C, Leonardou Polytimi, Mastropasqua Maria, Lee Joseph K T
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27599-7510, USA.
J Magn Reson Imaging. 2003 Aug;18(2):189-95. doi: 10.1002/jmri.10336.
To assess MR imaging findings and clinical manifestations of diffuse-type hepatocellular carcinoma (HCC).
We retrospectively reviewed our experience with diffuse HCC from November 1994 to October 2001. MR imaging findings and clinical features were assessed.
Twenty-two consecutive patients with diffuse-type HCC (19 men and three women, age range 16-80 years [mean, 52 years]) were identified in a review of liver MR studies. This represented 13% of all patients with HCC imaged during this time period. Diffuse HCC showed a permeative, infiltrative pattern with ill-defined borders and no evidence of convex margination in all cases. At least 50% of the liver volume was involved with tumor. Diffuse-type HCC showed hypointensity in 15 patients, mixed intensity in three, and isointensity in four on T1-weighted images; heterogeneous hyperintensity in 16 patients; and homogeneous hyperintensity in six on T2-weighted MR images. Diffuse-type HCC showed patchy enhancement in 12 patients, miliary enhancement in nine, and minimal enhancement in one on postcontrast early-phase images, and showed heterogeneous wash-out in all patients on postcontrast late-phase images. Proximal portal venous tumor thrombosis was seen in all patients. Serum alpha-fetoprotein (AFP) value was elevated (>10 ng/mL) in 14 of 18 patients, and 13 showed a value greater than 500 ng/mL. The four patients who did not have elevated AFP had tumors which were indistinguishable from those in patients with elevated AFP; they also did not have a distinctive clinical history.
Diffuse-type HCC was typically seen as an extensive, heterogeneous permeative hepatic tumor, with portal venous tumor thrombosis on MR images in all cases. Early enhancement, observed as patchy in 12 and miliary in nine of 22 patients, was a distinctive imaging feature. Elevated serum AFP value was a common finding; however, 22% had normal values.
评估弥漫型肝细胞癌（HCC）的磁共振成像（MR）表现及临床表现。
回顾性分析1994年11月至2001年10月期间弥漫型HCC的诊治经验，评估MR成像表现及临床特征。
在肝脏MR研究回顾中，共识别出22例连续的弥漫型HCC患者（男性19例，女性3例，年龄范围16 - 80岁[平均52岁]）。这占该时间段内所有接受HCC成像患者的13%。弥漫型HCC均表现为浸润性、弥漫性生长模式，边界不清，无外凸边缘。至少50%的肝脏体积被肿瘤累及。弥漫型HCC在T1加权像上，15例呈低信号，3例呈等信号，4例呈等信号；在T2加权像上，16例呈不均匀高信号，6例呈均匀高信号。增强扫描动脉期，12例呈斑片状强化，9例呈粟粒状强化，1例强化不明显；延迟期均呈不均匀廓清。所有患者均见门静脉主干癌栓形成。18例患者中14例血清甲胎蛋白（AFP）升高（>10 ng/mL），13例大于500 ng/mL。4例AFP未升高患者的肿瘤与AFP升高患者的肿瘤无明显差异，临床病史也无明显特征。
弥漫型HCC在MR图像上通常表现为广泛、不均匀的浸润性肝脏肿瘤，均伴有门静脉癌栓形成。早期强化表现为22例中的12例斑片状强化和9例粟粒状强化，是其独特的影像学特征。血清AFP升高较为常见，但22%的患者AFP值正常。
