Braga Larissa, Semelka Richard C, Danet Ioana-Maria, Venkataraman Shambhavi, Woosley John T
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Magn Reson Imaging. 2003 Oct;21(8):871-7. doi: 10.1016/s0730-725x(03)00187-5.
To demonstrate the MR imaging features of liver metastases in patients with the clinical and histologic diagnosis of tumors of unknown primary tumors, a retrospective 7-year study was performed that included a total of 14 consecutive patients (7 men and 7 women; age range, 39-82 years; mean age, 60.6 years) with liver metastases from unknown primary site who had undergone MR imaging. The following lesion features were evaluated: a) number, b) diameter, c) signal intensity on T1 and T(2)-weighted images, and d) pattern of enhancement on immediate, 45 s and 90 s post gadolinium images. Lesions were classified as hypovascular, hypervascular and nearly isovascular relative to liver parenchyma as shown on immediate post gadolinium images. Patients were separated into four major groups, related to the histologic diagnosis of the lesions: (I) poorly differentiated neoplasms; (II) well-differentiated and moderately differentiated adenocarcinoma; (III) squamous cell carcinoma; (IV) combined poorly differentiated carcinoma and poorly differentiated adenocarcinoma. MRI findings were correlated with histologic information obtained by chart review and confirmed by retrospective histopathology review. All patients had the histologic diagnosis of adenocarcinoma: 8 patients belonged to group II (1 patient with the subtype well-differentiated and 7 patients with the subtype moderately differentiated) and 6 patients to group IV. Eleven patients (79%) presented with multiple lesions distributed throughout both hepatic lobes; 3 patients exhibited solitary lesions. All solitary metastases possessed a diameter equal or larger than 5 cm. Patients with multiple metastases demonstrated a wide range of diameter, ranging from less than 1.5 cm to more than 5 cm. Regarding lesion vascularity, 4 of 13 of the patients had hypovascular metastases and 9 of 13 of the patients had hypervascular lesions. One patient demonstrated both types of lesions. Five of six patients with the histopathologic diagnosis of poorly differentiated adenocarcinoma demonstrated hypervascular metastases. Solitary metastases were most often hypovascular (2 of 3); however no correlation with the histologic subtype was possible. Liver metastases from unknown primary site are often multiple and often hypervascular. Poorly differentiated tumors are the most common histologic type. Metastases are not uncommonly hypovascular, and these are often solitary.
为了阐明临床及组织学诊断为原发肿瘤不明的患者肝脏转移瘤的磁共振成像（MR）特征，我们进行了一项为期7年的回顾性研究，纳入了14例连续的肝脏转移瘤患者（7例男性和7例女性；年龄范围39 - 82岁；平均年龄60.6岁），这些患者均来自原发部位不明且接受过MR成像检查。对以下病变特征进行了评估：a）数量，b）直径，c）T1加权像和T2加权像上的信号强度，以及d）钆剂注射后即刻、45秒和90秒图像上的强化模式。根据钆剂注射后即刻图像上相对于肝实质的情况，病变被分类为乏血管性、富血管性和近等血管性。患者根据病变的组织学诊断被分为四大组：（I）低分化肿瘤；（II）高分化和中分化腺癌；（III）鳞状细胞癌；（IV）低分化癌合并低分化腺癌。MR成像结果与通过病历回顾获得并经回顾性组织病理学检查证实的组织学信息相关。所有患者均经组织学诊断为腺癌：8例患者属于II组（1例高分化亚型和7例中分化亚型），6例患者属于IV组。11例患者（79%）表现为分布于两肝叶的多发病变；3例患者表现为孤立性病变。所有孤立性转移瘤直径均等于或大于5 cm。多发转移瘤患者的病变直径范围较广，从小于1.5 cm至大于5 cm。关于病变血管情况，13例患者中有4例为乏血管性转移瘤，13例患者中有9例为富血管性病变。1例患者表现为两种类型的病变。组织病理学诊断为低分化腺癌的6例患者中有5例表现为富血管性转移瘤。孤立性转移瘤最常见为乏血管性（3例中有2例）；然而，与组织学亚型之间无相关性。原发部位不明的肝脏转移瘤通常为多发且常为富血管性。低分化肿瘤是最常见的组织学类型。转移瘤不乏为乏血管性，且这些常为孤立性。
