Mastropasqua Maria, Braga Larissa, Kanematsu Masayuki, Vaidean Georgeta, Shrestha Roshan, Leonardou Polytimi, Firat Zeynep, Woosley John T, Semelka Richard C
Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, USA.
Magn Reson Imaging. 2005 May;23(4):557-62. doi: 10.1016/j.mri.2005.02.001.
To assess by MR imaging the frequency of hepatic nodules in patients waiting on the liver transplant list and to determine whether certain underlying hepatic diseases were more often associated with the development of such hepatic nodules.
We reviewed the MR and clinical records in all patients seen by the liver transplant service at our center since its inception in January 1998 until September 2002. A total of 371 patients (207 men and 164 women, age range 18-68 years, mean 45 years) were included in the study. The presence of hepatic nodules, size, number and underlying hepatic diseases were determined in all patients. Magnetic resonance imaging was performed on a 1.5-T MR imager using T1-weighted, T2-weighted and multi-phase gadolinium-enhanced sequences. Odds ratio (OR) and 95% confidence intervals (CIs) were computed to evaluate the association between the underlying hepatic disease and the development of hepatic nodule.
Among 371 liver transplantation candidates, the most common underlying hepatic disease was hepatitis C virus (HCV) infection, either alone (n=93; 25%) or associated with other hepatic diseases (n=40; 10.8%). Of all patients, 33 (8.9%) had regenerative nodules (RNs), 40 (10.7%) dysplastic nodules (DNs) and 57 (15.3%) hepatocellular carcinomas (HCCs). Hepatocellular carcinoma was observed in 35.3% of patients with HCV infection and alcohol abuse combined, 24.5% with cryptogenic cirrhosis, 25% with hemochromatosis and 19% with alcohol abuse. Patients who had either DNs or HCC were 2.5 times more likely to have either alcohol abuse or HCV, alone or combined, as the substrate of their liver disease (OR 2.54, 95% CI 1.56-4.13). Our data suggest a supra-additive interaction between HCV infection and ethanol in their association with MR imaging detected lesions.
Patients with cryptogenic cirrhosis, alcohol abuse, HCV infection (alone or combined) and hemochromatosis had the greatest likelihood of having HCC, with the combination of HCV infection and alcohol abuse having the highest of all.
通过磁共振成像（MR）评估等待肝移植患者肝脏结节的发生率，并确定某些潜在肝脏疾病是否更常与此类肝脏结节的发生相关。
我们回顾了自1998年1月本中心肝移植服务开展至2002年9月期间所有患者的MR和临床记录。共有371例患者（男性207例，女性164例，年龄范围18 - 68岁，平均45岁）纳入研究。确定所有患者肝脏结节的存在情况、大小、数量及潜在肝脏疾病。在1.5-T MR成像仪上采用T1加权、T2加权及多期钆增强序列进行磁共振成像检查。计算优势比（OR）及95%置信区间（CI）以评估潜在肝脏疾病与肝脏结节发生之间的关联。
在371例肝移植候选患者中，最常见的潜在肝脏疾病是丙型肝炎病毒（HCV）感染，单独感染（n = 93；25%）或与其他肝脏疾病合并感染（n = 40；10.8%）。所有患者中，33例（8.9%）有再生结节（RNs），40例（10.7%）有发育异常结节（DNs），57例（15.3%）有肝细胞癌（HCCs）。在HCV感染合并酒精滥用的患者中，35.3%观察到肝细胞癌；隐源性肝硬化患者中为24.5%；血色素沉着症患者中为25%；酒精滥用患者中为19%。患有DNs或HCC的患者患酒精滥用或HCV（单独或合并）作为其肝脏疾病基础的可能性是其他患者的2.5倍（OR 2.54，95% CI 1.56 - 4.13）。我们的数据表明HCV感染与乙醇在与MR成像检测到的病变关联中存在超相加相互作用。
隐源性肝硬化、酒精滥用、HCV感染（单独或合并）及血色素沉着症患者发生HCC的可能性最大，其中HCV感染合并酒精滥用的可能性最高。
