肝硬化肝脏中再生结节和发育异常结节的磁共振成像特征

MR features of regenerative nodules and dysplastic nodules in the cirrhotic liver.

作者信息

Xu Haibo, Kong Xiangquan, Xiong Ying, Zhang Xiangqun

机构信息

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

出版信息

J Huazhong Univ Sci Technolog Med Sci. 2005;25(5):601-3. doi: 10.1007/BF02896030.

DOI:10.1007/BF02896030

PMID:16463687

Abstract

In order to study MR features of the regenerative nodule (RN) and dysplastic nodule (DN) of the cirrhotic liver, 26 cases of cirrhotic liver with RNs and DNs, of which 8 cases accompanied with hepatocellular carcinoma, were subjected to MRI. Eighteen of 26 cases underwent additional enhanced MRI with administration of Gd-DTPA on T1WI and 10 of the 18 cases did additional SPIO (Feridex) enhancement on T2WI. Clinical data showed normal level of alpha-fetoprotein in 18 cases except 8 cases accompanied with HCC. The results showed that 12 cases had RNs with nodules measuring < 1 cm. The MR appearance of those RNs showed isointensity on T1WI and hypointensity on T2WI. The intensity of those RNs was isointense to the surrounding hepatic parenchyma on enhanced MRI with administration of Gd-DTPA or SPIO. Among the 14 cases of DNs, 8 cases had nodules measuring 1-3 cm in size and 6 had macroregenerative nodule measuring > 3 cm. In 8 cases with DNs measuring 1-3 cm in size, 5 cases appeared hyperintense on T1WI and hypointense on T2WI as well as the enhancement as that of nodules with < 1 cm in size; and the remaining 3 cases appeared hypointense on T1WI and hyperintense on T2WI, and were not isointense to the surrounding hepatic parenchyma on enhanced MRI but hyperintense on SPIO enhanced MRI. In 6 cases of macroregenerative nodule measuring > 3 cm in size, 2 cases appeared hyperintense to the surrounding hepatic parenchyma on T1, T2WI and enhanced MRI; 4 cases showed hyperintense on T1WI, and hypointense on T2WI and enhanced MRI. Sometimes, normal vessels were seen to pass through the surface of macroregenerative nodules. It was suggested that RNs of cirrhosis had features on MRI that usually allow distinction from hepatocellular carcinoma but not always from dysplastic nodules (DNs). A helpful distinction between HCC and DNs is that the latter are almost never hyperintense on T2WI. Additionally, low grade DNs appear hypointense on SPIO enhanced MRI.

摘要

为研究肝硬化肝脏再生结节（RN）和发育异常结节（DN）的磁共振成像（MR）特征，对26例伴有RN和DN的肝硬化患者行MRI检查，其中8例合并肝细胞癌。26例患者中18例行T1加权像（T1WI）钆喷替酸葡甲胺（Gd-DTPA）增强MRI检查，18例中的10例于T2加权像（T2WI）加做超顺磁性氧化铁（SPIO，商品名Feridex）增强检查。临床资料显示，除8例合并肝细胞癌患者外，其余18例甲胎蛋白水平正常。结果显示，12例患者有直径＜1cm的RN。这些RN的MR表现为T1WI等信号、T2WI低信号。在Gd-DTPA或SPIO增强MRI上，其信号强度与周围肝实质等信号。14例DN患者中，8例结节直径为1～3cm，6例为直径＞3cm的大再生结节。在8例直径为1～3cm的DN中，5例T1WI呈高信号、T2WI呈低信号，增强表现与直径＜1cm的结节相同；其余3例T1WI呈低信号、T2WI呈高信号，增强MRI上与周围肝实质信号不等，SPIO增强MRI呈高信号。6例直径＞3cm的大再生结节中，2例T1WI、T2WI及增强MRI上相对于周围肝实质呈高信号；4例T1WI呈高信号，T2WI及增强MRI呈低信号。有时可见正常血管穿过大再生结节表面。提示肝硬化RN的MRI表现通常有助于与肝细胞癌鉴别，但与发育异常结节（DN）鉴别有一定困难。肝细胞癌与DN的一个有用鉴别点是，后者T2WI几乎从不呈高信号。另外，低级别DN在SPIO增强MRI上呈低信号。