Hanna Robert F, Aguirre Diego A, Kased Norbert, Emery Shawn C, Peterson Michael R, Sirlin Claude B
Department of Radiology, Division of Body Imaging, University of California, San Diego, UCSD Liver Center, 200 W Arbor Dr, San Diego, CA 92103-8756, USA.
Radiographics. 2008 May-Jun;28(3):747-69. doi: 10.1148/rg.283055108.
Cirrhotic livers are characterized by advanced fibrosis and the formation of hepatocellular nodules, which are classified histologically as either (a) regenerative lesions (eg, regenerative nodules, lobar or segmental hyperplasia, focal nodular hyperplasia) or (b) dysplastic or neoplastic lesions (eg, dysplastic foci and nodules, hepatocellular carcinomas). The differentiation of these lesions is important because regenerative nodules are benign, whereas dysplastic and neoplastic nodules are premalignant and malignant, respectively. However, their accurate characterization may be difficult even at histopathologic analysis. Differential diagnosis may be facilitated by comparing the clinical and pathologic findings with radiologic imaging features; in particular, nodule size, vascularity, hepatocellular function, and Kupffer cell density assessed at magnetic resonance (MR) imaging are suggestive of the correct diagnosis. MR imaging is more useful than computed tomography for such assessments because it provides better soft-tissue contrast and a more nuanced depiction of different tissue properties. Moreover, a wider variety of contrast agents is available for use in MR imaging. Familiarity with the MR imaging characteristics of cirrhosis-associated hepatocellular nodules is therefore important for optimal diagnosis and management of cirrhotic disease.
肝硬化肝脏的特征是存在严重纤维化和肝细胞结节形成，这些结节在组织学上分为两类：(a) 再生性病变（如再生结节、大叶或节段性增生、局灶性结节性增生）或 (b) 发育异常或肿瘤性病变（如发育异常灶和结节、肝细胞癌）。区分这些病变很重要，因为再生结节是良性的，而发育异常和肿瘤性结节分别是癌前病变和恶性病变。然而，即使在组织病理学分析中，准确鉴别这些病变也可能存在困难。将临床和病理结果与放射影像学特征进行比较有助于鉴别诊断；特别是，在磁共振（MR）成像中评估的结节大小、血管分布、肝细胞功能和库普弗细胞密度有助于做出正确诊断。对于此类评估，MR成像比计算机断层扫描更有用，因为它能提供更好的软组织对比度，并能更细致地描绘不同组织特性。此外，有更多种类的造影剂可用于MR成像。因此，熟悉与肝硬化相关的肝细胞结节的MR成像特征对于肝硬化疾病的最佳诊断和管理非常重要。
