Dipartimento di Diagnostica per Immagini, Università degli Studi di Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy.
Radiol Med. 2009 Dec;114(8):1267-82. doi: 10.1007/s11547-009-0464-9. Epub 2009 Nov 9.
The authors sought to evaluate the potential of magnetic resonance (MR) imaging with superparamagnetic iron oxide (SPIO) contrast material for identifying, characterising and differentiating dysplastic nodules (DN) and hepatocellular carcinoma (HCC) in the cirrhotic liver by correlating the results with pathological findings on the explanted liver.
MR imaging was used to study the liver of 400 cirrhotic patients awaiting liver transplantation, 31 of whom were selected to receive a liver. Of these 31 patients, we included in the study 22 patients (mean age 53 years; range 46-57 years) who underwent liver transplantation within 12-24 h after MR examination. Patients were studied with a 1.5-T device, and scans were acquired before and after the administration of paramagnetic contrast material. For every lesion, we recorded signal intensity on unenhanced baseline T1- and T2-weighted images and enhancement pattern after SPIO administration. Histological examination of the entire liver provided the definitive diagnosis of the lesions.
Histological examination identified 59 lesions: 14 HCC, 4 HCC-DN, 39 DN, and 2 cystoadenomas. Among the 14 HCC, three were well differentiated, eight were moderately differentiated and three were poorly differentiated. Of the 39 DN, 28 were low-grade and 11 high-grade lesions. Unenhanced baseline MR imaging correctly identified and characterised 20 lesions, equal to 33.90% of all lesions: 6 HCC, 12 DN and 2 DN with a subfocus of HCC. SPIO-enhanced MR imaging showed greater sensitivity detecting and characterising 45 lesions, equal to 76.27% of all lesions identified at histology: 14 HCC, 27 DN and 4 DN with subfocus of HCC. SPIO administration improved the sensitivity of MR imaging in lesion detection and characterisation by 42.37%. False negative results with SPIO-enhanced MR imaging occurred in 12 DN (31%), which histological examination revealed to be low-grade DN with a diameter <1 cm.
SPIO-enhanced MR imaging proved to be of value in detecting and characterising lesions in the cirrhotic liver, allowing differentiation of DN from HCC and providing an early diagnosis of neoplastic degeneration of DN.
作者旨在通过与肝移植标本病理结果对照，评估超顺磁性氧化铁（SPIO）对比剂磁共振（MR）成像在识别、特征描述和鉴别肝硬化肝脏中发育不良结节（DN）和肝细胞癌（HCC）中的潜在价值。
对 400 例等待肝移植的肝硬化患者进行了 MR 成像研究，其中 31 例患者接受了肝移植。在这 31 例患者中，我们纳入了 22 例（平均年龄 53 岁；范围 46-57 岁）患者，这些患者在 MR 检查后 12-24 小时内接受了肝移植。患者使用 1.5-T 设备进行研究，在给予顺磁性对比剂前后采集扫描。对于每一个病灶，我们记录了未增强的基线 T1-和 T2 加权图像上的信号强度以及 SPIO 给药后的增强模式。对整个肝脏进行组织学检查以明确病变的最终诊断。
组织学检查共发现 59 个病灶：14 个 HCC、4 个 HCC-DN、39 个 DN 和 2 个囊腺瘤。在 14 个 HCC 中，3 个为高分化、8 个为中分化、3 个为低分化。在 39 个 DN 中，28 个为低级别、11 个为高级别病变。未增强的基线 MR 成像正确识别和特征描述了 20 个病灶，占所有病灶的 33.90%：6 个 HCC、12 个 DN 和 2 个伴有 HCC 亚灶的 DN。SPIO 增强 MR 成像显示出更高的敏感性，可检测和特征描述 45 个病灶，占所有组织学上发现的病灶的 76.27%：14 个 HCC、27 个 DN 和 4 个伴有 HCC 亚灶的 DN。SPIO 给药使 MR 成像在病灶检测和特征描述方面的敏感性提高了 42.37%。SPIO 增强 MR 成像的假阴性结果发生在 12 个 DN（31%）中，组织学检查显示这些 DN 为直径<1cm 的低级别 DN。
SPIO 增强 MR 成像在检测和特征描述肝硬化肝脏中的病灶方面具有价值，可区分 DN 和 HCC，并提供对 DN 肿瘤性变性的早期诊断。
