Halıloğlu Nuray, Özkavukcu Esra, Erden Ayşe, Erden İlhan
Department of Radiology, Ankara University School of Medicine, Ankara, Turkey.
Turk J Gastroenterol. 2011;22(2):158-64. doi: 10.4318/tjg.2011.0185.
BACKGROUND/AIMS: Diffuse or continuous multifocal tumors with accompanying portal vein thrombosis yield considerable changes in the magnetic resonance imaging findings of hepatocellular carcinoma. The overlapped imaging findings of these two co-existing pathologies may be confusing. We aimed to evaluate the magnetic resonance imaging findings of widespread hepatocellular carcinoma lesions complicated with portal vein thrombosis.
Twenty-two patients (20 male, 2 female; mean age: 57 years) with portal vein thrombosis and diffuse-type hepatocellular carcinoma who underwent contrast-enhanced hepatic magnetic resonance imaging in our department between August 2001 and November 2008 were evaluated retrospectively. The unenhanced axial T1-weighted, T2-weighted, and post-contrast early- and late-phase images were reviewed in each patient.
On T2-weighted magnetic resonance images, tumors were seen mildly hyperintense in 11 patients and heterogeneously hyperintense in 11 patients. Unenhanced T1-weighted images demonstrated homogeneous hypointensity in 15 patients and heterogeneous hypointensity in 7 patients. Post-contrast early-phase magnetic resonance images showed patchy enhancement in 12 patients, moth-eaten enhancement in 6 patients, strong enhancement in 1 patient, and minimal enhancement in 3 patients. Post-contrast late-phase magnetic resonance images demonstrated heterogeneous washout in all patients. Portal vein thrombosis was present in all patients. The mean diameter of main portal vein thrombi was 27 mm (range: 25-30 mm). Serum alpha-fetoprotein levels were elevated in all patients.
In patients with chronic parenchymal liver disease, when portal vein thrombosis and high serum alpha-fetoprotein values co-exist, careful attention must be paid to the hepatic parenchymal changes, especially on contrast-enhanced images, in order to not overlook diffuse-type hepatocellular carcinoma.
背景/目的：伴有门静脉血栓形成的弥漫性或连续性多灶性肿瘤会使肝细胞癌的磁共振成像表现产生显著变化。这两种并存病理状况重叠的成像表现可能会造成混淆。我们旨在评估广泛肝细胞癌病变合并门静脉血栓形成的磁共振成像表现。
回顾性评估2001年8月至2008年11月间在我科接受肝脏对比增强磁共振成像检查的22例伴有门静脉血栓形成和弥漫型肝细胞癌的患者（20例男性，2例女性；平均年龄：57岁）。对每位患者的平扫轴位T1加权、T2加权以及对比剂增强早期和晚期图像进行分析。
在T2加权磁共振图像上，11例患者的肿瘤呈轻度高信号，11例患者的肿瘤呈不均匀高信号。平扫T1加权图像上，15例患者表现为均匀低信号，7例患者表现为不均匀低信号。对比剂增强早期磁共振图像上，12例患者呈斑片状强化，6例患者呈虫蚀样强化，1例患者呈明显强化，3例患者呈轻微强化。对比剂增强晚期磁共振图像上，所有患者均表现为不均匀廓清。所有患者均存在门静脉血栓形成。门静脉主干血栓的平均直径为27mm（范围：25 - 30mm）。所有患者血清甲胎蛋白水平均升高。
在患有慢性实质性肝病的患者中，当门静脉血栓形成与高血清甲胎蛋白值并存时，必须仔细关注肝实质变化，尤其是在对比增强图像上，以免漏诊弥漫型肝细胞癌。
