Ramalho Miguel, Matos António P, AlObaidy Mamdoh, Velloni Fernanda, Altun Ersan, Semelka Richard C
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Radiol Bras. 2017 Jan-Feb;50(1):38-47. doi: 10.1590/0100-3984.2015.0132.
Magnetic resonance imaging (MRI) is the modern gold standard for the noninvasive evaluation of the cirrhotic liver. The combination of arterial phase hyperenhancement and delayed wash-out allows a definitive diagnosis of hepatocellular carcinoma (HCC) in patients with liver cirrhosis or chronic liver disease, without the requirement for confirmatory biopsy. That pattern is highly specific and has been endorsed in Western and Asian diagnostic guidelines. However, the sensitivity of the combination is relatively low for small HCCs. In this two-part review paper, we will address MRI of the cirrhotic liver. In this first part, we provide a brief background on liver cirrhosis and HCC, followed by descriptions of imaging surveillance of liver cirrhosis and the diagnostic performance of the different imaging modalities used in clinical settings. We then describe some of the requirements for the basic MRI technique, as well as the standard MRI protocol, and provide a detailed description of the appearance of various types of hepatocellular nodules encountered in the setting of the carcinogenic pathway in the cirrhotic liver, ranging from regenerative nodules to HCC.
磁共振成像（MRI）是对肝硬化肝脏进行无创评估的现代金标准。动脉期强化和延迟洗脱相结合能够确诊肝硬化或慢性肝病患者的肝细胞癌（HCC），无需进行确诊性活检。这种模式具有高度特异性，已得到西方和亚洲诊断指南的认可。然而，对于小肝癌，这种联合方法的敏感性相对较低。在这篇分两部分的综述文章中，我们将探讨肝硬化肝脏的MRI。在第一部分中，我们简要介绍肝硬化和HCC的背景知识，接着描述肝硬化的影像学监测以及临床中使用的不同成像方式的诊断性能。然后，我们阐述基本MRI技术的一些要求以及标准MRI方案，并详细描述在肝硬化肝脏致癌途径中遇到的各种类型肝细胞结节的表现，从再生结节到HCC。
