Li J K, Wang M, Yuan J, Song Z G
Department of Radiology, Hainan Branch of PLA General Hospital, Sanya 572013, China.
Department of Radiology, PLA General Hospital, Beijing 100853, China.
Zhonghua Zhong Liu Za Zhi. 2017 Aug 23;39(8):600-606. doi: 10.3760/cma.j.issn.0253-3766.2017.08.008.
To study imaging features of primary hepatic neuroendocrine neoplasm (PHNEN) with CT and MRI. CT/MRI findings of ten patients with pathologically confirmed PHNEN were retrospectively analyzed. The result was compared with pathologic features classified by the 2010 WHO classification of gastro-entero-pancreatic neuroendocrine tumor which was also compared with the conventional method. Six cases of neuroendocrine tumor (NET), all of which were classified as grade 2 (G2), consisted of 5 cases of carcinoid and 1 case of atypical carcinoid. Four cases of neuroendocrine carcinoma (NEC) classified as grade 3 (G3) were composed of 1 case of atypical carcinoid and 3 cases of small cell carcinoma. On the basis of conventional classification method, CT/MRI features were as follows: (1) Carcinoid: For 5 carcinoid cases, two with solitary mass, two with dominant masses and satellite nodules, and one with diffused nodules. Four cases were cystic-solid and one was solid. Four showed low density on plain CT and moderate to obvious enhancement in arterial phase. Three showed consistent enhancement in portal and delayed phase while one showed rapid washout in portal phase. Four showed low density in delayed phase. One case with cystic degeneration showed hypo-intensity on T1W, hyper-intensity on T2W and halo like hyper-intensity on DWI. In dynamic MRI, the solid part of tumor showed obvious enhancement in arterial phase, consistent enhancement in portal phase with slight washout and homogeneous or slight hypo-geneous signal density in delayed phase. (2) Atypical carcinoid: Two cases presented with cystic-solid mass. They were all dominant masses with satellite nodules. They showed low density on plain CT and mild to moderate enhancement in arterial phase. One case showed rapid washout in portal and delayed phase with embolus in portal vein. The other case showed consistent enhancement in portal phase and hypo-density in delayed phase without enhancement of satellite nodules. (3) Small cell neuroendocrine carcinoma: Three cases of small cell carcinoma were composed of one cystic-solid tumor, one solid tumor and one dominant mass with satellite nodules. Two cases showed low density in CT plain scan while one with cystic degeneration presented hypo-intensity on T1W, hype-rintensity on T2W and halo like hyper-intensity on DWI. Dynamic CT and MRI showed mild to moderate enhancement in arterial phase, consistent enhancement in portal phase and low density or hypo-intensity in delayed phase. PHNEN has specific features on CT and MRI which are valuable in diagnosis and differential diagnosis.
研究原发性肝神经内分泌肿瘤（PHNEN）的CT和MRI影像特征。回顾性分析10例经病理证实的PHNEN患者的CT/MRI表现。将结果与2010年世界卫生组织胃肠胰神经内分泌肿瘤分类的病理特征进行比较，并与传统方法进行对比。6例神经内分泌瘤（NET），均为2级（G2），包括5例类癌和1例非典型类癌。4例神经内分泌癌（NEC）为3级（G3），由1例非典型类癌和3例小细胞癌组成。基于传统分类方法，CT/MRI表现如下：（1）类癌：5例类癌中，2例为孤立肿块，2例为较大肿块伴卫星结节，1例为弥漫性结节。4例为囊实性，1例为实性。4例平扫CT呈低密度，动脉期呈中度至明显强化。3例门静脉期和延迟期强化一致，1例门静脉期快速廓清。4例延迟期呈低密度。1例伴囊性变者T1WI呈低信号，T2WI呈高信号，DWI呈晕状高信号。动态MRI检查，肿瘤实性部分动脉期明显强化，门静脉期强化一致，有轻度廓清，延迟期信号密度均匀或轻度减低。（2）非典型类癌：2例表现为囊实性肿块。均为较大肿块伴卫星结节。平扫CT呈低密度，动脉期呈轻度至中度强化。1例门静脉期和延迟期快速廓清，门静脉内有栓子；另1例门静脉期强化一致，延迟期呈低密度，卫星结节无强化。（3）小细胞神经内分泌癌：3例小细胞癌中，1例为囊实性肿瘤，1例为实性肿瘤，1例为较大肿块伴卫星结节。2例CT平扫呈低密度，1例伴囊性变者T1WI呈低信号，T2WI呈高信号，DWI呈晕状高信号。动态CT和MRI检查显示动脉期呈轻度至中度强化，门静脉期强化一致，延迟期呈低密度或低信号。PHNEN在CT和MRI上具有特异性表现，对诊断和鉴别诊断有重要价值。
