Trout Andrew T, Towbin Alexander J, Smith Ethan A, Gupta Anita, Dillman Jonathan R
Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3026, USA.
Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Radiol. 2018 Aug;48(9):1245-1255. doi: 10.1007/s00247-018-4108-x. Epub 2018 Aug 4.
Hepatocyte-specific contrast media are gadolinium chelates that are taken up by hepatocytes and partially cleared via the biliary tree. The absence of lesional uptake of the contrast media in the hepatobiliary phase is a marker of either the absence of hepatocytes or of poorly functioning, neoplastic hepatocytes. Uptake of the contrast media in the hepatobiliary phase, whether equal to or greater than background liver, reflects the presence of hepatocytes but does not equate to absence of neoplasia. Accurate diagnosis of liver lesions utilizing hepatocyte-specific contrast media requires an understanding of the mechanisms of uptake and clearance of the contrast media to avoid misdiagnosis. In this review we discuss the mechanisms of hepatocellular transport of hepatocyte-specific contrast media and utilize an understanding of those mechanisms to discuss the imaging appearance of a subset of hepatocellular lesions that can be seen in the pediatric and young adult liver. We pay particular attention to lesions that appear iso- to hyperintense in the hepatobiliary phase but have the potential for adverse clinical outcomes. We also discuss strategies for identifying these lesions.
肝细胞特异性造影剂是钆螯合物，可被肝细胞摄取并通过胆管系统部分清除。在肝胆期造影剂在病变部位无摄取是肝细胞缺失或肿瘤性肝细胞功能不良的标志。在肝胆期造影剂的摄取，无论等于或大于肝脏背景，都反映了肝细胞的存在，但并不等同于无肿瘤形成。利用肝细胞特异性造影剂准确诊断肝脏病变需要了解造影剂的摄取和清除机制，以避免误诊。在本综述中，我们讨论了肝细胞特异性造影剂的肝细胞转运机制，并利用对这些机制的理解来讨论在儿童和年轻成人肝脏中可见的一部分肝细胞病变的影像学表现。我们特别关注在肝胆期表现为等密度至高信号但具有不良临床结局可能性的病变。我们还讨论了识别这些病变的策略。
