Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université de Paris, Paris 5-Descartes, rue de l'Ecole de Médecine, 75006, Paris, France.
Eur J Radiol. 2019 Oct;119:108648. doi: 10.1016/j.ejrad.2019.108648. Epub 2019 Sep 7.
To describe the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic steatohepatitis (NASH).
MRI examinations of 21 patients with HCC and NASH were analyzed by two observers. There were 18 men and 3 women with a mean age of 67.9 ± 10.2 (SD) years (range: 36-85 years). Images were qualitatively and quantitatively analyzed with respect to imaging presentation.
HCC presented as a single tumor in 13/21 patients (62%), with a mean longest diameter of 26.9 ± 20.2 (SD) mm (range: 12-88 mm); 17/30 HCC (57%) had a largest diameter <20 mm. A signal drop between in- and out-of-phase T1-weighted MR images was observed in 16/30 HCC nodules (53%). All HCC nodules (30/30; 100%) showed hyperenhancement on arterial phase images and 12/30 HCC nodules (40%) did not show a wash-out on portal or delayed phase images. Encapsulation was observed in 18/30 HCC nodules (60%). MRI findings consistent with liver cirrhosis were present in 16/21 patients (76%).
Our results show that 57% of HCC in NASH can present as a lesion smaller than 20 mm and 40% do not display wash-out. These results suggest that classical imaging criteria developed for noninvasive diagnosis of HCC should be applied with caution to HCC in patients with NASH.
描述非酒精性脂肪性肝炎（NASH）患者肝细胞癌（HCC）的磁共振成像（MRI）特征。
对 21 例 HCC 和 NASH 患者的 MRI 检查结果由两位观察者进行分析。患者均为男性 18 例，女性 3 例，平均年龄 67.9±10.2（SD）岁（范围：36-85 岁）。对影像学表现进行定性和定量分析。
21 例患者中 13 例（62%）HCC 表现为单发肿瘤，平均最长直径为 26.9±20.2（SD）mm（范围：12-88 mm）；17/30 HCC（57%）最大直径<20 mm。30 个 HCC 结节中有 16 个（53%）在同相位和反相位 T1 加权 MR 图像上显示信号下降。所有 HCC 结节（30/30；100%）在动脉期图像上均表现为高增强，12/30 HCC 结节（40%）在门静脉期或延迟期图像上未见洗脱。18/30 HCC 结节（60%）有包膜。21 例患者中有 16 例（76%）存在与肝硬化相符的 MRI 表现。
我们的研究结果表明，57%的 NASH 相关 HCC 可以表现为小于 20 mm 的病变，40%的 HCC 不会出现洗脱。这些结果提示，用于非侵入性诊断 HCC 的经典影像学标准在应用于 NASH 患者的 HCC 时应谨慎使用。
