肝脏局灶性结节增生的CT及MRI诊断与临床应用价值  

CT and MRI in the diagnosis of focal nodular hyperlasia

作　　者：马秀华[1] 薛鹏[1] 仲继刚[1] 陈勇[1] 张斯佳[1] 郑红伟[1] 刘勇[1] 张伟[1] 

机构地区：[1]郑州人民医院医学影像科,450003

出　　处：《中华肝胆外科杂志》2013年第2期98-101,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨CT及MRI对肝脏局灶性结节增生（focal nodular hyperplasia，FNH）的诊断价值。方法回顾性分析16例经病理证实的FNH的CT及MRI检查资料。所有病例均行CT平扫及动态增强扫描，9例行MRI平扫及动态增强扫描。结果（1）16例共19个病灶，位于肝左叶8个，肝右叶5个，跨叶4个，尾叶2个。病灶形态规则，15个病灶边界清晰，4个边界模糊。瘤体直径2．2～9．6cm，平均4．3cm。（2）16例均行CT检查，平扫5例为等密度，11例为稍低密度，7例见裂隙状、星芒状低密度中央瘢痕。9例行MRI检查，T2WI呈稍高信号6例，等信号3例；T1wI呈稍低信号4例，等信号3例，稍高信号2例，反相位1例局部信号减低。6例病灶见中央瘢痕，T2wI呈高信号，T1wI呈低信号。（3）CT增强：动脉期15例呈明显强化，1例轻度强化，所有病灶中心瘢痕均未见强化，其中5例见明显强化增粗迂曲的动脉；门脉期强化程度均不同程度减低，12例呈稍高密度，3例呈等密度，1例呈低密度，其中3例中央瘢痕轻度强化；延迟期病灶实质部分强化程度持续下降，3例呈稍高密度，9例呈等密度，4例呈稍低密度，7例中央瘢痕延迟期强化呈稍高密度。9例行MRI增强三期信号变化特点类似CT增强特点，但动脉期强化幅度高于CT，门静脉期4例中央瘢痕开始强化，延迟期6例均持续强化呈稍高信号；1例较大病灶延迟期出现持续延迟强化包膜。（4）6例DWI呈不均匀稍高信号，中心见裂隙状低信号区，3例呈等信号。病变区ADC值：（1.31±0．08）×10-3mm2／s，正常肝实质ADC值（1．22±0．14）×10-3mm2／s，两者差异无统计学意义。结论CT和MRI平扫及动态增强扫描能全面、准确显示FNH的病理特征及血供特点。FNH的CT和MRI征象具有特征性，两者均能对其做出准确诊断，MRI较CT略有优势，二者相结合对FNH的诊断及鉴别诊断具有重要临床应�Objectives To study the value of CT and MRI in diagnosing focal nodular hyperplasia （FNH）. Methods The CT and MRI findings of 16 patients with FNH confirmed histopathologically were analyzed retrospectively. Both plain and dynamic enhanced CT scannings were performed in all the patients. Plain and dynamic enhanced MRI were carried out in 9 patients. Results （1） There were 16 patients with 19 lesions, and 8 lesions were in the left lobe, 5 lesions in the right lobe, 4 lesions between the left/right lobes and 2 lesions in the caudate lobe. The morphology of the lesions showed 15 lesions to have clear boundaries and 4 lesions to have fuzzy boundaries. The tumor diameters varied from 2.2 to 9.6 cm, （average 4. 3 cm）. （2） Sixteen patients underwent CT examination. On plain CT, the lesions were isotonic （n=5）, or slightly low-density （n=11）. In 7 lesions, there was a slit-like, stellate-shaped low density central scar. Nine patients underwent MRI examination. On T2WI, 6 lesions showed slightly higher signal while the remaining 3 lesions showed iso-signal. On TIWI, 4 lesions showed slightly lower signal, 3 lesions showed iso-signal and 2 lesions showed slight- ly higher signal while in 1 lesion the local signal showed reduction in anti-phase 1. A central scar was seen in 6 lesions which showed high signal on T2WI,and low signal on TIWI. （3） Enhanced CT.. 15 lesions were significantly enhanced and 1 lesion showed mild enhancement at the arterial phase. For the patients with mild enhancement, the scar in the center of the lesion showed no enhancement. In alllesions, the central scar did not enhance. In 5 lesions, enhancements of thickened and torturous arteries were seen. In all the lesions with enhancement, the enhancement was reduced at the portal venous phase, with 12 lesions showing slightly higher density, 3 lesions isodensity and 1 lesion low-density. Three lesions showed mild enhancement of the central scar. All the substantial parts of the lesions with enhancement declined at the delay

关 键 词：肝脏局灶性结节增生 磁共振成像 X线计算机 扩散加权 

分 类 号：R575[医药卫生—消化系统] R816[医药卫生—内科学] R44[医药卫生—临床医学]