局灶性肝紫癜的磁共振表现及扩散特征  

Magnetic resonance imaging and diffusion weighted imaging features of focal peliosis hepatis

作　　者：刘志健[1] 姚家美 王明亮 耿婷婷[4] 董光[1] 曾蒙苏 Liu Zhijian;Yao Jiamei;Wang Mingliang;Geng Tingting;Dong Guang;Zeng Mengsu(Department of Radiology,Weifang People's Hospital,Weifang 261041,China;Department of Pathology, Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Medical Imaging,Department of Medical Imaging,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Intensive Care Unit,Weifang People's Hospital,Weifang 261041,China)

机构地区：[1]潍坊市人民医院放射科,潍坊261041 [2]复旦大学附属中山医院病理科,上海200032 [3]复旦大学附属中山医院放射科上海市影像医学研究所复旦大学上海医学院影像学系,上海200032 [4]潍坊市人民医院重症医学科,潍坊261041

出　　处：《中华医学杂志》2019年第7期496-499,共4页National Medical Journal of China

摘　　要：目的 探讨局灶性肝紫癜的磁共振成像(MRI)表现及扩散特征。 方法 回顾性分析复旦大学附属中山医院2012年1月至2018年3月经病理证实的19例局灶性肝紫癜患者的临床资料及MR图像。图像分析包括病灶的数目、部位、大小、形态、平扫信号强度、动态增强特征、病灶内有无血管影,以及周围肝实质异常灌注等。测量病灶表观扩散系数(ADC)值及周围正常肝实质ADC值,比较两者差异有无统计学意义。根据患者有无肿瘤化疗病史,将所有病例分为两组,分析两组病灶的MRI征象差异有无统计学意义。 结果 19例患者共24枚病灶,肝右叶22枚、左叶2枚;边界模糊,平均径为7.5~72.0(24.4±17.2)mm。21枚病灶T1WI呈稍低信号,1枚呈稍高信号,2枚呈等信号;24枚病灶T2WI均呈稍高信号,DWI呈等或稍高信号。病灶的平均ADC值为(1.511±0.415)×10^-3 mm^2/s,邻近正常肝实质平均ADC值为(1.769±0.690)×10^-3 mm^2/s,两者差异无统计学意义(P>0.05)。动态增强扫描,20枚病灶呈渐进性填充式强化,4枚病灶呈持续性明显强化;9枚病灶内可见点条状血管影,8枚病灶伴周围肝实质异常灌注。有肿瘤化疗病史组病灶大小平均径[7.5~38.5(17.6±9.8)mm]<无肿瘤化疗病史组的病灶[9.0~72.0(33.8±21.2)mm],两组间病灶大小差异有统计学意义(P<0.05)。 结论 局灶性肝紫癜的MRI表现具有一定的特征性,结合扩散加权成像,可以帮助疾病诊断。Objective To investigate the MRI and diffusion weighted imaging (DWI) features of focal peliosis hepatis. Methods The clinical data and MRI of 19 cases with focal peliosis hepatis confirmed by pathology from January 2012 to March 2018 in Zhongshan Hospital of Fudan University were retrospectively analyzed. The number, location, size, shape, signal intensity of plain scan of lesions, enhancement pattern of lesions, vessels within lesions, and perfusion disorders of hepatic parenchyma were analyzed. The apparent diffusion coefficient (ADC) values of the lesions and adjacent hepatic parenchyma were measured, then the differences between them were explored statistically. All 24 lesions were categorized into group A with tumor-related chemotherapy and group B without tumor-related chemotherapy. The differences of MR features between the two groups were explored statistically. Results In all 24 lesions, 22 lesions were located in the right lobe, 2 lesions in the left lobe. The median size was 7.5-72.0 (24.4±17.2) mm.On T1WI,21 lesions showed slightly hypointensity, 1 lesion showed slightly hyperintensity and 2 lesions were isointensity;all 24 lesions showed slightly hyperintensity on T2WI, and isointensity or slightly hyperintensity on DWI. The mean ADC value was (1.511±0.415)×10^-3 mm^2/s in the lesions and (1.769±0.690)×10^-3 mm^2/s in the adjacent hepatic parenchyma, which showed no difference between the two groups (P>0.05). On dynamic MR images, 20 lesions showed gradually filling enhancement, 4 lesions showed markedly and persistent enhancement. Punctiform or filiform vessels were found in 9 lesions. Adjacent hepatic perfusion disorders showed in 8 lesions. The median lesion size was 7.5-38.5(17.6±9.8) mm in the tumor-related-chemotherapy group and 9.0-72.0(33.8±21.2) mm in the no chemotherapy group.There was significant difference between the two groups (P<0.05). Conclusions The MRI performance of focal peliosis hepatis had a certain characteristic. MRI combined with diffusion weighted imaging could help

关 键 词：磁共振成像 扩散 紫癜肝病 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]