肝脏原发性神经内分泌肿瘤的MRI特征  

MRI features of primary hepatic neuroendocrine tumor

作　　者：朴勇男 王海屹[2] 马露[2] 于果[3] 杜贵金[4] 叶慧义 刘桂芳 Piao Yongnan;Wang Haiyi;Ma Lu;Yu Guo;Du Guijin;Ye Huiyi;Liu Guifang(Health and Family Planning Bureau of Hunchun City, Jilin Province, Hunchun 133300, China)

机构地区：[1]吉林省珲春市卫生和计划生育局,133300 [2]解放军总医院放射诊断科 [3]解放军总医院放病理科 [4]山东省临沂市人民医院放射诊断科 [5]山东省青岛市中心医院放射诊断科

出　　处：《中华放射学杂志》2018年第2期125-130,共6页Chinese Journal of Radiology

摘　　要：目的探讨肝脏原发性神经内分泌肿瘤的MRI特征。方法回顾性分析2009年1月至2016年5月解放军总医院，经手术或穿刺病理证实且进行过肝脏MRI检查的13例肝脏原发性神经内分泌肿瘤患者资料。患者均行肝脏常规MRI平扫、DWI和动态增强扫描。根据肿块最大径将病变分为≥30 mm组和〈30 mm组，观察病变的MRI表现（边缘、平扫信号、DWI特征、囊变坏死、假包膜、脂质、出血、胆管扩张、强化特征、淋巴结情况）和病理表现。结果7例病灶单发，6例多发（其中4例弥漫多发），共有病灶106个。病灶最大径3~200 mm，中位最大径20 mm。最大径≥30 mm组病灶14个，〈30 mm组92个。（1）≥30 mm组：病灶边界均清楚，平扫T2WI呈混杂高信号，T1WI呈混杂低信号。DWI可见晕环结节状高信号。均可见囊变、坏死、假包膜，3个可见病灶周边胆管扩张，3例可见出血，3个病灶反相位图像可见片状信号轻度减低。增强扫描动脉期7个病灶呈环形强化，7个病灶呈不均匀强化，门静脉期及延迟期8个病灶肿块呈持续强化，6个病灶呈廓清征象。3个病灶腹膜后及肝门区可见肿大或异常信号淋巴结。（2）〈30 mm组：76个病灶边界清楚，16个病灶边界模糊。平扫82个病灶T2WI呈较均匀稍高信号，T1WI呈较均匀低信号；9个病灶T2WI呈混杂高信号，T1WI呈混杂低信号；1个病灶T2WI呈高信号，T1WI呈低信号。DWI上9个病灶可见晕环结节状高信号，83个病灶可见结节样高信号。10个病灶可见囊变、坏死。10个病灶可见假包膜，无周边胆管扩张、出血、脂质征象病灶。增强扫描动脉期31个病灶呈环形强化，3个病灶为不均匀强化，58个病灶强化均匀；门静脉期及延迟期62个病灶持续强化，30个表现廓清。未见肿大淋巴结。手术切除大体病理可见病灶中央坏死和出血。G1级1例，G2级3例，G3级9例。结论肝脏原发性神经ObjectiveTo investigate the MRI features of primary hepatic neuroendocrine tumor （PHNET）.MethodsClinical information and MR imaging features of 13 histopathologically confirmed PHNET patients were retrospectively reviewed. All patients underwent routine MRI examination including T2WI and chemical shift imaging, diffusion weighted imaging （DWI） and dynamic contrast-enhanced imaging. All lesions were divided into two groups according to the maximum diameter （≥ 30 mm for large lesion group and〈30 mm for small lesion group）. The following MRI features of lesions were evaluated： location, size, growth pattern, signal intensity （T1WI, T2WI, DWI, in-and opposed-phase） and dynamic contrast-enhancement pattern. The pathologic features were also analyzed.ResultsThe PHNET can be single lesion （n= 7） or multiple lesions （n=6） in which 4 cases showed diffuse pattern. One hundred and six lesions in 13 patients were detected. The median diameter of all lesions was 20 mm （ranging from 3 to 200 mm）. Fourteen lesions were found in ≥30 mm group and 92 lesions in〈30 mm group. （1） In ≥30 mm group, all lesions had well-defined margin, heterogeneous hyperintensity on T2WI, heterogeneous hypointensity on T1WI and halo sign on DWI. All lesions showed cystic degeneration, necrosis and pseudo-capsule. Three lesions showed dilation of bile duct around the lesion, and three lesions hemorrhaged and three lesions signal dropped on out-of-phase. On arterial phase, 7 lesions showed ring-like enhancement, and the other 7 lesions showed heterogeneous enhancement;then on portal venous phase and delayed phase, 8 lesions showed persistent enhancement and the other 6 lesions showed＂wash-out＂appearance. Three cases showed lymphadenopathy in the peritoneum and liver hilum. （2） In〈30 mm group, 76 lesions showed well-circumscribed edge and the other 16 lesions had ill-defined margin. Eighty two lesions showed relatively homogeneous hyperintensity on T2WI and relatively homogeneous hypointensity on T1WI

关 键 词：肝脏肿瘤 神经内分泌肿瘤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]