胃肠道腺癌化疗过程出现的肝紫癜与肝转移瘤MRI特征比较  

MRI features to differentiate between peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma

作　　者：刘志健[1] 耿婷婷[2] 王明亮 罗荣奎 董光[1] 耿海[1] 曾蒙苏 Liu Zhijian;Geng Tingting;Wang Mingliang;Luo Rongkui;Dong Guang;Geng Hai;Zeng Mengsu(Department of Radiology,Weifang People's Hospital,Weifang 261041,Shandong Province,China;Department of Intensive Care Unit,Weifang People's Hospital,Weifang 261041,Shandong Province,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 Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]潍坊市人民医院放射科,山东潍坊261041 [2]潍坊市人民医院重症医学科,山东潍坊261041 [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]复旦大学附属中山医院病理科,上海200032

出　　处：《中华肝胆外科杂志》2019年第9期660-663,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的比较胃肠道腺癌化疗过程中出现的肝紫癜和肝转移瘤MRI特点,提高鉴别诊断水平。方法回顾分析复旦大学附属中山医院2014年6月至2017年12月33例胃肠道腺癌患者资料,男性26例,女性7例,年龄(56.0±9.8)岁。33例患者化疗过程中出现肝紫癜11例,肝转移瘤22例。两组均行MRI平扫+增强,对比两组病灶的形态、边界等,病灶平扫信号及动态增强特征等。测量肝紫癜和肝转移瘤病灶、周围正常肝实质表观扩散系数(ADC)值。结果11例肝紫癜患者共14个病灶,10个病灶边界模糊,4个边界清晰;22例肝转移瘤患者共31个病灶,26个边界清晰,5个边界模糊。两组患者的病灶边界比较,差异有统计学意义(P<0.05)。肝紫癜病灶(11个)ADC值高于肝转移瘤病灶(29个),肝转移瘤病灶ADC值低于邻近正常肝实质,差异有统计学意义(P<0.05)。动态增强扫描,14个肝紫癜病灶中,10个病灶呈渐进性填充式强化,4个病灶呈持续性明显强化。31个肝转移瘤病灶,28个病灶呈环形强化,3个呈"快进快出"式强化。结论胃肠道腺癌化疗过程中出现的肝紫癜病灶边界模糊,弥散不受限,呈渐进性强化,MRI表现有助于肝紫癜与胃肠道腺癌肝转移瘤的鉴别诊断。Objective To compare the MRI features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.Methods The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed.Of the 26 males and 7 females aged(56.0±9.8)years,there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients.All patients underwent contrast-enhanced abdominal MRI scans.The differences in the MRI features,including morphology,margin,signal intensity on plain scanning and enhancement patterns were compared statistically.The apparent diffusion coefficient(ADC)values of peliosis hepatis,hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.Results In 14 lesions of the 11 patients with peliosis hepatis,10 lesions were ill-defined and 4 lesions were well-defined.In 31 lesions of the 22 patients with hepatic metastases,5 lesions were ill-defined and 26 lesions were well-defined.Significant differences existed between peliosis hepatis and hepatic metastases in the margin(P<0.05).The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma(P<0.05).In all the 14 lesions of peliosis hepatis,10 lesions showed gradual filling enhancement,and 4 lesions showed marked and persistent enhancement.In all the 31 lesions of hepatic metastases,28 lesions showed a ring-shaped enhancement,and 3 lesions showed"quick in and quick out"enhancement.Conclusions The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined,with no restriction of water diffusion in the diffusion weighted imagings,and with progressive enhancement.The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma

关 键 词：胃肿瘤 结直肠肿瘤 磁共振成像 肝紫癜 肝转移瘤 

分 类 号：R73[医药卫生—肿瘤]