无肝硬化甲胎蛋白阴性肝细胞癌与肝脏局灶性结节增生鉴别诊断的研究  

Differential diagnosis between alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis and hepatic focal nodular hyperplasia

作　　者：丁芳[1] 王明亮 韩晶 纪元 曾蒙苏 Ding Fang;Wang Mingliang;Han Jing;Ji Yuan;Zeng Mengsu(Department of Radiology,the Traditional Chinese Medical Hospital of Nantong,Nantong 226000,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]南通市中医院放射科,南通226000 [2]复旦大学附属中山医院放射科,上海200032 [3]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》2022年第5期352-355,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市临床重点专科项目(shslczdzk03202)。

摘　　要：目的分析无肝硬化甲胎蛋白阴性的肝细胞癌和肝脏局灶性结节增生(FNH)的临床和MRI特征及鉴别诊断。方法回顾性分析2017年3月至2020年11月于复旦大学附属中山医院及南通市中医院行肝脏手术的105例无肝硬化甲胎蛋白阴性的肝细胞癌患者资料,其中男性95例,女性10例,年龄(60.2±9.9)岁,病灶109个。收集同时段肝脏FNH的88例患者资料,其中男性36例,女性52例,年龄(32.8±9.5)岁,病灶99个。比较两组年龄、乙型病毒性肝炎(乙肝)病史、T_(1)加权成像(T_(1)WI)、T_(2)加权成像(T_(2)WI)、弥散加权成像(DWI)、表观扩散系数(ADC)、强化模式、病灶形状、病灶边界、包膜等。结果无肝硬化甲胎蛋白阴性的肝细胞癌患者年龄和乙肝病史比例高于肝脏FNH患者,差异有统计学意义(均P<0.05)。肝细胞癌病灶类圆形、边界清楚、有包膜比例高于肝脏FNH病灶,差异有统计学意义(均P<0.05)。肝细胞癌病灶的T_(1)WI、T_(2)WI、强化模式、DWI、ADC图等与肝脏FNH病灶比较,差异有统计学意义(均P<0.05)。年龄>45.5岁、乙肝病史、病灶边界清楚、"快进快出"的强化模式、有包膜诊断无肝硬化甲胎蛋白阴性的肝细胞癌受试者工作特征曲线下面积分别为0.97(95%CI:0.95~0.99)、0.79(95%CI:0.72~0.85)、0.78(95%CI:0.72~0.85)、0.94(95%CI:0.90~0.97)、0.99(95%CI:0.98~1.00)。结论有包膜、病灶边界清楚及"快进快出"的强化模式有助于无肝硬化甲胎蛋白阴性的肝细胞癌与肝脏FNH的鉴别。Objective To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia(FNH)to arrive at a correct differential diagnosis.Methods The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital,Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied.There were 109 lesions in 95 males and 10 females.These patients had the age of(60.2±9.9)years.The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected,and there were 99 lesions in 36 males and 52 females.These patients had the age of(32.8±9.5)years.Variables including age,history of hepatitis B virus infection,T_(1)weighted imaging(T_(1)WI),T_(2)weighted imaging(T_(2)WI),diffusion-weighted imaging(DWI),apparent diffusion coefficient(ADC),enhancement mode,lesion shape,lesion boundary and capsule were compared between the two groups.Results The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group(both P<0.05).The proportion of lesions with quasi-circular shape,clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group(all P<0.05).There were also significant differences in the T_(1)WI,T_(2)WI,enhancement modes,DWI,and ADC map between the two groups of lesions(all P<0.05).The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age>45.5 year,with a history of hepatitis B,with clear lesion boundary,with a"washin and washout"enhanced mode and with lesion encapsulation were 0.97(95%CI:0.95-0.99),0.79(95%CI:0.72-0.85),0.78(95%CI:0.72-0.85),0.94(95%

关 键 词：癌 肝细胞 诊断 鉴别 甲胎蛋白类 局限性结节状增生 

分 类 号：R735.7[医药卫生—肿瘤]