肝细胞癌伴中央瘢痕的钆塞酸二钠增强MRI表现与病理学对照分析  

Hepatocellular Carcinoma with Centralscar:Imaging Findings of Gadoxetic Acid⁃Enhanced MRI and Pathological Features

作　　者：王晨辰 朱文静[1] 姜吉锋[1] 陆健[1] 张涛[1] 邢飞[1] 肖锋[2] WANG Chenchen;ZHU Wenjing;JIANG Jifeng(Department of Radiology,The Third Affiliated Nantong Hospital of Nantong University,Nantong,Jiangsu Province 226000,P.R.China)

机构地区：[1]南通大学附属南通第三医院影像科,226000 [2]南通大学附属南通第三医院病理科,226000

出　　处：《临床放射学杂志》2023年第4期622-627,共6页Journal of Clinical Radiology

基　　金：南通市卫生健康委员会科研立项课题项目(编号:MA2021025)。

摘　　要：目的探讨肝细胞癌(HCC)伴中央瘢痕的钆塞酸二钠(Gd-EOB-DTPA)增强MRI表现与病理学对照分析。方法回顾性分析2016年5月至2022年1月南通大学附属南通第三医院经手术病理证实为HCC,术前均行Gd-EOB-DTPA增强MRI检查且具有中央瘢痕征象的17例患者资料。根据中央瘢痕不同病理性质分为炎症性、血管性和胶原性三种类型。分别对病灶主体、中央瘢痕的最大径、基本MRI征象、增强后多期强化特点及动态强化模式进行分析。采用独立样本t检验或Fisher确切概率法对不同病理性质中央瘢痕的影像表现进行比较。结果17例患者均为单发病变,病理显示,炎症性瘢痕8例、血管性瘢痕5例,胶原性瘢痕4例,三种类型瘢痕主要成分均为纤维组织。病灶主体最大径(53.6±20.7)mm,T_(2)WI、DWI均呈高信号,动态强化模式以“快进快出”型为主(15/17,88.2%)、“快进慢出”型少见(2/17,11.8%),肝胆期(HBP)均表现为低信号。中央瘢痕最大径(20.0±10.9)mm,主要表现为T_(2)WI高信号(16/17,94.1%)、DWI低信号(9/17,52.9%),58.8%(10/17)呈延迟强化,41.2%(7/17)无延迟强化,HBP以EOB“靶征”样高信号(14/17,82.4%)为主,低信号少见(3/17,17.6%)。炎症性、血管性瘢痕T_(2)WI均表现为高信号,胶原性瘢痕T_(2)WI可为低信号(1例)或高信号(3例)。炎症性、胶原性瘢痕可延迟强化(3例、2例)或无强化(5例、2例),血管性瘢痕均呈延迟强化(5例)。炎症性、胶原性与血管性瘢痕的最大径、基本MRI征象(T_(2)WI及DWI)及HBP表现差异均无统计学意义(P均>0.05),动态增强延迟强化特征差异具有统计学意义(P=0.044)。结论HCC中央瘢痕的主要成分是纤维组织,Gd-EOB-DTPA动态强化模式有助于鉴别炎症性、胶原性和血管性瘢痕,EOB“靶征”表现具有一定特征,但非特异性,仍需结合病灶主体MRI表现特点。Objective To analyzethe imaging findings of Gd⁃EOB⁃DTPA enhanced MRI and pathological features of hepatocellular carcinoma(HCC)with central scar.Methods 17 cases of HCC confirmed by surgery and pathology in the third affiliated Nantong hospital of Nantong university from May 2016 to January 2022 were retrospectively analyzed,all of whom underwent preoperative Gd⁃EOB⁃DTPA⁃enhanced MRIand showed acentral scarsign.According to different pathologi⁃cal properties of central scars,there were categorizedinto three types:inflammatory,vascular,and collagenous.The maximum diameter,basic MRI signs,enhancement characteristics of dynamic multiphase and dynamic enhancement mode of mass and central scar were analyzed.Independent sample t⁃test or Fisher's exact test were used to compare the imaging findings of central scars with different pathological types.Results All the 17 cases were single lesions,including inflammatory scar(n=8),vascular scar(n=5)and collagen scar(n=4).Pathology revealed that the main components of three types of central scars were fibrous tissue.The mass meanmaximum diameters were(53.6±20.7)mm,all masses were hyperintense on T_(2)WI and DWI.Most masses(15/17,88.2%)showed“wash⁃in with wash⁃out”dynamic enhancement mode,and“wash⁃in without wash⁃out”enhancement modewas rare(3/17,17.6%).All masses were hypointense on HBP.Central scarmean maximum diameters were(20.0±10.9)mm.All central scars were mostly hyperintense on T_(2)WI(16/17,94.1%)and hypointense on DWI(9/17,52.9%).Most central scars showed delayed enhancement(10/17,58.8%),fol⁃lowed by no delayed enhancement(7/17,41.2%).On HBP images,central scars mainly showed EOB“target sign”hyper⁃intense(14/17,82.4%),and the rest were hypointense(3/17,17.6%).Both inflammatory and vascular scars showed hy⁃perintense on T_(2)WI,and collagenous scars showed hypointense(n=1)or hyperintense(n=3)on T_(2)WI.Inflammatory and collagenous scars showed delayed enhancement(n=3,n=2,respectively)or no delayed enhancement(n=5,n=2,re⁃specti

关 键 词：肝细胞癌 中央瘢痕 钆塞酸二钠 病理 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]