Gd-EOB-DTPA增强MRI肝胆期高信号HCC的影像学表现及病理对照分析  

Comparative Analysis of Imaging and Pathology Features of Hepatocellular Carcinoma Showing Hyperintensity on the Hepatobiliary Phase of Gd-EOB-DTPAenhanced MRI

作　　者：俞丽华 邢飞[1] 张涛[1] 陆健[1] 马秦榕 YU Li-hua;XING Fei;ZHANG Tao;LU Jian;MA Qing-rong(Department of Radiology,the Third Affiliated Nantong Hospital of Nantong University,Nantong 226000,Jiangsu Province,China;Department of Pathology,the Third Affiliated Nantong Hospital of Nantong University,Nantong 226000,Jiangsu Province,China)

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

出　　处：《中国CT和MRI杂志》2023年第12期102-104,共3页Chinese Journal of CT and MRI

基　　金：南通市卫生健康委员会科研立项课题(MA2021025)。

摘　　要：目的探讨普美显(Gd-EOB-DTPA)增强MRI肝胆期(HBP)高信号肝细胞癌(HCC)影像学表现及病理对照分析。方法回顾性分析南通第三人民医院自2018年12月至2022年10月经手术病理证实的29例Gd-EOB-DTPA增强MRI检查HBP高信号HCC患者的影像学及病理资料,观察肿瘤的影像特征(包括病灶大小、MRI平扫、动态增强模式及HBP表现),并与病理结果进行对照分析。结果29例均为单发病灶,最大径3.0(2.2,4.2)cm,主要表现为T1WI低信号、T2WI高信号,19例DWI、ADC均呈稍高信号,2例为病变内含脂。动态强化模式以快进慢出型为主(58.6%,17/29),其次是快进快出型(41.4%,12/29)。肝胆期,51.7%(15/29)表现为HBP低信号环、44.8%(13/29)表现为对比剂局灶性未摄取、27.6%(8/29)表现为“结中结”表现。根据HCC Edmondson病理分级,高分化3例(Ⅰ级1例,Ⅰ/Ⅱ级2例)、中分化(Ⅱ级)19例、低分化(Ⅱ/Ⅲ级5例,Ⅲ级2例)7例。高中分化组与低分化组高信号HCC在ADC图信号、动态强化模式上具有统计学差异(P=0.030,P=0.011)。影像与病理对照发现,HBP低信号环与肿瘤纤维包膜相对应,对比剂局灶性未摄取与肿瘤囊变、坏死或去分化区相一致,“结中结”表现与肿瘤异质性分化密切相关。结论HBP高信号HCC病理上以高中分化为主,ADC图信号、动态强化模式与肿瘤分化程度有关,HBP低信号环、对比剂局灶性未摄取、“结中结”表现有助于其诊断。Objective To analyze the imaging and pathology features of hepatocellular carcinoma(HCC)showing hyperintensity on the hepatobiliary phase(HBP)of Gd-EOB-DTPA-enhanced MRI.Methods The imaging and pathological data of 29 patients with HBP hyperintensity HCC examined by Gd-EOB-DTPAenhanced MRI in the Third Affiliated Nantong Hospital of Nantong University from December 2018 to October 2022 were retrospectively analyzed.The imaging features of the tumor(including lesion size,MRI plain scan,dynamic enhancement mode and HBP imaging)were observed and compared with the pathological results.Results All the 29 cases were single lesions with an maximum diameter of 3.0(2.2,4.2)cm.HBP hyperintensity HCC mainly showed hypointensity on T1WI and hyperintensity on T2WI.25 cases showed slightly hyperintensity on DWI and ADC,and 2 cases contained fat in mass.The dynamic enhancement patterns of hyperintensity HCC were mainly wash-in and no wash-out type(58.6%,17/29),followed by wash-in and wash-out type(41.4%,12/29).Hyperintensity HCCs were mainly showed HBP hypointense rim(51.7%,15/29),focal defects in uptake(44.8%,13/29),and“nodule-in-nodule”architecture(27.6%,8/29)on HBP imaging.According to the pathological grade of HCC Edmondson,3 cases were highly differentiated(1 case of gradeⅠ,2 cases of gradeⅠ/Ⅱ),19 cases of moderately differentiated,and 7 cases of low differentiated(5 cases of gradeⅡ/Ⅲ,2 cases of gradeⅢ).There was a statistically significant difference in ADC map signal and dynamic enhancement pattern between the high-moderately differentiated group and the poorly differentiated group(P=0.030,P=0.011).According to the comparison of imaging and pathology,it was found that the HBP hypointense rim was corresponding to the tumor fibrous capsule,focal defects in uptake was consistent with the cystic degeneration,necrosis or dedifferentiation of the tumor,and“nodule-innodule”architecture was closely related to the heterogeneous differentiation of the tumor.Conclusion HBP hyperintensity HCC is mainly moderately

关 键 词：肝细胞癌 钆塞酸二钠 结中结 肝胆期低信号环 

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