31例肝局灶性结节性增生患者的MRI及病理特征分析  

MRI and pathological features analysis of 31 cases with focal nodular hyperplasia of liver

作　　者：王芷玥 吴白龙 杨波[1] 王雷[1] 李家庭[1] 冉梦玉 Wang Zhiyue;Wu Bailong;Yang Bo;Wang Lei;Li Jiating;Ran Mengyu(Department of Medical Imaging,The Third the Peopel's Hospital of Bengbu,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠市第三人民医院医学影像科,安徽蚌埠233000

出　　处：《医药前沿》2024年第19期1-4,共4页Journal of Frontiers of Medicine

摘　　要：目的:分析肝局灶性结节性增生(FNH)患者的磁共振成像(MRI)及病理特征。方法:选取2017年1月—2019年12月某三甲医院经手术病理确诊的FNH患者31例。所有患者术前均行MRI平扫及增强扫描,其中4例使用钆塞酸二钠(Gd-EOB-DTPA)增强扫描,分别进行影像学及病理学对照分析。结果:形态学表现:31例FNH患者共61个病灶,呈分叶状或类圆形,长径0.4~9.4 cm,平均(2.8±2.2)cm。其中20个病灶长径>3.0 cm;24个病灶见中心瘢痕。长径>3.0 cm的病灶中,瘢痕检出率为80.0%(16/20),假包膜检出率为9.8%(6/61)。FNH信号特点:T1WI显示等稍低信号。T2WI及DWI显示等稍高信号,弥散无明显受限。动态增强扫描显示“快进慢出”强化方式(动脉期明显强化;门脉期及平衡期呈等稍高信号,瘢痕延迟强化)。病理特点:大体检查结果显示,病灶表现为灰黄色结节,质地中等,界限清楚,部分中心见星状瘢痕,3例可见包膜。镜检结果显示,瘢痕由纤维组织、厚壁畸形血管及炎性细胞构成,肝细胞形态正常,缺乏静脉系统。免疫组化结果显示,甲胎蛋白(AFP)阴性,CD34血管阳性,CK19、CK7胆管阳性,肝细胞特异性抗原(Hepa)阳性,Ki-67部分阳性,谷氨酰胺合成酶(GS)地图状阳性。结论:FNH在MRI上以T1WI等稍低信号,T2WI及DWI等稍高信号为主;“快进慢出”强化方式是FNH的典型MRI特征,与其病理基础一致;Gd-EOB-DTPA增强扫描更能准确反应FNH的血供特点及病理特征。Objective To analyze the magnetic resonance imaging(MRI)and pathological features of focal nodular hyperplasia(FNH)of the liver.Methods A total of 31 FNH patients from a ClassⅢGrade A hospital were selected from January 2017 to December 2019.All patients were confirmed histopathologically after surgical resection.All the patients were performed MRI plain and enhanced scan,4 of them with Gd-EOB-DTPA enhanced scan.The pathological and imaging features were comparatively analysed.Results Morphological characteristics:in 31 FNH patients,a total of 61 lesions were identified,presenting as lobulated or round shapes with a diameter ranging from 0.4 to 9.4 cm,and an average of(2.8±2.2)cm.Among these,20 lesions had a diameter greater than 3.0 cm,24 lesions showed central scars.The detection rate of scars in lesions larger than 3.0 cm was 80.0%(16/20),and the detection rate of pseudocapsules was 9.8%(6/61).FNH signal characteristics:on T1WI,the signal was isointense to slightly hypointense.On T2WI and DWI,the signal was isointense to slightly hyperintense,with no significant diffusion restriction.Dynamic enhanced scan displays the"quick in-slow out"enhancement pattern(enhanced scans showed significant enhancement in the arterial phase,and isointense to slightly hyperintense signal in the portal and equilibrium phases,with delayed enhancement of scars).Pathological characteristics:macroscopic examination revealed gray-yellow nodules with moderate texture and clear boundaries,with some showing stellate scars in the center and 3 cases showing capsules.Microscopic examination showed that scars were composed of fibrous tissue,thick-walled malformed blood vessels,and inflammatory cells.Hepatocytes appeared normal,and there was a lack of venous system.Immunohistochemical results:Alpha-fetoprotein(AFP)was negative,CD34(vascular marker)was positive,CK19 and CK7(bile duct markers)were positive,hepatocyte-specific antigen(Hepa)was positive,Ki-67(proliferation marker)was partially positive,glutamine synthetase(GS)was map-like posit

关 键 词：肝 局灶性结节性增生 磁共振成像 钆塞酸二钠 

分 类 号：R575[医药卫生—消化系统]