肝细胞癌和发育不良结节的MRI与病理对照研究

Comparison Study of MBI and Pathology of Hepatocellular Carcinoma and Dysplastic Nodule

比较肝细胞癌（HCC）和发育不良结节（DN）的磁共振信号，形态学改变与组织病理学的关系。材料和方法：收集21例HCC（≤5．0cm），7例DN。全部病例均做MR检查进行病理分级及观察结节内铁沉积。结果：21例HCC中，T1WI上为稍低信号T2WI上为稍高信号者17例，占80．95％，组织学为梁索型，病理分级为Ⅰ－Ⅲ级。7例DN中，T1WI上为稍高信号T2WI上为等信号者6例，占85．71％，病理上为多结节聚集，可见核不典型增生改变，二者信号差异有统计学意义（P＜0．001）。21例HCC中仅2例见铁沉积，均出现在瘤内出血区，7例DN中3例有铁沉积，以间质及窦除为多。少数高分化癌（Ⅰ级）者不易与DN区分，应作增强扫描。结论：大部分HCC与DN在中场强MR检查时凭信号可以区分二者，但少数高分化癌中，二者鉴别有一定困难。

The purpose of this study is to correlate the MR signal intensity(SI), morphologic appearance and pathologic change of hepatocellular carcinoma(HCC) and dysplastic nodules(DN) Materials and Methods: Twenty one cases of HCC(≤5. 0mm) and 7cases of DN both proven by surgery and histology were analy. All specimens were examined microscopically with HE and Prussian blue stains and examined by a Toshiba 0. 35T superconductive MR system. Results: in 21 cases of HCC the SI appeared as slightly hypointense on T1 WI and slightly hyperintense on T2WI in 17 cases i. e. 80. 95%. Pathologically, they were graded as 1-11. In 7 cases of DN, 6 cases appeared as slightly hyperintense on T1 WI and isointense on T2 WI i. e. 85. 71%. Microscopically, they were the aggregation of multinodules with mild to medium atypical nuclear proliferation. There were significant difference in SI between HCC and DN(P＜0.001)Morphologically, the occurence of capsules and inhomogeneity within the tumor were higher in HCC than in DN. Iron deposition was present in 2 cases of HCC within the intratumoral hemorrhagic areas. lron deposition was seen in 3 cases of DN in interstitial and sinusoid areas. A few of high differentiated HCC (Grace I) can't be easily differentiated from DN, therefore should be further examined by enhancement due to different blood supplies. Conclusion: The majorities of HCC and DN could be differentiated by the SI issued on the medium magnetic field MRI, but it would be difficult for a few of high differentiated HCC.