原发性肝神经内分泌癌的影像表现

Imaging appearance of primary hepatic neuroendocrine carcinomas

目的探讨原发性肝神经内分泌癌的CT和MRI表现，提高影像诊断水平。方法回顾性分析经手术病理证实的6例肝原发性神经内分泌癌患者资料，术前4例行CT平扫及增强扫描，2例行MR平扫及增强扫描。结果6例中肿瘤呈多发1例，表现为1个大肿瘤伴周围多个小结节灶，其余5例均为单发。CT平扫除1例病灶周边可见点状钙化外，均表现为肝内低密度占位，病灶中央见较大范围的不规则更低密度区，边界清晰。肿瘤在MR T1WI表现为不均匀低信号，T2WI表现为略高信号。增强扫描实质部分表现为早期轻中度持续强化，但强化程度有所下降，也可表现为门静脉期和延迟期呈轻度强化，中心更低密度或信号区多无明显强化；周围肝内血管呈受压推移改变，腹腔及后腹膜均未见明显肿大的淋巴结。结论CT和MRI能显示原发性肝神经内分泌癌的特征，在该病的诊断和鉴别诊断中有一定价值。

Objective To investigate the CT and MRI findings of primary hepatic neuroendocrine carcinomas. Methods Imaging findings of 6 patients with pathologically confirmed hepatic neuroendocrine carcinomas were retrospectively analyzed. Four patients underwent plain CT and contrast enhanced CT examinations. The other 2 patients underwent plain MRI and contrast enhanced MRI. Results One out of the 6 cases manifested multicentric tumor which appeared as one large tumor surrounded with multiple small nodules peripherally, and the tumors of the other 5 cases were solitary. On plain CT images, all lesions were well-defined and hypoattenuating with central areas of even lower density except punctuate calcifications at tumor periphery in 1 case. On pre-contrast MRI, the cases manifested heterogeneous low signal intensity on T1WI and slightly high intensity on T2WI. On dynamic contrast enhanced CT and MRI, Tumors manifested slight to mild enhancement in arterial phase, slight enhancement in portal venous phase or delayed phase with no enhancement in the center, accompanied by dislocation of surrounding vessels. There was no lymphadenopathy in peritoneal cavity and retroperitonium. Conclusion CT and MRI scanning can demonstrate specific features of primary hepatic neuroendocrine carcinoma, which may help the diagnosis and differential diagnosis of the tumor.