原发性肝脏透明细胞癌的影像学诊断与临床应用价值

The diagnosis and clinical value of imaging for primary clear cell carcinoma of the liver

目的探讨原发性肝脏透明细胞癌（primaryclear cell carcinomaofliver，PCCCL）的影像学特征及其临床应用价值。方法回顾性分析12例经手术病理证实的PCCCL的MRI及CT检查资料。其中行MRI平扫及增强扫描8例，行CT平扫及增强扫描10例。结果病灶67％（8／12）位于肝右叶，25％（3／12）位于左叶，8％（1／12）位于尾叶，瘤径1．6～9．8em，平均3．6cm。MRI检查75％（6／8）呈T2WI混杂高信号，T1WI同相位等或稍低信号，反相位信号均减低，其中67％（4／6）明显减低，DWI均呈高信号；增强动脉期75％（4／6）轻度强化，门脉期持续轻度强化，病理证实透明细胞比例较高。25％（2／8）呈T2WI等信号，T1wI同相位稍高信号，反相位信号均减低，DWI呈等或稍高信号；增强动脉期明显强化，门静脉期廓清，透明细胞比例相对较低。50％（4／8）见环形强化的包膜。CT平扫均为低密度，增强动脉期80％（8／10）轻度强化，门脉期持续强化，病理证实75％（6／8）透明细胞比例较高，25％（2／8）透明细胞比例相对较低。20％（2／10）动脉期不均匀明显强化，门脉期强化程度明显下降，透明细胞比例较低。20％（2／10）显示延迟强化的包膜。结论MRI和CT平扫及动态增强扫描能全面、准确显示PCCCL的病理特征及组织构成，具有一定的特征，是目前诊断PCCCL的有效方法。二者结合对PCCCL的术前诊断具有重要价值，可为临床制定最佳治疗方案及预后评估提供重要信息。

Objective To investigate the imaging features of primary clear cell carcinoma of the liver （PCCCL） and its clinical value. Methods MRI and CT finding of 12 patients with PCCCL proved by pathology were analyzed retrospectively. 8 patients underwent plain and dynamically en- hanced MRI and 10 patients underwent plain and dynamically enhanced CT scanning. Results The numbers were 67% （8/12） in the right lobe, 25% （3/12） in the left lobe, and 8%（1/12） in the eau date lobe. Tumor diameters were 1.6 to 9.8 em, and the average was 3.6 cm. For the MRI examina- tion, 75%（6/8） showed a mixed high signal on T2WI and an equal or slightly lower signal on TIWI. All of the signal was reduced on anti-phase T1WI, 67 % （4/6）was obviously reduced, and all showed high signal on DWI. The 75%0 （4/6） slightly enhanced at the arterial phase continued to enhance at the portal venous phase. The pathology confirmed that there was a higher proportion of clear cell. 25% （2/8） showed an equal signal on T2WI and a slightly higher signal on T1WI, all of the signal re- duced on anti-phase T1WI, and all showed equal or slightly higher signal on DWI. All were signifi cantly enhanced at the arterial phase and clearanced at the portal venous phase. The pathology con- firmed that there was a relative lower proportion of clear cell. 50G （4/8） could be seen with the cap- sule and ring enhanced. All showed low-density on CT scan, 80G （8/10） were slightly enhanced at arterial phase and the signals continued to strengthen at the portal venous phase. The pathology con- firmed that 75% （6/8） had a higher proportion of clear cell and 25% （2/8） had a relatively low pro- portion of clear cell. 20% （2/10） showed significantly uneven enhancement at the arterial phase and the degree of enhancement decreased at the portal venous phase. The pathology confirmed that there was a lower proportion of clear cell. 20% （2/10） could be seen with the capsule with the ring en- hanced. Conclusions Plain and dynamically enhanced MRI and CT scans could show the pathological features and tissue composition of PCCCL fully and accurately. They were effective methods and eachhad certain characteristics. The combination of these had important values to diagnosis PCCCL and could provide important iifformation for clinics to develop the best treatment plan and prognostic evaluation.