MRI及其定期随访对肝硬化结节癌变的诊断价值

The value of MRI and regular follow-up in the diagnosis of hepatocellular carcinoma with dysplastic nodule in liver cirrhosis

目的探讨MR及定期随访在肝硬化结节癌变诊断中的价值,旨在早期发现肝硬化结节癌变。方法回顾性分析经病理或手术证实48例肝硬化结节恶变患者的T1WI、T2WI、增强扫描、DWI表现及随访资料,分析肝硬化结节恶变MR表现、信号变化。结果 48例患者共66个病灶,T1WI呈等、低信号,偶有高信号;T2WI多为稍高信号,亦可见等信号;三期增强扫描"快进快出"、"快进慢出"、"持续性强化"都可出现,典型"快进快出"为主;DWI呈高信号多见。部分病灶首次MR检查并未发现癌变,随访过程中T2WI信号增高,强化方式改变或进行性增大等改变,后经证实已癌变。结论磁共振常规技术及DWI能对大多数肝硬化结节癌变做出明确诊断,定期随访能早期发现结节恶变,明显提高诊断准确率。

Objective To oxplore MR findings, signal changes of nodules in the cirrhotic liver, and to discuss the value of MR and regular follow-up in diagnosing malignant transformation of nodules, Malignant transformation of hepatic cir rhotic nodules is the necessary stage of liver cirrhosis into hepatocellular carcinoma in order to improve the early diagnosis. Methods 48 patients with malignant transformation of hepatic cirrhotic nodules by pathology and operation were retro spectively analyzed. Results There were a total 66 lesions in 48 patients, T1WI showed iso-intensity and hypo-intensity, occasionally, hyper-intensity; T2WI was mainly slight hyper-intensity, iso-intensity was also visible. Among the 66 le sions, ＂fast in fast out＂, ＂fast in and slow out＂, continuous enhancement were visible, but typically ＂fast in fast out＂ was the most common performance. Hyper-intensity was common on DWI. A part of the lesions was not revealed carcinogene sis at the first time, signal changed during follow-up, for example, T2WI signal increased, strengthening mode changed, progressive enlarged and so on, were clinicopathologic defined malignant transformation. Conclusion Magnetic resonance conventional technology and DWI can make a definite diagnosis for most of hepatocellular carcinoma nodules, and regular follow-up can obviously improve accuracy of early detection.