原发性肝透明细胞癌的CT及MRI诊断分析

CT and MRI Diagnosis of Primary Clear Cell Carcinoma of Liver

目的：探讨原发性肝透明细胞癌（PCCCL）的CT、MRI表现及其诊断价值。方法选取2008年1月-2013年7月我院经病理证实的PCCCL患者7例，均行CT平扫和双期增强扫描，其中5例另行MRI横断面T2加权像（T2WI）＋脂肪抑制（FS）、扩散加权成像（DWI）、 T1加权像（T1WI）和动态增强扫描。回顾性分析7例患者的CT、MRI表现。结果7例患者中，6例为单发病灶，病灶直径为2.2～4.7cm，平均约3.3cm；1例为多发病灶，最大病灶直径约14.7 cm。 CT平扫：病灶均呈相对低密度改变，6例密度不均匀，其中1例病灶内伴稍高密度出血灶。CT增强扫描：5例病灶动脉期轻度强化，以边缘强化为主，门脉期持续强化，逐步充填改变；其中1例病灶中央同时出现斑片状异常强化，1例出现延迟强化包膜；2例病灶动脉期强化明显，门脉期未见明显扩清。 MRI T1WI：3例病灶呈稍低信号，信号均匀，反相位信号程度均有下降；2例T1 WI病灶信号混杂，内伴斑状高信号，其中1例反相位序列高信号区信号减低。 MRI T2WI：所有病灶呈混杂高信号。 DWI：4例呈高信号，1例呈等信号。 MRI增强扫描：3例病灶动脉期轻度强化，边缘强化明显，门脉期病灶持续强化；2例病灶动脉期强化明显，门脉期强化程度无下降；4例显示延迟强化包膜。结论 PCCCL的影像学表现差异较大，但T1 WI及动态增强的运用仍能表现出一定的特征，为术前正确诊断提供依据。

ObjectiveTostudytheimagingfeaturesofprimaryclearcellcarcinomaoftheliver（PCCCL）onCT, MRI and their diagnostic value .Methods The clinical data and CT and MRI findings of 7 cases with pathologically -proved PCCCL in our hospital from Jan.2008 to Jul.2013, were retrospectively summarized and analyzed .Both non-contrast and con-trast scans with spiral CT were performed in 7 cases.MRI with T2WI＋FS, DWI, T1WI （ in phase/out of phase ） and dynamic multiphase contrast scanning were performed in 5 cases.Results Among the 7 cases, 6 had single lesion, and the maximum di-ameter of tumor range from 2.2 cm to 4.7 cm with a mean diameter of 3.3 cm; 1 case had multiple lesions and the maximum di-ameter of lesion was 14.7 cm.All showed low-density on plain CT , 6 lesions were of inhomogeneous density , and one of them had hemorrhage with slightly high density .The solid portion of mass enhanced slightly in the arterial phase in 5 lesions, especially the peripheral part of the lesions , and it continued to enhance in the portal venous phase , and markedly enhancement was found in the central of one case .The rim enhancement of tumor capsule was found in one case .2 cases were found with marked enhance-ment in the arterial phase and no obvious decrease in the portal venous phase .For the MRI examination , 3 cases showed slightly lower and homogeneous signal on T 1WI, and all of the signal was reduced in T 1WI; 2 cases showed a mixed signal with patchy high signal in T1WI, and the high signal was reduced in one case .All cases were heterogeneously hyperintense in T 2WI; 4 cases were hyperintense in DWI , one case was isointense .3 cases were slightly enhanced in the arterial phase and continued to enhance in the portal venous phase , especially the peripheral part of the lesions .2 cases were significantly enhanced in the arterial phase and no obvious decrease in the portal venous phase .The rim enhancement of tumor capsule was found in 4 cases.Conclusion The imaging features of PCCCL was significantly different , but the use of T1WI （in phase/out of phase） and dynamic multiphase con-trast scanning still show some characteristics of PCCCL , and it could be helpful in providing reference for accurate diagnosis be-fore surgery.