原发性透明细胞型肝癌的MRI表现与临床病理对照

MRI Findings of Primary Clear Cell Carcinoma of the Liver: Comparison with Clinical and Pathological Manifestations

目的探讨原发性透明细胞型肝癌(PCCCL)的MRI表现,并与临床病理进行对照,以提高其诊断准确性。方法回顾性分析10例经手术病理证实的PCCCL患者的MRI表现及临床资料,并复习文献。结果 10例均为中老年男性,8例有乙肝病史,5例AFP阳性。病灶单发,肝右叶8例,左叶2例,呈椭圆形,结节状,边界较清。MR T1WI上病灶呈不均匀等、低信号,T2WI上为相对高信号,T2WI脂肪抑制和反相位上病灶信号衰减,DWI多呈混杂高信号。增强动脉期呈不均匀轻至中度强化,门静脉期及延迟期呈相对低信号,病灶内有无强化的低信号区,4例病灶见环形强化的假包膜。结论 PCCCL具有一定特征的MRI表现,综合多种检查方法并结合临床,将有助于该病的明确诊断,确诊依赖病理。

Objective To explore MRI findings of primary clear cell carcinoma of the liver（PCCCL） and to compare MRI features with the clinical and pathological manifestations so as to improve its diagnosis accuracy.Methods Ten patients with pathologically-proved PCCCL were enrolled in this study.MRI manifestations were retrospectively analyzed.The relevant literatures were reviewed.Results All 10 cases were middle-aged males.Among the 10 cases,8 had a history of hepatitis B and positive AFP was detected in 5.The lesions were solitary,oval nodule with clear border in all cases,and the lesions were located in right hepatic lobe（n=8） or in left hepatic lobe（n=2）.On MR T1 WI the lesions were inhomogeneous iso- or hypo-intensity,while presented as hyper-intensity signal on T2 WI.On Fat suppression,especially in T1 WI opposed phase,the lesions showed decayed signals,and heterogeneous hyper-intensity signals on DWI.Contrast-enhanced MRI scanning showed that the lesions presented as inhomogeneous mild-to-moderate enhancement in arterial phase,relatively lower signals in portal phase and delayed phase with lower signal areas within the lesion.Ring-like enhancement of pseudocapsule was demonstrated in 4 cases.Conclusion PCCCL has certain MRI characteristics. Combination use of various imaging examinations is helpful for the diagnosis although the confirmation of the diagnosis depends on pathological results.