Gd-EOB-DTPA对肝局灶性结节增生的诊断价值探讨

Diagnostic Value of Gd-EOB-DTPA in Hepatic Focal Nodular Hyperplasia

【目的】探讨肝特异性对比剂Gd-EOB-DTPA在肝局灶性结节增生(FNH)的MRI平扫及多期增强检查中的诊断价值。【方法】回顾性分析利用肝特异性对比剂Gd-EOB-DTPA行肝MRI平扫及多期增强检查的36例FNH患者(共46个病灶)的影像学资料。观察FNH在MRI平扫、多期增强(包括肝细胞期)以及DWI上的影像表现。【结果】146个病灶动脉期均呈明显强化,信号强度高于肝,6.52%(3/46)病灶内部和/或周围见迂曲血管影;门脉期及平衡期除中心瘢痕外均呈均匀性等或稍高信号。2肝细胞期FNH的信号特点有5种类型:均匀性高信号17.39%(8/46)、不均匀高信号34.78%(16/46)、中央低信号-边缘环形高信号28.26%(13/46)、等信号17.39%(8/46)和稍低信号2.18%(1/46)。316个病灶含有中心瘢痕,其中62.50%(10/16)病灶直径大于30 mm,81.25%(13/16)呈T1WI低信号、T2WI高信号;13个病灶的中心瘢痕门脉期开始强化,16个病灶的中心瘢痕肝细胞期均呈低信号。436例患者中,12例(20个病灶)行DWI检查,5个病灶呈等信号,14个呈稍高信号,1个呈稍低信号;FNH和正常肝组织的平均ADC值分别为(1.17±0.047)×10-3 mm2/s、(1.24±0.039)×10-3 mm2/s(P=0.199>0.05),二者间的差异不具有统计学意义。【结论】FNH绝大多数在Gd-EOB-DTPA肝细胞期呈等或高信号,有助于FNH的诊断。FNH的ADC值与周围正常肝组织无统计学差异。

【Objective】 To discuss the diagnostic value of hepatocyte-specific contrast agent Gd-EOB-DTPA in the magnetic resonance imaging examination of hepatic focal nodular hyperplasia（FNH）. 【Methods】 In this retrospective trial, 36 patients（including 46 lesions） diagnosed with FNH underwent Gd-EOB-DTPA enhanced MRI examinations. Analyze their imaging findings on nonenhanced, multiphase enhanced imaging and Diffusion Weighted Imaging（DWI）. 【Results】 1all of the 46 lesions show obvious enhancement in arterial phase, whose signal are much higher than the background liver parenchyma, 6.52% of which can see tortuous vessels in or around the lesion, and they all become isointense or slightly hyperintense in portal venous phase and late phase except the central scar. 2 the signal of lesions in hepatocellular phase has 5 types ： homogeneously hyperintense, inhomogeneously hyperintense, isointense, peripheral hyperintense with a hypointense center and hypointense. 3in the 46 lesions, 16 has central scar, and the diameter of 10（62.50%, 10 / 16） is larger than 30 millimeter. 13 of the 16 central scars show typical signal characteristics in T1 weighted imaging and T2 weighted imaging, 13 show enhancement in portal venous phase, and all become hypointense in hepatocellular phase. 4Between the 36 patients, 12 patients（20 lesions） have DWI, 5 of the which show isointense,14 show slightly hyperintense and 1 show hypointense. The mean ADC value of all the lesions and the background liver parenchyma is（1.17 ± 0.047） × 10^-3mm2/ s and（1.24 ± 0.039） × 10^-3mm2/ s（P = 0.199 〉0.05） separately, so the difference between them has no statistical significance. 【Conclusion】 Most FNH are isointense or hyperintense in hepatocellular phase, which contributes to thediagnosis. While the difference of ADC value between FNH and the background liver parenchyma has no statistical significance.