酒精相关性肝细胞癌的临床特点和CT、MRI影像表现

The Clinical Characteristics and the Image Presentation of CT and MRI of Hepatocellular Carcinoma Based on Alcoholic Liver Cirrhosis

目的：探讨酒精相关性肝细胞癌的临床特点、CT及MRI表现,以提高对酒精相关性肝细胞癌的诊断水平。方法回顾性分析本院2010年6月~2014年10月经手术、病理及临床证实的10例酒精相关性肝细胞癌的临床特点及影像学表现。结果10例酒精相关性肝细胞癌均有长期大量饮酒史,肝炎免疫检查无异常,肝功能检查以AST、GGT升高较明显。10例均有酒精性肝硬化背景,其中4例有弥漫性脂肪肝。分型上巨块型7例（70%）,好发于肝右叶,多为单发（7/10例,70%）。肝血管（特别是门脉）内癌栓多见（6/10例,60%）,瘤灶内可出现坏死,部分瘤内出现脂肪变性（2/10例）、钙化（1/10例）,出血较为少见。 CT平扫以低密度表现为主,MRI平扫,T1WI上大部分为均质稍低信号（4/6例）,T2WI上以不均质高信号为主。 DWI均呈高信号。 CT及MRI增强后多表现为动脉期明显强化,门脉期强化程度减退,延迟期呈低密度,增强模式呈“快进快出”型,2例出现延迟性强化的假包膜。结论虽然酒精相关性肝细胞癌与不分原因的原发性肝细胞癌的临床特点及影像学表现有很大一部分重叠,但酒精相关性肝细胞癌具有一定的特点。其诊断需依赖长期嗜酒史、临床表现、实验室检查及影像学检查进行综合分析。

Objective To investigate clinical characteristics and the imaging manifestations of CT and MRI of the alcohol-related hepatocellular carcinoma（HCC）,so as to improve the diagnostic capacity of the alcohol-related HCC. Methods From June 2010 to October 2014,10 patients with alcohol-related HCC had reviewed retrospectively,all of them were confirmed surgical-ly and pathologically. Results 10 patients with HCC were long-term and excessive alcoholic consumption,and their immune examination of hepatitis was normal. The liver function showed that the AST and GGT were significantly increased. All the cases were with alcohol-related cirrhosis,and 4 cases（40%） showed diffusely hepatic adipose infiltration,7 cases（70%） were massive single masses and located in the right hepatic lobe,6 cases（60%） were with cancer embolus in hepatic vessel（mainly in portal vein）. There were all low density on CT noncontrast scan. The imaging manifestations of MRI were slightly low intensity on T1WI, and high intensity on both T2WI and DWI. The enhancement scanning of CT and MRI were high during arterial phase,and re-duced in portal phase and delayed phase,showed as the characteristic of“fast-in and fast-out”. Conclusion The clinical char-acteristics and the imaging manifestations of CT and MRI in the alcohol-related HCC were likely the same as primary HCC. How-ever,the alcohol-related HCC had some their own features. The diagnosis of the alcohol-related HCC must be comprehensively an-alysed on long-term and excessive alcohol consumption,clinical characteristics,laboratory and imaging examination.