慢性肝病背景微小肝癌的MR诊断

The MR diagnosis of micro hepatocellular carcinomas in patients with chronic liver disease

目的了解微小肝癌的MR特点,提高对微小肝癌的认识和早期诊断率。方法收集整理慢性肝病背景患者病理及临床诊断的微小肝癌共50例(55癌灶),分析其MR平扫及动态增强各序列图像表现及复查变化。结果各序列表现比较:DWI高信号病灶数所占比例为96.4%(53/55);T2 WI高信号病灶数所占比例为76.4%(42/55);T1 WI低信号病灶数所占比例为67.3%(37/55);双回波含脂质成分病灶数所占比例为14.5%(8/55);动态增强"快进快出"病灶数所占比例为67.3%(37/55);"快进慢出"病灶数所占比例为32.7%(18/55);延迟期有假包膜强化病灶数所占比例为29.1%(16/55)。DWI与T2 WI高信号病灶数所占比例差异有统计学意义(P=0.007)。所有病例2个月~2.5年内复查增大。结论高场MR为目前微小肝癌最好的检查方法,应作为慢性肝病患者定期复查首选的影像检查。

Objective （MHCC） retrospectively,and to improve the awareness and the early diagnostic rate of MHCC. Methods Fifty-five foci from 50 cases clinically and pathologically diagnosed of MHCC were collected, and the manifestations of scan and dynamic contrast-enhancement （DCE） in MR were also analyzed. Results Main MR manifestations were described as follows foci with high signal in diffusion weighted imaging （DWI） and T2 weighted imaging （T2WI） accounted for 96. 4% （53/55） and 76. 4% （42/55）,respectively,with significant difference （P = 0. 007）. Rate of foci with low signal in Tl weighted imaging （丁1WI） was 67. 3% （37/55）. Foci with lipids compositions in double echo was 14. 5 % （8/55）. In DCE,67.3% （37/55） foci appeared arterial hypervascularity and venous or delayed phase washout, while 32. 7% （18/55） were with arterial hypervascularity and venous or delayed phase late washout. All neoplastic foci were enlarged in reexamination within 2 months to 2. 5 years. Conclusion At present, 1. 5/3. 0T MR might be served as the best method for detecting MHCC, which should be preferred as the first choice in regular examination for patients with chronic liver disease.