儿童肝脏局灶性结节增生的MSCT表现

MSCT features of hepatic focal nodular hyperplasia in children

目的探讨儿童肝脏局灶性结节增生(FNH)的MSCT表现,以提高对该病的诊断准确率。方法回顾性分析7例经病理证实为FNH的患儿临床及影像资料,结合文献复习、分析总结其特征表现。结果 7例患儿中AFP均为阴性。所有病灶均为单发,位于肝左外叶1例,左内叶2例,右后叶4例;最大径2.0～10.7cm,平均为(6.5±3.1)cm。7例FNH均边界清晰,无包膜显示;5例呈圆形,2例呈卵圆形。7例均行MSCT检查,平扫呈稍低或等密度,无囊变、出血及钙化;6例动脉期呈明显强化,均可见供血动脉(5例显著较均匀强化,1例呈周边环状结节样不均匀强化),门脉期及延迟期均与肝脏组织呈等密度,其中5例见中央星芒状瘢痕,4例伴有瘢痕延迟强化;另1例动脉期无明显强化,门脉期及延迟期相对正常肝脏实质呈稍低强化,此例可见门静脉-下腔静脉分流。结论儿童肝脏FNH的MSCT表现具有一定的特征性,对诊断和鉴别诊断具有一定的意义。

Objective To investigate MSCT features of focal nodular hyperplasia (FNH) in children, and to improve the diagnostic accuracy of FNH. Methods Clinical data and MSCT findings of 7 hepatic FNH in children confirmed by pathology were retrospectively reviewed. The MSCT features were analyzed. Results Among the patients, 3 were male and 4 female. The age ranged from 8 months to 12 years. No significant AFP elevation was observed. All the cases were single lesion. One case was located in left lateral lobe, 2 in left inner lobe, and the others in the right posterior lobe. The average tumor maximum diameter was (6.5±3.1) cm (range, 2.0~ 10.7cm). All lesions were well-circumscribed without capsule. Five cases were round and 2 were ovoid. All patients underwent MSCT scan, the lesions showed slightly hypodense or isodense without cystic degeneration, hemorrhage, calcification on plain CT scan. Five cases showed central stellate scar. In the arterial phase, 5 lesions showed markedly homogeneous enhancement and 1 showed peripherally heterogeneous enhancement and all the 6 cases showed isodense compared with the normal liver parenchyma in the portal venous and delayed phases. Feeding arteries were observed in six lesions. Four of the 5 cases with the central scar areas demonstrated delayed enhancement. The other one demonstrated no enhancement in the arterial phase and continuous enhancement in the portal venous and delayed phases, and portosystemic shunt was shown in this case. Conclusion Hepatic FNH in children shows characteristic MSCT features, which play an important role in the diagnosis and differential diagnosis.