肝细胞癌癌前结节影像学特征的研究进展

Research progress in imaging characteristics of precancerous nodules in hepatocellular carcinoma cells

肝细胞癌(HCC)发生是一个多步骤过程,在其发展中检测出HCC癌前病变和进展期HCC,对预测肿瘤行为、判断病变程度、采用最佳治疗策略、改善患者生存至关重要。肝脏成像技术的快速进展和广泛应用,尤其是肝细胞特异性对比剂钆塞酸二钠MRI(Gd-EOB-DTPA MRI)可提供肝结节血管变化、肝细胞功能信息,能够精确区分肝硬化再生结节、低度异型增生结节、高度异型增生结节、早期HCC(early HCC)和HCC,从而进行恶性进展的风险度分层。现综述Gd-EOB-DTPA MRI在HCC早期诊断中的价值,分析HCC多步发展过程中的关键概念,以及癌前病变最终可能转化成典型HCC的影像学表现。

Hepatocarcinogenesis is a multi-step process in which detection of precancerous lesions and advanced hepatocellular carcinoma in its progressive stage is crucially important for predicting tumor behavior,estimating the extent of lesions,implementing the optimal treatment strategy,and improving the survival of patients.The rapid development and wide application of liver imaging technology,especially the application of hepatocyte-specific gadoxetate disodium MRI contrast agent(Gd-EOB-DTPA MRI),not only provide information on vascular changes of liver nodules and hepatocyte function,but also has become a precise diagnostic method for differentiating cirrhotic regenerative nodule(RN),low-grade dysplastic nodule(LGDN),high-grade dysplastic nodule(HGDN),early hepatocellular carcinoma and HCC.Hence,the risk for malignant progression is stratified.This review summarizes the value of Gd-EOB-DTPA MRI for early HCC diagnosis and analyzes the key concepts in the multi-step process of HCC development as well as the imaging manifestations of precancerous lesions that may eventually be transformed into typical HCC.