非动脉期高强化的肝胆期“甜甜圈”样高信号结节的影像及临床病理学特征

Doughnut-Like Hyperintense Nodules on Hepatobiliary Phasewithout Arterial-Phase Hyperenhancement: Imagingand Clinicopathological Features

目的 探讨肝硬化背景下钆塞酸二钠(Gd-EOB-DTPA)增强MRI非动脉期高强化(APHE)肝胆期(HBP)“甜甜圈”样高信号结节的影像及临床病理学特征。方法 回顾接受Gd-EOB-DTPA增强MRI检查的1752例肝硬化患者,从中筛选出HBP“甜甜圈”样高信号结节的病例。分析这类结节的发生率、影像学特征、随访中恶性转化率以及病理所见。结果 38例(2.2%)患者共发现355个非APHE的HBP“甜甜圈”样高信号结节,均为多发,其中,33例与乙型肝炎有关,2例与酒精性肝硬化有关,3例与自身免疫性肝炎有关。所有结节均表现为非APHE,门静脉期(PVP)明显强化,过渡期(TP)持续强化,HBP呈“甜甜圈”样高信号。在TWI及DWI上,病灶主体均呈等信号,38.9%(138/355)的病变中央部分TWI表现为稍高信号,其中68.8%(95/138)DWI上呈稍高信号。5例患者伴有HBP门静脉周围高信号(PHI)。同时,13例患者119个结节进行了Gd-EOB-DTPA随访观察,随访周期为(657.2±507.1)天(84~1520天),所有结节均未发现恶性转变。2个结节穿刺病理活检诊断为非肿瘤性肝硬化增生结节。结论 肝硬化背景下非APHE的HBP“甜甜圈”样高信号结节虽少见,但影像表现相对典型,无恶变倾向,为临床诊断和鉴别诊断提供思路。

Objective To determine clinicopathological features of doughnut like hyperintense nodules on the hepatobil-iary phase(HBP) without arterial phase hyper enhancement(APHE) after injection of Gd EOB DTPA in cirrhotic liver.Methods We retrospectively enrolled 1752 consecutive patients with liver cirrhosis who were examined by Gd-EOB-DTPAsearched for HBP doughnut like nodules. We evaluated the characteristics including incidence,imaging features,frequencyof malignant transformation during follow up,and pathological findings.Results 355 HBP doughnut like nodules withoutAPHE were identified in 38(2. 2%,38/1752)patients,all of which were multiple,including 33 patients with hepatitis B vi-rus related,2 with alcoholic cirrhosis,and 3 with autoimmune hepatitis related. All the nodules showed no APHE,with sig-nificant enhancement in the portal vein phase(PVP),persistent enhancement in the transitional phase(TP),and “dough-nut” like hyperintense in the HBP. On T2WI and DWI,the main body of the nodules showed isointensity,38. 9%(138/355) of the nodules showed slightly hyper intensity on T2WI in the central area,of which 68. 8%(95/138) showed slightlyhyper intensity on DWI. 5 patients were accompanied with periportal high signal(PHI) on HBP. 119 nodules in 13 patientswere followed up during an observation period of(657. 2 ± 507. 1) days(range 84-1520 days),and none showed malig-nant transformation. Two nodules were diagnosed by fine needle biopsy as non neoplastic cirrhotic nodules.Conclusion Although HBP doughnut like nodules without APHE in cirrhotic liver are rare,the imaging features are relatively typical andnone become malignant transformation,which provides ideas for clinical diagnosis and differential diagnosis.