原发性肝细胞癌不同类型MRI征象分析

Analysis of the Different Types of MRI Features in Primary Hepatocellular Carcinoma

目的 分析原发性肝细胞癌不同类型MRI征象。方法 收集我院近3年收治的原发性肝细胞癌76例的临床和MRI资料进行回顾性分析,MRI采用3.0T磁共振及腹部表面线圈,扫描序列T_(1)WI、T_(2)WI、脂肪抑制、DWI/ADC、动态增强。结果 根据大体病理形态分为巨块型17例、结节型23例、小肝癌31例、弥漫型5例。前三型均为单发病灶,位于肝右叶47例、左叶16例、方叶5例、尾叶3例。巨块型、结节型呈不规则肿块,5例病灶向肝包膜外生长表现为外生型。小肝癌呈类圆形或不规则结节。弥漫型呈分布全肝的小结节病灶。T_(1)WI上,瘤灶主要为稍低信号,T_(2)WI、脂肪抑制呈稍高信号,DWI高/稍高信号,ADC低信号。巨块型、结节型信号混杂,小肝癌、弥漫型信号较均匀。癌灶实质“快进快出”强化方式64例(84.21%),其他强化方式12例(15.79%)。包膜强化53例,坏死26例,出血7例,门静脉癌栓13例,肝硬化63例。包膜强化两两比较无统计学差异。巨块型与结节型、巨块型与小肝癌坏死比较,巨块型与小肝癌门静脉癌栓比较有统计学差异,P<0.05。结论 原发性肝细胞癌不同类型MRI表现有一定的特征性,MRI多序列成像对肝癌定性诊断具有意义,对临床治疗方案制定及治疗评估具有重要的指导作用。

Objectiv Different types of MRI signatures of primary hepatocellular carcinoma were analyzed.Methods The clinical and MRI data of 76 cases of primary hepatocellular carcinoma admitted in our hospital in recent 3 years were collected for retrospective analysis,The MRI uses a 3.0T magnetic resonance and an abdominal surface coil,Scanning sequences T_(1)WI,T_(2)WI,fat inhibition,DWI/ADC,dynamic enhancement.Results According to the gross pathological morphology,they were divided into 17 massive cases,23 nodular cases,31 small liver carcinoma cases and 5 diffuse cases.The first three types were all single foci,located in 47 cases in the right liver,16 left lobe,5 square lobe and 3 caudal cases.The massive and nodular type showed irregular masses,and the growth of five lesions to the outer envelope of the liver showed exogenous type.Small liver carcinoma has circular or irregular nodules.The diffuse type is the small nodular lesions distributed in the whole liver.On T_(1)WI,the tumor foci were mainly slightly lower signal,slightly higher T_(2)WI and fat inhibition,higher DWI high/slightly higher signal,and low ADC signal.The signals of giant lump type and nodular type were mixed,and the signals of small liver cancer and diffuse type were more uniform.The"fast in and fast out"enhancement method was 64 cases(84.21%),Other reinforcement methods were used in 12 cases(15.79%).The envelope strengthened 53,26 necrosis,7 bleeding,13 portal vein cancer plugs,and 63 cirrhosis.There was no statistical difference in the pairwise comparison of envelope reinforcement.Compared with massive and nodule and small liver cancer necrosis,there were statistical differences between giant block and small liver cancer portal tumor plugs,P<0.05.Conclusion Different types of MRI manifestations in primary hepatocellular carcinoma are somewhat characteristic,MRI multisequence imaging has great significance for the qualitative diagnosis of liver cancer,It has an important guiding role in clinical treatment plan formulation and treatment evaluation.