肝脏局灶性结节性增生患者临床特征及影像学表现

Clinical and imaging feature in patients with focal nodular hyperplasia of the liver

目的分析肝脏局灶性结节性增生(FNH)患者的临床特征及超声、电子计算机断层扫描(CT)和磁共振成像(MRI)表现。方法2020年3月~2023年3月我院诊治的FNH患者96例,均接受超声、CT和MRI检查,经穿刺活检或手术后组织病理学检查诊断。结果在96例FNH患者中,19例(19.8%)有上腹部饱胀不适,8例(8.3%)有乙型肝炎,95例(99.0%)血清甲胎蛋白(AFP)阴性,1例(1.0%)轻度升高,14例(14.6%)血清谷丙转氨酶(ALT)和谷草转氨酶(AST)轻度升高;病理学检查诊断经典型86例(89.6%)和非经典型10例(10.4%);超声检查病灶边界清楚,大多表现为低回声区,57例病灶内见丰富的血流信号;CT扫描可见病灶呈稍低密度或等密度结节,密度均匀,与周围肝实质分界清楚。增强扫描动脉期见病灶呈均匀强化83例,动脉期无强化13例;在38例接受MRI检查的患者,病灶表现为T1WI呈等信号或低信号,T2WI呈等信号或高信号,边界均清楚,增强扫描动脉期病灶均明显强化,门静脉期病灶呈等或略高信号,延迟期强化减低。结论大多数FNH缺乏特异性的临床表现和影像学特征,穿刺活检或直接手术可能是当下最可能的选择。

Objective The aim of this study was to analyze the clinical and imaging feature in patients with focal nodular hyperplasia of the liver(FNH).Methods A total of 96 patients with FNH were encountered in our hospital between March 2020 and March 2023,and all underwent color Doppler ultrasonography,computed tomography(CT)and magnetic resonance imaging(MRI).The diagnosis was made based on histo-pathological examinations.Results Among the 96 patients with FNH,the upper abdominal fullness and discomfort was found in 19 cases(19.8%),hepatitis B carriers in 8 cases(8.3%),serum alpha-fetoprotein(AFP)negative in 95 cases(99.0%)and slightly elevated in 1 case(1.0%),slight serum alanine aminotransferase and/or aspartate aminotransferase level elevation in 14 cases(14.6%);the pathological examination diagnosed typical FNH in 86 cases(89.6%)and non-typical FNH in 10 cases(10.4%);the abdominal color Doppler ultrasonography showed most of the lesions with clear boundaries,low echo area in 79 cases,even echo in 13 cases,high echo in 4 cases,and abundant blood flow signals in 57 cases;the CT imaging showed that there were slightly low-density or isodensity or uniform density nodules,with clear boundary from the surrounding liver parenchyma,and uniform enhancement at arterial phase in 83 cases,and without enhancement in 13 cases;out of the 38 patients underwent upper abdominal MRI scan,showed equal or low signals of the lesions on T1WI,equal or high signals on T2WI,with clear boundaries,and the lesions were obviously enhanced at arterial phase,equal or slightly high signals at portal venous phase and reduced enhancement at delayed phase.Conclusion There is a lack of specific clinical and imaging manifestations in most patients with FNH,and the biopsies or even direct surgery might be the optimal choice at this scenario.