Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis

We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase- associated protein 2, a new molecular marker of well- differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.

Differentiation between dysplastic nodule and early-stage hepatocellular carcinoma: The utility of conventional MR imaging

AIM:To elucidate the variety of ways early-stage hepatocellular carcinoma(HCC)can appear on magnetic resonance(MR)imaging by analyzing T1-weighted,T2-weighted,and gadolinium-enhanced dynamic studies.METHODS:Seventy-three patients with well-differentiated HCC(wHCC)or dysplastic nodules were retrospectively identified from medical records,and new histological sections were prepared and reviewed.The tumor nodules were categorized into three groups:dysplastic nodule(DN),wHCC compatible with Edmondson-Steiner grade I HCC(w1-HCC),and wHCC compatible with Edmondson-Steiner gradeⅡHCC(w2-HCC).The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.RESULTS:Among the 73 patients,14 were diagnosed as having DN,40 were diagnosed as having w1-HCC,and 19 were diagnosed as having w2-HCC.Hyperintensity measurements on T2-weighted axial images(T2WI)were statistically significant between DNs and wHCC(P=0.006)and between DN and w1-HCC(P=0.02).The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC.Hyperintensity on both T1W out-phase imaging(P=0.007)and arterial enhancement on dynamic study(P=0.005)showed statistically significant differences between w1-HCC and w2-HCC.The other imaging features revealed no significant differences between w1-HCC and w2-HCC.CONCLUSION:In the follow-up for a cirrhotic nodule,increased signal intensity on T2WI may be a sign of malignant transformation.Furthermore,a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.

Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis

Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography(CT)or magnetic resonance imaging(MRI)or as an initial diagnostic test for small newly detected liver nodules.CEUS has unique advantages over CT and MRI including no renal excretion of contrast,real-time imaging capability,and purely intravascular contrast.Hepatocellular carcinoma(HCC)is characterized by arterial-phase hypervascularity and later washout(negative enhancement).Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase.However,there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout.Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rimlike or diffuse hypervascularity followed by rapid washout.Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS.CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance.CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.

Expression of heat shock proteins (HSP27, HSP60, HSP70, HSP90, GRP78, GRP94) in hepatitis B virus-related hepatocellular carcinomas and dysplastic nodules

AIM: Expression of heat shock proteins (HSPs) is frequently up-regulated in hepatocellular carcinoma (HCC), which evolves from dysplastic nodule (DN) and early HCC to advanced HCC. However, little is known about the differential expression of HSPs in multistep hepatocarcinogenesis. It was the purpose of this study to monitor the expression of HSPs in multistep hepatocarcinogenesis and to evaluate their prognostic significance in hepatitis B virus (HBV)related HCC.METHODS: Thirty-eight HCC and 19 DN samples were obtained from 52 hepatitis B surface antigen-positive Korean patients. Immunohistochemical and dot immunoblot analyses of HSP27, HSP60, HSP70, HSP90, glucoseregulated protein (GRP)78, and GRP94 were performed and their expression at different stages of HCC development was statistically analyzed.RESULTS: Expression of HSP27, HSP70, HSP90, GRP78, and GRP94 increased along with the stepwise progression of hepatocarcinogenesis. Strong correlation was found only in GRP78 (Spearman's r= 0.802). There was a positive correlation between the expressions of GRP78, GRP94, HSP90, or HSP70 and prognostic factors of HCC. Specifically, the expression of GRP78, GRP94, or HSP90 was associated significantly with vascular invasion and intrahepatic metastasis.CONCLUSION: The expressions of HSPs are commonly up-regulated in HBV-related HCCs and GRP78 might play an important role in the stepwise progression of HBVrelated hepatocarcinogenesis. GRP78, GRP94, and HSP90 may be important prognostic markers of HBV-related HCC, strongly suggesting vascular invasion and intrahepatic metastasis.

Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver

AIM: To design a classification tool for the histological assessment of hepatocellular carcinoma (HCC), dysplastic nodules (DN), and macroregenerative nodules (MRN) in cirrhotic liver.METHODS: Two hundred and twelve hepatocellular nodules (106 HCC;74 MRN;32 DN) were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis (MCA).RESULTS: MCA distributed HCC, DN, and MRN as defined by traditional histological evaluation as well as the individual histological variables, in a 'malignancy scale'.Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features (i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss,capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity). The classification tool dassified most (83%) of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepandes were present for DN and MRN between the routine histological assignment and the classification tool. Of 25 HCC assigned by routine assessment in the validation set, 8were assigned to the DN category by the classification tool.CONCLUSION: We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this tool systematically records histological features of diagnostic importance in the evaluation of small HCC.

Difference Analysis of MRI Apparent Diffusion Coefficient and R_(2)^(*)Value Between Small Hepatocellular Carcinoma and Cirrhosis Nodules

Objective:To investigate the differences of apparent diffusion coefficient and transverse relaxation rate(R_(2)^(*))in magnetic resonance imaging(MRI)between micro hepatocellular carcinoma and nodules of cirrhosis.Method:The clinical data of 68 patients with micro hepatocellular carcinoma(76 lesions)and 45 patients with nodular cirrhosis(48 lesions)were retrospectively analyzed.Diffusion weighted imaging and R_(2)^(*)imaging were performed on all patients.The differences of apparent diffusion coefficient and R_(2)^(*)values in patients with micro hepatocellular carcinoma and nodular cirrhosis were compared.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of apparent diffusion coefficient values and R_(2)^(*)values for microhepatocellular carcinoma.Result:Compared with nodules of cirrhosis,the mean apparent diffusion coefficient and R_(2)^(*)value of micro-hepatocellular carcinoma were significantly decreased(P<0.05).The diagnosis threshold of apparent diffusion coefficient is at 1.35×10^(-3)mm^(2)/s,and the sensitivity for the diagnosis of micro-hepatocellular carcinoma was 80.88%,and the specificity was 91.11%,and the corresponding area under the ROC curve was 0.88;The diagnostic threshold for R_(2)^(*)value was at 53.96 Hz,and the sensitivity for the diagnosis of small hepatocellular carcinoma was 91.18%,and the specificity was 77.78%,and the corresponding area under the ROC curve was 0.84.Conclusion:MRI apparent diffusion coefficient value and R_(2)^(*)value can be used to differentiate and diagnose micro hepatocellular carcinoma and nodules of cirrhosis,in which the apparent diffusion coefficient of nodules of cirrhosis was less than 1.35×10^(-3)mm^(2)/s,R_(2)^(*)values were lower than 53.96 Hz may indicate the occurrence of nodular canceration.

Giant Hepatic Regenerative Nodule in a Patient With Hepatitis B Virus-related Cirrhosis

Hepatic regenerative nodules are reactive hepatocellular proliferations that develop in response to liver injury.Giant hepatic regenerative nodules of 10 cm or more are extremely rare and have only been reported in patients with biliary atresia or Alagille syndrome.A 50-year-old man presented with a pathologically confirmed giant 11.3×9.4×11.2 cm hepatic regenerative nodule and hepatitis B virus-related cirrhosis.Imaging of intrahepatic nodule included mild hyperenhancement in the portal phase of contrast-enhanced CT and the hepatobiliary phase in the gadoxetic acid-enhanced MRI scan,as well as the portal vein crossing through sign in the setting of liver cirrhosis.This case highlights the imaging characteristics of giant hepatic regenerative nodules in hepatitis cirrhosis.

MSCT结合血清CCNA2、AFP检测在肝硬化结节与肝细胞肝癌鉴别诊断中的应用价值研究

目的探讨多层螺旋计算机断层扫描(MSCT)结合血清细胞周期素A2(CCNA2)、甲胎蛋白(AFP)在肝硬化结节与肝细胞肝癌鉴别诊断中的应用价值。方法选取2019年1月~2022年1月本院收治的经病理证实的104例肝硬化结节与肝细胞肝癌患者,其中肝硬化结节69例,肝细胞肝癌35例,均接受腹部MSCT平扫及增强扫描,检测血清CCNA2和AFP水平。分析肝硬化结节和肝细胞肝癌患者的MSCT影像学特征和肝硬化结节组和肝细胞肝癌组血清CCNA2和AFP水平;绘制受试者操作特征曲线(ROC)分析MSCT结合血清肿瘤标志物鉴别肝硬化结节与肝细胞肝癌的应用价值。结果104例患者经病理检查确肝硬化结节组69例、肝细胞肝癌组35例。以病理诊断为“金标准”,MSCT鉴别诊断肝细胞肝癌的敏感度、特异度为77.14%、75.36%(Kappa=0.493);肝细胞肝癌组血清CCNA2和AFP水平显著高于肝硬化结节组(P<0.05);ROC结果显示,MSCT和血清CCNA2和AFP预测肝细胞肝癌的曲线下面积(AUC)分别为0.886、0.836和0.775,MSCT结合血清CCNA2和AFP预测肝细胞肝癌的AUC为0.902,敏感度为82.86%(P<0.05)。结论MSCT结合血清CCNA2、AFP检测在肝硬化结节和肝细胞肝癌的临床鉴别中具有较好的应用价值。

AFP阴性肝硬化肝癌MRI与CEUS表现及诊断价值分析

目的分析甲胎蛋白(AFP)阴性肝硬化肝癌磁共振成像(MRI)与超声造影(CEUS)表现及诊断价值。方法选取2020年6月~2022年6月我院AFP阴性肝硬化肝癌患者62例为肝癌组,同期选取肝硬化结节患者44例为结节组。均行MRI、CEUS检查。比较两组临床资料、MRI表现、CEUS表现,分析MRI、CEUS及MRI联合CEUS对增生结节及早期肝癌的诊断价值。结果肝癌组与结节组性别、年龄、体质量指数、肝硬化病程、AFP、AST、ALT、病灶直径比较,P>0.05,因此不具有统计学意义。MRI表现:两组在T1WI、T2WI以及DWI等方面的信号没有明显差异;而在动态增强扫描中,肝癌组的动脉期存在显著强化,门脉期及延迟期造影剂迅速廓清,而结节组表现各异,无明显规律;肝癌组病灶ADC值低于结节组(P<0.05)。CEUS表现:不同时相增强程度:肝癌组与结节组CEUS动脉期、门脉期、延迟期增强强度比较,差异有统计学意义(P<0.05);肝癌组CEUS起始时间、达峰时间短于结节组,峰值强度、曲线下面积、曲线尖度高于结节组(P<0.05)。以病理结果为金标准,MRI、CEUS对AFP阴性肝癌及肝硬化结节均具有较高的诊断一致性,MRI联合CEUS诊断敏感性为98.39%(61/62),特异性为88.64%(39/44),准确性为94.34%(100/106),阳性预测值为92.42%(61/66),阴性预测值为97.50%(39/40),Kappa值为0.863;MRI联合CEUS诊断敏感性、Kappa值高于单独诊断(P<0.05)。结论AFP阴性肝硬化肝癌具有一定特征的MRI与CEUS表现,二者联合可提高对AFP阴性肝硬化肝癌的鉴别诊断价值。

CT结合血清肿瘤标志物鉴别肝硬化结节与小肝癌的作用

分析计算机断层扫描(CT)结合血清癌抗原19-9(CA19-9)、癌胚抗原(CEA)、甲胎蛋白(AFP)对104例肝硬化结节与小肝癌患者的诊断价值。所有患者接受腹部CT平扫及增强扫描,检测血清CA19-9、CEA、AFP水平。结果表明,CT结合血清CA19-9、CEA、AFP预测小肝癌的AUC为0.891,敏感度为85.90%(P<0.05)。CT结合血清CA19-9、CEA、AFP在鉴别诊断肝硬化结节和小肝癌中具有较高的敏感度,可作为临床鉴别肝硬化结节和小肝癌的有效手段。

肝硬化再生结节与小肝癌结节的影像学特征分析

目的:分析肝硬化再生结节与小肝癌结节的影像学特征。方法:回顾性分析2020年6月—2023年6月贺州市人民医院收治的66例肝硬化患者的影像学资料,探讨肝硬化再生结节与小肝癌结节的影像学特征。结果:磁共振成像-弥散加权成像(MRI-DWI)扫描发现,肝硬化再生结节组患者平均病灶大小、表观弥散系数(ADC)均高于小肝癌结节组,差异均具有统计学意义(t=6.903、5.593,P<0.05);肝硬化再生结节组T_(1)WI稍高信号及等信号呈现率高于小肝癌结节组(χ^(2)=12.158、10.627,P<0.05),等信号或低信号呈现率则低于小肝癌结节组(χ^(2)=31.611,P<0.05);肝硬化再生结节组T_(2)WI低信号呈现率高于小肝癌结节组,等信号、高信号或稍高信号呈现率低于小肝癌结节组,差异具有统计学意义(χ^(2)=54.393,P<0.05)。结论:磁共振成像能够更好地鉴别出肝硬化再生结节与小肝癌结节,提高早期肝癌的诊断率。

Diffusion-weighted images(DWI) without ADC values in assessment of small focal nodules in cirrhotic liver

Objective： To assess if diffusion-weighted magnetic resonance （MR） imaging without apparent diffusion coefficient （ADC） values provides added diagnostic value in combination with conventional MR imaging in the detection and characterization of small nodules in cirrhotic liver. Methods： Two observers retrospectively and independently analyzed 86 nodules （_〈3 em） certified pathologically in 33 patients with liver cirrhosis, including 48 hepatocellular carcinoma （HCC） nodules, 13 high-grade dysplastic nodules （HDN）, 10 low-grade dysplastic nodules （LDNs） and 15 other benign nodules. All these focal nodules were evaluated with conventional MR images （Tl-weighted, T2-weighted and dynamic gadolinium-enhanced images） and breath-hold diffusion-weighted images （DWI） （b=500 s/mm2）. The nodules were classified by using a scale of 1-3 （1, not seen; 3, well seen） on DWI for qualitative assessment. These small nodules were characterized by two radiologists. ADC values weren＇t measured. The diagnostic performance of the combined DWI-conventional images and the conventional images alone was evaluated using receiver operating characteristic （ROC） curves. The area under the curves （Az）, sensitivity and specificity values for characterizing different small nodules were also calculated. Results： Among 48 HCC nodules, 33 （68.8%） were graded as 3 （well seen）, 6 （12.5%） were graded as 2 （partially obscured）, and 9 weren＇t seen on DWI. Among 13 HDNs, there were 3 （23.1%） and 4 （30.8%） graded as 3 and 2 respectively. Five （50%） of 10 benign nodules were partially obscured and slightly hyperintense. For 86 nodules, the average diagnostic accuracy of combined DWI-conventional images was 82.56%, which was increased significantly compared with conventional MR images with 76.17%. For HCC and HDN, the diagnostic accuracy of combined DWI-conventional images increased from 78.69% to 86.07 %. Conclusions： Diffusion-weighted MR imaging does provide added diagnostic value in the detection and characterization of HDN and HCC, and it may not be helpful for LDN and regenerative nodule （RN） in cirrhotic liver.

肝脏影像报告和数据系统中恶性辅助征象对小肝细胞癌的分类及诊断效能的影响

目的探究基于钆塞酸二钠增强MRI(Gd-EOB-MRI)2018版肝脏影像报告和数据系统(LI-RADS v2018)恶性辅助征象对<20 mm的小肝细胞癌(HCC)分类及诊断效能的影响。方法回顾性收集未经治疗且经病理证实为HCC、再生结节(RN)、高级别异型增生结节(HGDN)、低级别DN(LGDN)109例病人,共纳入<20 mm病灶130个。采用卡方检验或Fisher确切概率检验比较各组病灶的主要和辅助征象并筛选HCC特异性辅助征象。按以下方法将病灶分类:(1)主要征象分类法;(2)主要+辅助征象分类法,即先依据主要征象分类,再由辅助征象调整;(3)添加主要征象分类法,即将HCC特异性辅助征象添加为主要征象,再按方法2分类。分别计算3种分类方法中LR-5和LR-(4+5)对HCC的诊断效能,并采用McNemar’s检验比较其差异。结果移行期(TP)及肝胆期(HBP)低信号为HCC特异性辅助征象(均P<0.05),被添加为主要征象。主要征象分类和主要+辅助征象分类下LR-5对HCC的诊断敏感度、特异度、准确度相同(67.0%、75.8%、74.6%),与添加主要征象分类法(74.2%、78.8%、70.0%)比较,仅诊断敏感度降低(P<0.05),而特异度及准确度差异无统计学意义(P>0.05)。主要+辅助征象分类和添加主要征象分类下LR-(4+5)对HCC的诊断敏感度、特异度、准确度相同(88.7%、75.4%、36.4%),与仅依据主要征象分类法(83.5%、78.5%、63.6%)比较,其敏感度及准确度差异均无统计学意义(P>0.05),但特异度降低(P<0.05)。结论经辅助征象调整后的分类不能改变LR-5对小HCC的诊断效能,却降低了LR-(4+5)诊断HCC的特异度。将TP/HBP低信号作为新的HCC主要征象重新分类,可以提高LR-5诊断HCC的敏感度,但特异度和准确度不降低。

肝硬化不典型增生结节的影像学与病理对照研究

目的分析肝硬化背景下不典型增生结节在1.5T MRI中的影像学表现,并评估其诊断价值。方法回顾性分析2018年1月至2019年1月经1.5T MRI诊断为肝硬化不典型增生结节(dysplastic nodule,DN)的25例患者,共检出28个结节,其中有22例患者为单发结节,3例患者为双发结节。所有结节均经超声引导下穿刺活检并经病理证实。结果25例患者检出的28个结节,其中22例单发病例中,16个为不典型增生结节,6个为不典型增生结节伴局部癌变,3例多发病例中均为不典型增生结节与肝癌结节并存。结论在1.5T MRI上,DN主要表现为T1WI呈高或等信号,T2WI呈高信号,增强扫描后在动脉期、静脉期及延时期以轻度强化为主。当DN结节中出现T2WI及DWI高信号,增强扫描可见“快进快出”时,提示出现结节癌变或部分癌变,临床需结合实际情况采取合适的治疗手段。

超声造影时间-强度曲线诊断肝硬化伴肝小结节病灶的价值

目的探讨超声造影(CEUS)时间-强度曲线诊断肝硬化伴肝小结节病灶的价值。方法本研究为前瞻性研究,纳入2019年7月至2022年8月在南阳市中心医院超声科接受检查的80例疑似肝硬化伴肝小结节患者,所有患者均接受CEUS时间-强度曲线检查,以病理学检查结果为“金标准”,比较良、恶性结节CEUS时间-强度曲线参数[到达时间(AT)、达峰时间(TTP)、峰值强度(PI)],采用受试者工作特征(ROC)曲线分析检验CEUS时间-强度曲线参数对肝硬化伴肝小结节病灶的诊断价值。结果经病理学活检证实,80例疑似肝硬化伴肝小结节患者中32例为恶性结节,48例为良性结节。CEUS时间-强度曲线检出恶性结节29例,良性结节46例,准确率为93.75%(75/80)。恶性结节组织和良性结节组织AT比较,差异无统计学意义(P>0.05);恶性结节组织TTP低于良性结节组织,PI高于良性结节组织(P<0.05)。绘制ROC曲线显示,TTP、PI单独及二者联合诊断恶性结节的曲线下面积(AUC)均>0.70,预测价值较理想,联合诊断的价值最高。结论CEUS时间-强度曲线可以作为鉴别诊断肝硬化伴肝小结节病灶的良恶性的指标。

138例肝硬化不典型增生结节患者中医证型证素分布分析

目的探讨肝硬化不典型增生结节(DN)的中医证型证素分布规律,为探索肝硬化DN中医证候内涵和规律提供依据。方法纳入2013年3月—2021年1月就诊于河南中医药大学第一附属医院诊断为肝硬化DN的患者共138例。采集患者的发病年龄、性别等一般资料,记录病因、中医证候、肝功能Child-Pugh分级资料,归纳中医证型、证素分布特征。计数资料组间比较采用χ~2检验或Fisher精确检验。结果肝硬化DN患者病位证素以肝、脾为主(97.83%、94.93%),其次为肾(23.91%);病性证素以气虚、气滞为主(73.91%、58.70%),其次为湿(34.78%);中医证型主要为肝郁脾虚证、湿热内盛证、瘀毒蕴结证、水湿内阻证,以肝郁脾虚证多见(58.70%),显著高于其他证型(P<0.05);中医证型与性别、年龄、病因等比较,差异均无统计学意义(P值均>0.05)。不同中医证型的肝硬化DN患者Child-Pugh分级比较,差异有统计学意义(χ~2=34.320,P<0.05),其中肝功能Child-Pugh A级以肝郁脾虚证多见(59.8%),而C级则以湿热内盛证多见(39.1%)。结论初步概括了肝硬化DN常见证型及证素分布规律,为肝硬化DN的中医辨治提供参考。

超声造影LI-RADS分类对肝硬化背景下直径<2cm肝脏结节性质诊断的价值

目的探讨超声造影肝脏影像报告和数据管理系统(CEUS LI-RADS)对肝硬化背景下直径<2 cm肝脏结节良恶性鉴别诊断的价值。方法回顾性分析2019年7月至2022年7月肝硬化伴最大直径≤2 cm肝脏单发实性结节患者142例,经肝脏穿刺病理或手术病理确诊恶性67例和良性75例,采用常规多普勒超声及超声造影评估结节位置、大小、增强程度及模式、廓清及廓清时间,LI-RADS分类包括LR-1~5和M,以LR-5为肝细胞癌和LR-M为其他恶性肿瘤评估诊断效能。结果良恶性组患者临床资料包括性别、年龄、饮酒、高血压、糖尿病和高脂血症、肝硬化病程、乙型肝炎和丙型肝炎以及病毒载量,血生化包括空腹血糖、总胆固醇和低密度脂蛋白胆固醇、谷丙转氨酶、总胆红素、乳酸脱氢酶、血肌酐和尿素氮以及白蛋白水平差异无统计学意义(P>0.05)。两组常规超声显示结节位置、最大直径、回声及血流灌注差异无统计学意义(P>0.05)。恶性组动脉期显著增强,门脉期和延迟期等或低增强,“快进快出”模式,延迟廓清,廓清时间延长,差异有统计学意义(P<0.05)。CEUSLI-RADS分类评估LR-5和LR-M共50例,LR-1~492例,以LR-5和LR-M作为诊断肝结节恶性的标准,诊断准确性为83.80%,敏感度为70.15%,特异度为96.00%,阳性预测值为94.00%,阴性预测值为78.26%,阳性似然比为53.73%,阴性似然比为31.09%,假阳性率为4.00%,假阴性率为29.85%。受试者操作曲线(ROC)计算超声造影LI-RADS分类诊断恶性结节的曲线下面积(AUC)为0.846(95%CI=0.797~0.899,P<0.001),最大约登指数为66.15%。结论超声造影LI-RADS分类对肝硬化伴直径<2 cm肝脏结节良恶性质鉴别诊断仍有较高的准确性和特异度,有较好的临床应用价值。

肝硬化患者出血后多发再生结节梗死的CT和MRI表现

目的:探讨肝硬化患者静脉曲张出血后多发再生结节梗死的CT和MRI表现。方法:共收集21例诊断为肝硬化患者静脉曲张出血后多发再生结节梗死的患者纳入本研究,其中男13例,女8例,检查采用3.0T MR扫描仪或256排螺旋CT,所有病例均行动态增强扫描,分析病变的强化模式、信号强度、形状、数量、大小、边缘、位置和分布。结果:在CT或MRI成像中,3例患者病灶在10个及以下,19例患者病灶在10个以上;肝脏病灶直径3~26 mm;大部分病灶为圆形结节、呈簇状聚集分布;病灶主要分布于肝包膜下区域;CT和MRI动态增强后,大部分结节未见明显强化;少数可以有边缘强化;在T1WI所有病灶呈等信号或稍低信号;在T2WI大部分病变为边界限清晰的高信号;CT和MRI随访13例患者病灶消失,8例患者病灶缩小或明显减少。结论:CT和MRI可显示肝硬化静脉曲张出血后再生结节梗死的影像特征,通过影像随访、临床病史、肿瘤指标可与肝脏恶性肿瘤相鉴别。

DN-HCC及DN患者超声造影及CEUS LI-RADS标准分类结果观察

目的 探讨异型增生结节伴局灶性肝细胞癌(DN-HCC)及异型增生结节(DN)患者超声造影(CEUS)表现及CEUS肝脏影像报告和数据系统(CEUS LI-RADS)标准分类结果。方法 2019年10月至2021年10月北京市大兴区人民医院收治的肝脏局灶性病变患者78例(80个病灶,其中DN 12个,DN-HCC 68个),接受CEUS检查。根据CEUS LI-RADS v2017标准,对所有病灶进行分类。结果 DN组动脉期同步等增强占比为66.7%,显著高于DN-HCC组的13.2%(P<0.05);DN组动脉期高增强占比为16.7%,显著低于DN-HCC组的58.8%(P<0.05)。DN组病灶动脉期和延迟期CEUS增强模式有三种,低/等占25.0%,等/等占66.7%,高/高占8.3%;DN-HCC组CEUS增强模式包括六种,其中等/等占4.4%,低/低占5.9%,等/低占8.8%,低/等占13.2%,高(含局部高增强)/低占29.4%,高(含局部高增强)/等占38.2%。DN组CEUS LI-RADS v2017标准分类中LR-3类占比为100.0%,高于DN-HCC组的26.5%(P<0.05)。结论 CEUS动脉期高增强或延迟期减退对DN与DN-HCC具有鉴别意义,值得临床验证。

MRI多b值成像在肝硬化再生结节与小肝癌结节病变鉴别诊断中的应用价值

目的研究磁共振成像(MRI)多b值成像在肝硬化再生结节与小肝癌结节病变鉴别诊断中的应用价值。方法以回顾性分析为法,研究对象为2019年10月至2022年1月入广安市人民医院的100例肝脏结节患者,其中48例患者经病理检查确诊为肝硬化再生结节,设为肝硬化组;52例患者经病理检查确诊为小肝癌结节,设为小肝癌组。100例肝脏结节患者均行电子计算机断层扫描(CT)检查(CT平扫+增强扫描)与MRI多b值成像[MRI多b值扩散加权成像(DWI)联合MRI常规平扫图像、表观扩散系数(ADC)图]评估肝硬化结节良性与恶性。比较两种检查方式的诊断准确度、特异度、敏感度、不良反应(头晕、恶心呕吐、皮疹)与MRI检查ADC平均值。结果以病理检查结果为标准,肝硬化再生结节与肝癌结节病变鉴别中MRI多b值成像的诊断准确度、特异度、敏感度依次为93.00%、97.67%、89.47%,CT检查的诊断准确度、特异度、敏感度依次为67.00%、64.44%、69.09%;肝硬化再生结节与小肝癌结节病变鉴别中MRI多b值成像的诊断准确度、特异度、敏感度明显高于CT检查,差异均有统计学意义(P<0.05)。肝硬化再生结节患者的平均ADC值为(1.71±0.24)×10^(-3)mm^(2)/s,明显高于小肝癌结节患者[(1.19±0.26)×10^(-3)mm^(2)/s],差异有统计学意义(P<0.05)。100例肝脏结节患者经MRI多b值成像检查后不良反应发生率为1.00%,经CT检查后不良反应发生率为3.00%;两种检查方法的总不良反应发生率比较,差异无统计学意义(P>0.05)。结论肝硬化再生结节与小肝癌结节病变鉴别中MRI多b值成像的应用效果显著,诊断准确度、特异度、敏感度及安全性均明显高于CT检查,且ADC值可辅助鉴别肝硬化结节良性与恶性。