Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions

AIM： To evaluate the utility of diffusion-weighted imaging （DWl） in screening and differential diagnosis of benign and malignant focal hepatic lesions. METHODS： Magnetic resonance imaging （MRI） examinations were performed using the Signa Excite Xl Twin Speed 1.5T system （GE Healthcare, Milwaukee, Wl, USA）. Seventy patients who had undergone MRI of the liver [29 hepatocellular carcinomas （HCC）, four cholangiocarcinomas, 34 metastatic liver cancers, 10 hemangiomas, and eight cysts] between April 2004 and August 2008 were retrospectively evaluated. Visualization of lesions, relative contrast ratio （RCR）, and apparent diffusion coefficient （ADC） were compared between benign and malignant lesions on DWl. Su- perparamagnetic iron oxide （SPIO） was administered to 59 patients, and RCR was compared pre- and postadministration.RESULTS： DWI showed higher contrast between malignant lesions （especially in multiple small metastatic cancers） and surrounding liver parenchyma than did contrast-enhanced computed tomography. ADCs （mean±SD × 10^-3 mm2/s） were significantly lower （P 〈 0.05） in malignant lesions （HCC： 1.31 ± 0.28 and liver metastasis： 1.11 ± 0.22） and were significantly higher in benign lesions （hemangioma： 1.84 ± 0.37 and cyst： 2.61 ± 0.45） than in the surrounding hepatic tissues. RCR between malignant lesions and surrounding he- patic tissues significantly improved after SPIO administration, but RCRs in benign lesions were not improved.CONCLUSION： DWI is a simple and sensitive method for screening focal hepatic lesions and is useful for differential diagnosis.

Characteristics and pathological mechanism on magnetic resonance diffusion-weighted imaging after chemoembolization in rabbit liver VX-2 tumor model

AIM: To investigate dynamic characteristics and pathological mechanism of signal in rabbit VX-2 tumor model on diffusion-weighted imaging (DWI) after chemoembolization. METHODS: Forty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity opened. Forty VX-2 tumor models from them were divided into four groups. DWI was performed periodically and respectively for each group after chemoembolization. All VX-2 tumor samples of each group were studied by pathology. The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values. The statistical significance between different time groups, different area groups or different b-value groups was calculated by using SPSS12.0 software. RESULTS: Under b-value of 100 s/mm2, ADC values were lowest at 16 h after chemoembolization in area of VX-2 tumor periphery, central, and normal liver parenchyma around tumor, but turned to increase with further elongation of chemoembolization treatment. The distinction of ADC between different time groups was significant respectively (F = 7.325, P < 0.001; F = 2.496, P < 0.048; F = 6.856, P < 0.001). Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor, increased quickly in sixteen h after chemoembolization but, from the 16th h to the 48th h, cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at, and then increased continually. After chemoembolization, Cellular necrosis in the area of VX-2 tumor periphery was more significantly high than that before chemoembolization. The areas of dead cells in VX-2 tumors manifested low signal and high ADC value, while the areas of viable cells manifested high signal and low ADC value. CONCLUSION: DWI is able to detect and differentiate tumor necrotic areas from viable cellular areas before and after chemoembolization. ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema, tissue cellular death and microcirculation disturbance after chemoembolization.

Gene expression and MR diffusion-weighted imaging after chemoembolization in rabbit liver VX-2 tumor model

AIM: To investigate the dynamic characteristics and the correlation between PCNA, Bax, nm23, E-cadherin expression and apparent diffusion coefficient (ADC) on MR diffusion-weighted imaging (DWI) after chemoembolization in rabbit liver VX-2 tumor model. METHODS: Forty New Zealand rabbit liver VX-2 tumor models were included in the study. DWI was carried out periodically after chemoembolization. All VX-2 tumor samples in each group were examined by histopathology and Strept Avidin-Biotin Complex (SABC) immunohistochemical staining. RESULTS: The PCNA expression index in VX-2 tumors was higher than in the normal parenchyma around the tumor (P < 0.001). Nm23, Bax or E-caderin expression index in VX-2 tumors were lower than in the normal parenchyma around the tumor (all P < 0.001). PCNAand nm23 expression in the VX-2 tumor periphery first increased and then decreased (P < 0.001 and P = 0.03, respectively), while the expression of Bax and E-cadherin before and after chemoembolization was insignificant. When b-value was 100 s/mm2, there was a linear correlation between PCNA expression and ADC in the area of VX-2 tumor periphery (P < 0.001), and PCNA expression in VX-2 tumor periphery influenced the ADC. CONCLUSION: The potential of VX-2 tumor infiltrating and metastasizing decreases, while its ability to proliferate increases for a short time after chemoembolization. To some degree, the ADC value indirectly reflects the proliferation of VX-2 tumor cells.

MR diffusion-weighted imaging of rabbit liver VX-2 tumor

AIM: To investigate the implanting method of rabbit liver VX-2 tumor and its MR diffusion-weighted imaging (DWI) characteristics. METHODS: Thirty-five New Zealand rabbits were included in the study. VX-2 tumor was implanted subcutaneously in 14 rabbits and intrahepatically in 6 for pre-experiments. VX-2 tumor was implanted intrahepatically in 12 rabbits for experiment and three were used as the control group. DWI, T1- and T2-weighted of MRI were performed periodically in 15 rabbits for experiment before and after implantation. The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values. The statistical significance was calculated by analysis of variance (ANOVA) of the randomized block design using SPSS10.0 software. RESULTS: The successful rate of subcutaneous implantation of VX-2 tumor was 29% (4/14) while that of intrahepatic implantation of it was 33% (2/6) in the preexperiment. The successful rate of intrahepatic implantation of VX-2 tumor in the experiment was 83% (10/12) and 15 tumors grew in 10 successfully implanted rabbits. The DWI signal of VX-2 tumor was high and became lower when the b value increased step by step. The signal of VX-2 tumor on the map of ADC was low. When the b value was 100 or 300 s/mm2, the ADC value of normal group and VX-2 tumor group was respectively 2.57±0.26, 1.73±0.31, 1.87±0.25 and 1.57±0.23 mm2/s. Their distinction was significant (F= 43.26, P<0.01), the tumor ADC value between b values 100 and 300 s/mm2 was significant (Tukey HSP,P<0.05) and the ADC value between VX-2 tumor and normal liver was also significant (Tukey HSP, P<0.01). VX-2 tumor developed quickly and metastasized early to all body, especially to the lung, liver, lymph nodes of mediastinum, etc. CONCLUSION: The DWI signal of rabbit VX-2 tumor has its characteristics on MR DWI and DWI plays an important role in diagnosing and discovering VX-2 tumor.

Advancements in Liver Tumor Detection:A Comprehensive Review of Various Deep Learning Models

Liver cancer remains a leading cause of mortality worldwide,and precise diagnostic tools are essential for effective treatment planning.Liver Tumors(LTs)vary significantly in size,shape,and location,and can present with tissues of similar intensities,making automatically segmenting and classifying LTs from abdominal tomography images crucial and challenging.This review examines recent advancements in Liver Segmentation(LS)and Tumor Segmentation(TS)algorithms,highlighting their strengths and limitations regarding precision,automation,and resilience.Performance metrics are utilized to assess key detection algorithms and analytical methods,emphasizing their effectiveness and relevance in clinical contexts.The review also addresses ongoing challenges in liver tumor segmentation and identification,such as managing high variability in patient data and ensuring robustness across different imaging conditions.It suggests directions for future research,with insights into technological advancements that can enhance surgical planning and diagnostic accuracy by comparing popular methods.This paper contributes to a comprehensive understanding of current liver tumor detection techniques,provides a roadmap for future innovations,and improves diagnostic and therapeutic outcomes for liver cancer by integrating recent progress with remaining challenges.

Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?

BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.

转移性肝癌肿瘤标志物的检测与影像学诊断分析

目的 :探讨影像学检查及来源于胃肠道的转移性肝癌其肿瘤标志物的检测对转移性肝癌的诊断价值。方法 :采用回顾性分析的方法对我院近 7年来收治的 2 0 8例转移性肝癌患者行B超、CT等影像学检查 ,对来源于胃肠道的 12 1例转移性肝癌患者的癌胚抗原 (CEA)、甲胎蛋白 (AFP)等肿瘤标志物检测情况进行分析 ,以病理学检查结果作为诊断转移性肝癌的金标准 ,比较四种检查对诊断转移性肝癌的灵敏度 ,为诊断筛选方案的确定提供依据。结果 :CEA诊断的灵敏度为 71 4 %(6 0 / 84 ) ,AFP为 17 3%(13/ 75 ) ,B超为 79 1%(12 9/ 16 3) ,CT为89 6 %(95 / 10 6 )。经比较 ,CEA诊断胃肠道肿瘤肝转移的灵敏度高于AFP (P <0 0 5 ) ;CT高于B超 (P <0 0 5 )。结论 :CEA是诊断消化道肿瘤肝转移的一个较好指标 ,AFP诊断的意义不大。对B超检查阳性者做CT检查可提高其诊断的准确率 ,B超检查阴性者需作CT以提高转移性肝癌的检出率。

胆囊癌的诊断分析(附127例报告)

目的 探讨胆囊癌各种诊断方法的价值 ,以期进一步改善胆囊癌患者的预后。方法 回顾性分析本院 1989～ 2 0 0 4年收治的经手术确诊的 12 7例胆囊癌患者的临床资料。结果 最常见症状为持续性右上腹疼痛 90例 ( 70 .87% ) ,腹胀不适 6 5例 ( 5 1.18% ) ,食欲减退 6 0例 ( 4 7.2 4 % ) ,黄疸 5 8例 ( 4 5 .6 7% )及消瘦 38例 ( 2 9.92 % ) ,合并急性胆囊炎 2 4例 ( 18.89% ) ,合并胆囊结石 10 1例 ( 79.5 3% )。血清γ GT明显升高 85例 ( 6 6 .93% ) ,胆汁酸明显升高占 5 1.5 2 % ( 34/ 6 6例 )。影像学检查阳性率分别为B超 82 .6 8% ,CT 85 .0 6 % ,MRI 81.2 5 % ,DSA 6 4 .86 % ,ERCP 5 1.0 2 %。结论 长期胆囊结石患者出现疼痛规律改变 ,尤其伴有血清胆汁酸升高者 ,应高度怀疑胆囊癌 ,及时进行B超及CT检查。凡胆囊结石患者 ,尤其女性、5 0岁以上患者 ,应及时切除病变胆囊 。

磁共振弥散加权成像对肝脏肿瘤的诊断价值

目的探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)在肝脏良、恶性肿瘤鉴别诊断中的价值。方法对120例肝脏良、恶性肿瘤患者行常规磁共振平扫和DWI扫描,其中48例患者同时进行了多期增强扫描。采用扩散系数值(b值)0、1 000s.mm-2测量病变整体、边缘及中心的表观扩散系数(apparent diffusion coefficient,ADC)值及灌注ADC值。分析不同的b值时,比较各测量参数在良、恶性肿瘤之间的差异。结果肝细胞癌ADC值与肝转移瘤比较差异无统计学意义(P>0.05),肝细胞癌、肝转移瘤ADC值与肝血管瘤比较差异有统计学意义(均P<0.05),肝细胞癌、肝转移瘤、肝血管瘤ADC值与肝囊肿比较差异均有统计学意义(均P<0.05)。结论磁共振DWI对肝脏肿瘤的诊断具有重要的诊断价值。

CT灌注成像技术对肝脏良恶性肿瘤的鉴别诊断价值分析

目的探讨CT灌注成像应用于肝脏良恶性肿瘤的鉴别诊断价值。方法选取我院2015年6月至2016年6月收治的56例肝脏疾病患者作为研究对象,所有病例均进行CT灌注成像,观察并总结CT灌注成像的特征,以术后病理诊断为金标准,分析CT灌注成像在良恶性肝脏肿瘤中的诊断价值。结果良性肝脏肿瘤患者的BF值为(329.15±52.11)m L·100 g-1·min-1,恶性肝脏肿瘤患者的BF值为(435.05±41.05)m L·100 g-1·min-1,差异有统计学意义(P<0.05)。良性肝脏肿瘤患者的HPI值为0.24±0.05,恶性肝脏肿瘤患者的HPI值为0.69±0.18,差异有统计学意义(P<0.05)。CT灌注成像对于肝脏良恶性肿瘤的诊断准确率为89.29%,特异度为87.50%,敏感度为90.63%。结论 CT灌注成像应用于肝脏良恶性肿瘤疾病的鉴别诊断中,可有效提高诊断准确率,为临床治疗和干预提供更准确、更丰富的信息。

MRI在肝脏占位性病变诊断中的应用

目的:探讨MRI在肝脏占位病变诊断中的应用价值。材料与方法:对98例肝肿瘤患者的MRI影像分析了图像质量、病灶显示清晰度及病变信号特征。全部病例均用1.0T超导磁共振机检查,采用自旋回波(SE)及快速自旋回波(TSE)序列摄取横轴位T_1及T_2加权像。36例患者接受了Gd-DTPA增强,其中12例进行了动态增强检查。结果:图像优良者89％,较差者占11％。MRI能显示的最小病灶为0.5～1.4cm。转移瘤均呈不同程度的长T_1、长T_2信号,信号不均匀,无包膜。肝细胞癌呈不均匀长T_2信号,T_1加权像上7例呈等信号或轻度高信号,其余呈轻度低信号。5例可清晰显示包膜,3例可见门静脉内瘤栓形成。海绵状血管瘤呈均匀性长T_1低信号、长T_2显著高信号,轮廓清晰,边缘光整或呈分叶状。结论:MRI对肝占位病变的诊断敏感度高,特异性好,对发现病变及定性、定量诊断均具有重要价值,值得广泛应用。

移植肝少见肿瘤或肿瘤样病变的影像学表现

目的研究移植肝少见肿瘤或肿瘤样病变的影像学表现。方法回顾性分析2006年12月至2013年8月间中山大学附属第三医院收治的肝移植术后移植肝少见肿瘤或肿瘤样病变的4例患者的影像学资料,重点分析患者肝脏病变的计算机体层摄影术(CT)和(或)磁共振成像(MRI)平扫及动态增强表现。结果 4例患者中,误诊3例,分别为肝未分化肉瘤、继发性淋巴瘤、嗜酸性肉芽肿;正确诊断1例,为胆囊癌肝转移。肝未分化肉瘤表现为囊实性占位,周围实性部分及分隔显著持续性强化,囊性部分无强化,短期内迅速增大;病灶周围无水肿带;可见较多钙化灶。肝继发性淋巴瘤表现为肝内多发结节灶,多数信号均匀,增强各期强化程度较低,不伴肝内血管侵犯,伴随肝外淋巴结肿大;少数病灶内见出血。肝嗜酸性肉芽肿表现为肝脏多发病灶信号及强化方式多样,提示病灶由多种成分组成,处于病变的不同阶段,多数病变呈环形进行性强化表现。胆囊癌肝转移肝移植术后复发表现为肝内稍低密度灶,动脉期轻度强化,门静脉期呈稍低密度,伴有腹膜后淋巴结肿大、融合。结论移植肝少见肿瘤或肿瘤样变的影像学征象各有特点,影像学检查有助于早期发现上述少见移植肝肿瘤或肿瘤样病变,结合病史及临床表现,有助于正确诊断。

PET/CT与MRI诊断原发性肝细胞癌介入治疗后边缘复发灶的对比研究

目的对比PET/CT与MRI诊断原发性肝癌(HCC)介入治疗后边缘复发灶的应用价值。方法收集2015年10月~2019年12月在西部战区总医院治疗的肝癌患者62例,经导管动脉化疗栓塞术(TACE)治疗6个月后进行影像和AFP随访。每例均行PET/CT和MRI检查,边缘病灶定性以穿刺病理结果为金标准。比较两种影像检查的灵敏度、特异度、准确度。结果PET/CT图像的准确度为91.9%,灵敏度为97.8%,均明显高于MRI(准确度79.0%、灵敏度86.7%)(P<0.05);其中,PET/CT图像确诊的患者AFP水平为(12.6±2.7)ng/mL,显著低于MRI图像(16.7±4.3)ng/mL(P<0.05)。结论在肝癌TACE治疗后随访中,PET/CT较MRI有更高的灵敏度和准确度,能更早发现边缘复发病灶,对患者预后十分有利,可在临床推广应用。

New approaches for precise response evaluation in hepatocellular carcinoma

With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.

磁共振弥散加权成像技术在肝脏良、恶性肿瘤中的鉴别诊断价值

目的探讨磁共振弥散加权成像(DWI)技术对肝脏良、恶性肿瘤的鉴别诊断价值。方法选取肝脏局灶性占位性病变患者60例,包括原发性肝癌18例,肝血管瘤25例,肝转移瘤10例,肝囊肿7例。所有患者行DWI检查(b值分别取0、500、1 000 s/mm2),对比各组患者局灶性病灶的平均表观弥散系数(ADC值)。结果四种肝脏病变中,肝囊肿各b值下ADC平均值最高,肝血管瘤次之,肝转移瘤和肝细胞癌最低,差异有统计学意义(P<0.05)。肝转移瘤与肝细胞癌各b值下ADC平均值的差异无统计学意义(P>0.05)。结论 DWI及ADC值可鉴别肝脏常见占位性病变的良、恶性。

肝癌肉瘤合并肝细胞癌、胆管细胞癌一例

本研究经河北省人民医院伦理委员会批准,免除受试者知情同意,批准文号:2022083。患者男,67岁,主因“发现血糖升高5年,体质量下降4个月”入河北省人民医院。查体:右侧腿部纤维瘤切除术后,右侧大腿根部长约5 cm的手术瘢痕。有慢性乙肝病史5年。实验室检查:AFP 13.880 ng/mL、CA19-941.840 U/mL、T-Bil 27.8l mol/L、D-Bil 7.4l mol/L升高。2021年4月27日行MRI(强化应用莫迪司对比剂)示:肝右后叶可见团块状T1WI、T2WI高低混杂信号影,DWI序列呈不均匀高信号影,范围约为101 mm×58 mm,边界欠清,其内可见分隔,T1WI同反相位信号未见明显变化,增强扫描(图1A~1G)呈不均匀强化,内可见片状无强化信号,边缘及分隔强化较明显,肝胆期(延迟1 h扫描)信号不均匀。肝左叶外侧段可见一小圆形异常强化影,直径约8 mm,增强扫描动脉期呈明显强化。门静脉右支可见对比剂充盈缺损影(图1G)。

基于Faster-RCNN的肝细胞癌与肝内胆管细胞癌多模态MR影像智能肿瘤识别与分类诊断模型构建

目的探讨基于Faster-区域卷积神经网络(RCNN)的肝细胞肝癌与肝内胆管细胞癌(HCC/ICC)多模态MR影像肿瘤识别及分类诊断模型的应用可行性。方法选取2017年1月—2020年1月我院接受手术的156例HCC或ICC,术前4周内行MR增强扫描,使用image_registration软件chi2_shift方法对患者MR动脉期、静脉期及延迟期影像进行配准、融合,利用Faster-RCNN模型对患者进行肿瘤目标识别及分类。通过Z轴连续性筛选方法降低肿瘤识别的假阳性率,在患者层面使用加权投票方法获得分类诊断结果。结果Faster-RCNN模型可以有效识别肿瘤区域并进行分类诊断。Z轴连续性筛选可以降低肿瘤识别的假阳性率,提高精确率和召回率。经配准后的融合图像在图像层面目标识别精确率为83.7%,召回率为91.9%,分类整体准确率为92.0%;在患者层面,加权投票后融合影像的分类整体准确率为93.5%。结论基于Faster-RCNN的HCC/ICC多模态MR影像鉴别诊断模型可以高效、准确地对HCC/ICC进行目标识别和分类诊断,有望实现临床转化,协助诊疗工作。

五例肝上皮样血管内皮瘤的CT/MRI表现及文献复习

目的探讨肝上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,HEHE)的CT/MRI影像学表现特点。方法回顾性分析温州市中心医院2015年6月至2020年2月5例经病理证实的HEHE患者的临床及CT/MRI资料,分析其影像学表现特点。结果本组男3例,女2例,年龄32~57岁,平均(47.8±9.6)岁。按病灶数量可分为单发结节型1例,多发结节型3例,弥漫融合型1例。5例HEHE患者共检出病灶90个,肝右叶65个,肝左叶25个,肝右叶病灶数量多于肝左叶,最大病灶直径约5.3 cm,最小病灶直径约0.4 cm。CT平扫除1例21个病灶中心可见斑点状钙化影,其余病灶均呈低密度影。MRI平扫T1WI均呈低信号,T2WI均呈中高信号,66个病灶中心可见更高信号;DWI均呈高信号。5例患者病灶均有沿肝包膜下分布趋势,79个病灶离肝包膜<2 cm,3例6个病灶可见“包膜皱缩征”,4例66个病灶可见“靶征”,2例3个病灶可见“棒棒糖征”,1例2个病灶可见“瘤内血管征”,1例弥漫融合型肝左右叶均可见肝内胆管扩张,1例多发结节型肝S5段可见肝内胆管扩张。增强扫描19个病灶呈均匀强化型,65个病灶呈环形强化型,6个病灶呈中心填充型。5例患者均获得随访,随访时间6~17个月,1例单发结节型患者经手术切除病灶无复发,3例多发结节型患者经介入治疗病情稳定,1例弥漫融合型患者经介入治疗,病灶依旧明显进展,出现腹水。结论HEHE以肝内多发病灶为主,病灶数越多,影像学表现越典型。HEHE病灶多沿肝包膜下分布,较大病灶可引起肝包膜皱缩,“靶征”“棒棒糖征”“瘤内血管征”均有助于提高该病的诊断,DWI序列可发现更多小病灶。

磁共振扩散加权成像对肝脏肿瘤的诊断

目的探究采用磁共振扩散加权成像在肝脏肿瘤的临床诊断效果。方法选择我院2012年5月-2015年5月收治的肝脏良性肿瘤和恶性肿瘤患者80例，对所有患者给予磁共振扩散加权成像诊断。对比良、恶性肝脏肿瘤患者的ADC值情况。结果肝脏血管瘤的ADC值高于肝细胞癌、肝脏转移瘤以及肝囊肿患者，差异有统计学意义（P〈0．05）。而肝细胞癌、肝脏转移瘤以及肝囊肿患者之间的ADC值差异无统计学意义（P〉0．05）。结论肝脏肿瘤患者采用磁共振扩散加权成像能够有效鉴别灌注ADC值。

肝上皮样血管内皮瘤影像学对比分析

目的:总结肝脏上皮样血管内皮瘤(hepatic epithelioid haemangioendothelioma,HEHE)的影像学特点。方法:回顾性分析9例经病理证实的HEHE影像特征。7例同时行超声、CT、MR检查,2例仅行CT检查。结果:9例患者的肝脏病灶均为多中心性,其中2例合并多部位发生;结节型5例,融合型4例;HEHE好发于肝包膜下,可出现包膜皱缩;超声下病灶呈等或低回声,病灶内稀疏血流信号或无血流信号;CT平扫为不均匀低密度;MR平扫为T1不均匀低信号,T2不均匀高信号。结节型病灶在CT平扫及增强可出现特征性“靶征”;强化方式呈云絮状渐进性强化或持续环形强化或环形强化并渐进性向心性强化,增强扫描呈“慢进慢出”并廓清,门静脉期或延迟期可见门静脉或肝静脉出现于肿瘤的边缘,形成典型的“棒棒糖征”。结论:HEHE在影像学上的“棒棒糖征”、环形、云絮且向心性强化,结节型病灶的“靶征”及肝包膜皱缩,均可为该病的诊断与鉴别提供较大的帮助。