乙型肝炎肝硬化背景下小肝癌的CT平扫、增强扫描与MRI平扫、DWI表现分析

目的 :分析乙型肝炎肝硬化背景下小肝癌的CT平扫、增强扫描与MRI平扫、DWI的表现。方法 :选取经组织病理学确诊的乙肝肝硬化背景下的小肝癌65例共74个肿瘤病灶,比较CT平扫、CT增强扫描、MRI平扫、DWI对小肝癌总的检出率、不同直径小肝癌的检出率及包膜显示率。结果:CT平扫对病灶检出率为64.86%;CT增强扫描动脉期、门静脉期、延迟期对病灶检出率分别为85.14%、68.92%、72.97%;MRI平扫对病灶检出率为86.49%;DWI为93.24%。各种方法对小肝癌病灶检出率的差异有统计学意义(P0.001)。CT平扫、CT增强扫描、MRI平扫、DWI对包膜的显示率分别为40.54%、59.46%、71.62%、97.30%,差异有统计学意义(P0.001)。CT增强扫描动脉期、门静脉期、延迟期对直径≤1 cm的小肝癌检出率均低于对直径1~3 cm小肝癌的检出率(均P0.05)。结论:DWI对小肝癌的检出率和包膜显示率最高,且CT增强扫描更易检出直径1~3 cm的病灶。     

多期动态增强CT与MRI对小肝癌诊断的比较分析研究

目的评估慢性肝病合并小肝癌患者在多期动态增强CT及MRI扫描中强化程度的差异以及MRI双动脉期扫描的必要性。方法观察137例经病理证实的直径小于20mm的小肝癌病例。所有病例均行多期动态增强CT及MRI检查。比较病灶在CT及MRI动脉期强化程度和平衡期对比剂流出程度的差异,以及病灶在MRI动脉早期与动脉晚期强化程度的差异。相对于正常肝实质密度或信号,动脉期病灶明显强化评为1分,轻度强化为2分,无强化为3分;平衡期病灶密度或信号无减低(即无对比剂流出效应)为4分,轻度减低为5分,明显减低为6分。结果增强MRI动脉期小肝癌强化程度高于CT动脉期,CT平衡期小肝癌的对比剂流出效应优于MRI平衡期,组间比较差异均有统计学意义(P0.05)。在增强MRI双动脉期扫描中,动脉晚期小肝癌强化程度高于动脉早期,差异有统计学意义(P0.05)。近半数小肝癌(65/137,47.45%)在MRI平衡期出现边缘环状强化,明显高于CT平衡期(4/137,2.92%),差异有统计学意义(2=72.079,P0.05)。结论小肝癌在增强MRI动脉期强化效果优于CT,在MRI平衡期对比剂流出效应弱于CT,但MRI平衡期病灶的边缘环状强化可以辅助诊断。MRI双动脉期扫描,尤其是动脉晚期有助于提高小肝癌的检出。     

乙肝肝硬化背景小肝癌CT与MRI强化特征的比较研究

目的 比较乙肝肝硬化背景小肝癌(SHCC)CT与MRI的强化特征.方法 87例乙肝肝硬化SHCC患者共计91个病灶均行CT和MRI动态增强扫描,分别测量病灶平扫及增强各期CT值和MRI信号强度值,计算增强后CT与MRI各期相对强化率和病灶-肝脏对比率,绘制时间-密度/信号强度曲线并分型,观察记录病灶CT与MRI动脉期强化方式及假包膜的显示情况,分析比较乙肝肝硬化背景SHCC CT与MRI的强化特征.结果 MRI动脉期及平衡期SHCC相对强化率较CT高,差异有统计学意义(P＜0.05),CT与MRI门静脉期SHCC相对强化率差异无统计学意义(P＞0.05).MRI动脉期、门静脉期及平衡期SHCC病灶-肝脏对比率均较CT高,差异均有统计学意义(P＜0.05).CT与MRI SHCC时间-密度/信号强度曲线类型差异有统计学意义(P＜0.05),两两比较速升速降型及速升缓降型差异有统计学意义(P＜0.05),缓慢上升型及基本无强化型差异无统计学意义(P＞0.05).CT与MRI SHCC动脉期强化方式差异无统计学意义(P＞0.05).MRI动态增强SHCC假包膜显示率较CT高,差异有统计学意义(P＜0.05).结论 CT和MRI动态增强都能很好地反映SHCC相对肝实质的"陕进快出"的强化方式,MRI对显示SHCC动脉期快速强化的特征及假包膜较CT有优势,而CT更有利于观察SHCC强化"退出"的特点.     

双源CT双能量上腹部虚拟平扫临床应用价值的初步探讨

目的 探讨双源CT(dual source computed tomography,DSCT)上腹部双能量虚拟平扫临床应用的可行性.资料与方法 对46例临床拟诊上腹部病变患者行DSCT上腹部常规平扫(CNCT)及动脉期、门静脉期双能量扫描(80 kV/404 mA和140 kV/96 mA).利用Liver VNC软件处理分别得到动脉期、门静脉期2组虚拟平扫数据,并与CNCT对照,比较三者在图像质量、辐射剂量、平均CT值、信噪比(SNR)及病灶检出上差异的统计学意义.结果 3次扫描患者接受的辐射剂量、所测肝、脾平均CT值的差异无统计学意义(P>0.05);虚拟平扫图像SNR明显高于CNCT组(P=0.00),2组虚拟平扫之间差异无统计学意义(P>0.05);虚拟平扫的图像质量较CNCT有所下降(F=241.80,P=0.00),但可满足临床诊断需求,动脉期虚拟平扫图像质量优于门静脉期(P=0.004);虚拟平扫和CNCT病灶检出性能相似.结论 相对门静脉期而言,肝动脉期的双能量虚拟平扫能提供更好的图像质量,可满足诊断需要,并可减少一次平扫的辐射剂量,具有更高的SNR、相似的病灶检出性能,具有潜在的临床应用价值.     

64层螺旋CT多期扫描双动脉期诊断小肝癌的价值探讨

目的 评估64层螺旋CT双动脉期扫描对小肝癌的诊断价值.方法 23例(25个病灶)小肝癌患者,经64层螺旋CT双动脉期、门静脉期三期增强扫描.采用对比剂追踪触发技术启动动脉早期扫描,触发监测点设为腹腔干层面的降主动脉,触发阈值140 HU,触发后延迟5 s开始动脉早期扫描,延迟20 s开始动脉晚期扫描,动脉早期与动脉晚期扫描分别屏气进行;门静脉期扫描用固定的延迟70 s;每次全肝扫描的时间为4～5 s.测量各期病灶与肝脏(同层面肝实质)的密度差值(取CT值差值的绝对值);分析与统计动脉早期、动脉晚期及门静脉期对病灶的检出率. 结果动脉早期及动脉晚期病灶与肝脏密度差值的差异有显著统计学意义(P<0.01);动脉早期检出率(11个,44.0%)低于动脉晚期(19个,76.0%);双动脉期加门静脉期检出率(25个,100%)高于动脉晚期加门静脉期(21个,84.0%)及动脉早期加门静脉期(15个,60.0%).结论 64层螺旋CT双动脉期及门静脉期多期扫描提高对多血供小肝癌的检出率.     

双源CT能谱成像在鉴别肾上腺无功能腺瘤与肾上腺转移瘤中的价值

目的探讨双源CT虚拟平扫技术及碘含量测定技术在鉴别肾上腺良恶性病变中的价值。方法搜集行肾上腺CT扫描者40例(共40个肾上腺结节),其中24个结节为无功能腺瘤,16个结节为转移瘤,对全部结节的动脉期及门静脉期常规平扫CT值、虚拟平扫CT值、碘含量(ICad)结果进行分析。结果动脉期肾上腺腺瘤平均ICad[(24.65±1.06)mg/ml]略高于肾上腺转移瘤[(22.85±9.53)mg/ml],差异有统计学意义(P=0.002),门静脉期肾上腺腺瘤ICad[(13.96±1.11)mg/ml]低于肾上腺转移瘤[(24.70±5.49)mg/ml],差异有统计学意义(P=0.036)。腺瘤与转移瘤的动脉期、门静脉期虚拟平扫平均CT值(Va、Vp)与常规平扫CT值(Vpre)差异无统计学意义;腺瘤的Vpre、Va、Vp均低于转移瘤,差异具有统计学意义(P=0.006、0.008、0.006)。结论双能量CT技术能够通过虚拟平扫技术及碘含量测定技术对二者进行鉴别诊断,以减少受检者经济负担及减轻辐射剂量。     

双源CT虚拟平扫图像质量及去除碘油的能力评价

目的：评价肝癌肝动脉化疗栓塞（TACE）术后双源CT虚拟平扫的图像质量以及去除栓塞区域碘油的能力。方法：对40例肝癌TACE术后患者先行常规腹部平扫（TNC）,然后静脉注射对比剂行双能量动脉期、门静脉期增强扫描,之后采用肝脏虚拟平扫后处理软件LiverVNC对双能量强化图像进行处理,得到VNC图像,以TNC图像为标准,评价VNC图像的图像质量及VNC去除碘油的能力,比较图像的信噪比（SNR）、对比信噪比（CNR）、碘油沉积缺损区及病灶周边区CT值并进行统计学分析。结果：VNC具有很强的去除碘油的能力,对于碘油沉积患者,VNC较TNC在图像质量上有所下降,碘油沉积缺损区的CT值VNC较TNC低,差异有统计学意义（TNC动脉期CT值-54．4±19．1,VNC—CT值：44．8±12．9,P〈0．05;TNC门静脉期CT值=54．4±19．1,VNC-CT值=45．3±13．4,P〈0．05）,病灶周边区的CT值VNC与TNc差异无统计学意义（TNC动脉期CT值-56．4±7．6,VNC—CT值=55．1±7．8,P〉0．05;TNC门静脉期CT值：56．4±7．6,VNC—CT值-58．3±8．2,P〉0．05）,病灶的动脉期VNC与门静脉期VNC的CT值差异无统计学意义（碘油沉积缺损区动脉期CT值-44．8±12．9,门静脉期CT值-45．3±13．4,P〉0．05;病灶周边区动脉期CT值-55．1±7．8,门静脉期CT值=58．3±8．2,P〉0．05）。结论：对于较少碘油沉积的病例,VNC能基本满足诊断需求,对于肝癌TACE术后病灶,VNC对病灶周边区的显示好于病灶内。     

多层螺旋CT双期增强扫描对肝微小细胞癌的诊断价值

目的探讨多层螺旋CT双期增强扫描对原发性肝微小细胞癌的诊断价值。方法对36例肝微小细胞癌的患者,分别采用CT平扫及双期增强扫描对患者进行检查,所有患者均经病理组织证实;分析平扫和增强扫描病灶的密度和边缘表现,并对小肝癌检出率及不同扫描时相肿瘤与肝脏密度差值的变化情况进行比较。结果肝微小细胞癌的病灶范围在1.3~2.0cm之间。CT平扫病灶呈类圆形低密度影者占83.3%,等密度者占16.7%,增强后瘤内密度均匀者占58.3%,瘤内密度不均匀占41.7%,增强后病灶边界清楚者占66.7%,边界模糊者占33.3%;动脉期的检出率为91.7%,门脉期的检出率为80.6%,而CT平扫的检出率为63.9%,差异具有统计学意义(P0.05);门脉期肿瘤与肝脏密度的差值最大,而平扫期肿瘤与肝脏密度的差值最小,门脉期与动脉期及平扫的差值均有统计学意义(P0.05)。结论螺旋CT双期增强扫描对肝微小细胞癌的检出率高,诊断准确可靠,具有较高的诊断价值。     

DWI 对乙肝肝硬化背景微小肝癌（≤1cm）的检测价值

目的：探讨在常规 MRI扫描的基础上增加DWI序列对乙肝肝硬化背景微小肝癌(≤1 cm)的检测价值。方法51例乙肝肝硬化患者共54个微小肝癌,同时行常规 MRI(T2 WI+T1 WI 双回波序列+动态增强)及 DWI 扫描。由2位阅片者采用双盲法分析常规 MRI 图像及联合常规 MRI +DWI 图像,记录病灶的信号特点、强化方式及阅片者的信心评分,比较2种成像模式下阅片者的信心评分及一致性,并通过 ROC 曲线评估阅片者对微小肝癌的诊断能力,以及检测微小肝癌的敏感性、特异性和阳性预测值。结果增加 DWI 图像后：①2位阅片者检测微小肝癌的信心评分提高,差异有统计学意义(P <0.05),同时,2位阅片者检测微小肝癌的一致性增加。②2位阅片者检测微小肝癌的 ROC 曲线下面积均提高,差异有统计学意义(P <0.05)。③2位阅片者检测微小肝癌的敏感性及阳性预测值差异均无统计学意义(P >0.05),特异性差异均有统计学意义(P <0.05)。结论在常规 MRI 扫描的基础上增加 DWI 序列有助于提高对乙肝肝硬化背景微小肝癌诊断能力。     

多层螺旋CT在小肠Crohn病中的应用研究

目的 探讨MSCT双期动态增强扫描在小肠Crohn病中的应用价值.方法 45例经综合方法 诊断,并通过临床治疗证实的小肠Crohn病患者均行MSCT双期动态增强扫描,并在ADW4.2工作站进行后处理.测量患病肠段在不同期相内的CT值,采用方差分析比较其CT值;并测量各期相内患病肠段与正常肠段的CT值筹值,以差别10 HU为界,划分病例数,将不同期相内的病例数采用卡方检验进行比较.结果病变肠段平扫平均CT值为(39.3±3.7)HU,动脉期为(74.8±13.8)HU,门静脉期为(90.2±12.3)HU,差异有统计学意义(F=258.87,P<0.01).病变肠段平扫与动脉期和门静脉期CT值两两比较,差异均有统计学意义(P<0.05).45例中,平扫CT值差值≤10 HU和>10 HU者分别为44和1例,动脉期分别为6和39例,门静脉期分别为2和43例,经X2检验,平扫与动脉期间差异有统计学意义(X2=32.49,P<0.01),平扫与门静脉期间差异有统计学意义(X2=39.22,P<0.01),动脉期与门静脉期间差异无统计学意义(X2=1.10,P>0.05).增强扫描使病灶显示更为清楚,大大提高了小肠Crohn病的检出率.结论 MSCT双期动态增强扫描可对小肠Crohn病作出初步诊断,并可对病变进行全面评价.     

恩替卡韦治疗失代偿期乙型肝炎肝硬化的临床观察

目的：探讨恩替卡韦治疗乙型肝炎后肝硬化的临床疗果。方法：选择乙型肝炎后肝硬化男性患者84例,随机分为两组,对照组采用常规保肝对症治疗,治疗组在常规治疗基础上加用恩替卡韦。观察治疗后各项指标变化。结果：①治疗组HBV—DNA水平显著下降,与对照组比较,差异有统计学意义（P〈0．05）;②治疗组血清生化显著下降,与对照组比较差异有统计学意义（P〈0．05）;③两组患者病程及病情进展比较,差异有统计学意义（P〈0．05）。结论：恩替卡韦治疗乙型肝炎后肝硬化能有效快速抑制病毒复制,改善肝功能,可改善短期及长期预后。     

Focal Nodular Hyperplasia with Retraction of Liver Capsule: A Case Report

Focal nodular hyperplasia (FNH) is characterized by the presence a central scar with radiating fibrous septa. Our case had a capsular retraction, which was the result of an extension of the central scar to the surface. In addition, a hypointense scar on the T2-weighted image and a minimal enhancing central scar on the enhanced T1-weighted image, which was due to dense, sclerotic collagenous tissue, were observed. We report the first case of FNH with a capsular retraction.     

Liver transplant rejection and cholestasis: comparison of technetium 99m-diisopropyl iminodiacetic acid hepatobiliary imaging with liver biopsy

To determine whether the scintigraphic evaluation of technetium-99m diisopropyl iminodiacetic acid (DISIDA) uptake and excretion can distinguish among liver transplant patients with biopsy evidence for rejection, cholestasis or neither condition, we reviewed scintigrams and biopsies in 36 patients. There were 76 scintigrams with corresponding biopsies. Uptake and excretion were graded from image data on scales reflecting normal through severely abnormal values. Biopsies were evaluated for findings of cholestasis and rejection. The majority of scintigrams demonstrated normal uptake (60/75, 80%) and delayed excretion (65/76, 85%), which was most marked immediately after transplantation. One-way analysis of variance showed that the mean excretion values significantly differed between patients with normal biopsies and those with cholestasis and/or rejection (P =0.0003). However, mean uptake scores demonstrated no statistically significant difference between these two groups of patients (P =0.1). These findings suggest that ^99mTc-DISIDA scintigraphy can differentiate between transplants with and without rejection/cholestasis but not between rejection and cholestasis. If ^99mTc-DISIDA excretion is normal, rejection and cholestasis are unlikely. Offprint requests to: C.M. Engeler     

Angiography of Hepatic Vascular Malformations Associated with Hereditary Hemorrhagic Telangiectasia

Purpose: To describe the angiographic features of hepatic involvement in hereditary hemorrhagic telangiectasia (HHT), particularly the presence of portovenous shunts. Methods: We reviewed the angiographic findings of seven patients with HHT. The patients comprised three women and four men with a mean age of 51 years. Results: Intrahepatic telangiectasias were found in all seven patients and shunts between three vascular channels were found in six of seven patients. In the four patients who had portovenous shunts combined with arterioportal shunts, the portovenous shunts were large. Three patients had no portovenous shunts. Two of these patients had arteriovenous shunts, and one had no shunt. The mean age (69 years) of the patients with portovenous shunts was older than those without portovenous shunts (26 years). Conclusions: Hepatic vascular lesions in HHT are varied, ranging from telangiectasias to large shunts between three vascular channels. In an advanced stage of involvement, large portovenous shunts are present.     

高压氧对肝硬变患者肝储备功能的影响(论著)

目的：观察高压氧（ＨＢＯ）对肝硬变患者肝储备功能的影响。方法：将３８例肝硬变患者按肝功能Ｐｕｇｈ等分级方法［１］分为肝功能良好组（ｎ＝１８）和损害组（ｎ＝２０）。于ＨＢＯ治疗前及治疗后６、１２天进行口服葡萄糖耐量试验（计算服糖后１２０、６０分钟血糖浓度比值即ＯＧＴＴＲ１２０／６０），检测血清前白蛋白（ＰＡ）、白／球蛋白比值（Ａ／Ｇ）、总胆红素（ＴＢｉ）、凝血酶原时间（ＰＴ）及靛青绿１５分钟潴留率（ＩＣＧＲ１５），根据以上检查结果判断ＨＢＯ治疗对肝储备功能的影响。结果：ＨＢＯ可明显提高Ａ／Ｇ值及ＰＡ水平，降低ＯＧＴＴＲ１２０／６０、ＴＢｉ及ＩＣＧＲ１５，对ＰＴ亦有明显改善及控制作用。结论：ＨＢＯ可提高肝硬变患者肝储备功能，是肝硬变患者术前准备的有助方法     

多层螺旋CT肝脏灌注测量在肝硬化中的初步应用

目的探讨多层螺旋CT肝脏灌注测量在肝硬化中的应用价值。资料与方法37例接受多层螺旋CT肝脏灌注测量。20例无明显肝脏疾患的志愿者(正常组),17例肝硬化患者(肝硬化组),再按其肝硬化程度分为两组:9例为轻中度肝硬化(轻中度肝硬化组),8例为重度失代偿肝硬化(重度失代偿组)。计算各例的各项灌流指标并进行组间比较。结果(1)肝硬化组与正常组相比,门静脉灌流量(HPP)、门静脉灌流指数(PPI)明显减低[HPP:(0.49±0.19)ml·min-1·ml-1与(0.60±0.16)ml·min-1·ml-1,P=0.045;PPI:0.58±0.14与0.67±0.06,P=0.015],门静脉与肝动脉灌流比率(HPP/HAP)亦明显减低(1.63±0.87与2.12±0.65,P=0.04),肝动脉灌注指数(HPI)升高(0.42±0.14与0.33±0.06,P=0.015),提示肝硬化时HPP减少,门静脉血流在肝脏血供中的比例减少,而动脉的灌流比重增加;(2)重度失代偿组肝硬化HAP较轻中度组明显升高[分别为(0.48±0.16)ml·min-1·ml-1与(0.25±0.07)ml·min-1·ml-1,P=0.002],HPI亦明显升高(分别为0.54±0.10与0.32±0.07,P=0.0001),PPI则明显降低(分别为0.46±0.10与0.68±0.07,P=0.0001),提示不同程度肝硬化其灌注指标存在差异,灌注改变与肝硬化程度有关。结论肝脏CT灌注测量可以反映肝硬化的血流灌注改变,灌注值的变化也能够提示肝硬化的程度。     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

急性胰腺炎伴肝损害78例临床分析

目的探讨急性胰腺炎（AP）患者合并肝损害的发病机制、临床特点。方法对128例AP患者的临床资料进行回顾性分析。结果 128例AP中有78例合并肝损害,发生率为60.9%。其中重型急性胰腺炎（SAP）较轻症急性胰腺炎（MAP）肝损害发生率更高,损害程度更明显,差异均具有统计学意义（P〈0.05）。结论 AP大多伴有肝损害,其损害程度可反映急性胰腺炎严重程度,并与其病程有关。     

定量聚合酶链反应检测HBV感染患者血清HBV DNA的临床意义

采用信号引物能量转换定量聚合酶链反应（PCR）检测104例不同HBV感染患者血清HBV DNA含量。结果：不同HBV感染患者HBV含量范围在10^4.49-10^9.93拷贝／ml，其中急性乙肝含量显著低于慢性乙肝、乙肝后肝硬变和原发性肝癌患者的含量（P＜0.05和P＜0.01)；HBeAg( )患者的含量显著高于HBeAg(-)／抗－HBe( )患者的含量（P＜0.001)；相关分析显示：血清HBV DNA含量与血清ALT水平无明显相关。结论：HBV感染的慢性化可能与血清HBV DNA含量高有关，肝损伤与血清HBV DNA含量无明显关系；e系统血清传换后，HBV并未停止复制，只是复制水平降低，应用定量PCR检测血清HBV DNA含量有助于HBV感染患者预后的判断和重新评价HBV感染的自然史及HBVM的临床意义。     

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Objective

To determine the helical CT findings which help differentiate between focal eosinophilic necrosis (FEN) of the liver and metastasis in patients with underlying gastric or colorectal cancer.

Materials and Methods

In 21 patients with underlying gastric and colorectal cancer examined during a recent 18-month period, the presence of FEN (n=90) was proven at CT. The diagnosis was verified by biopsy in eight patients and by the transient nature of the findings related to peripheral eosinophilia (>10%) in the remainder. For comparison, 20 consecutive patients with pathologically proven hepatic metastasis from gastric or colorectal cancer (n=158) were selected. Single-phase helical CT images (7-mm collimation, pitch 1:1) were independently analyzed in a random order by two blinded readers. The parameters evaluated included the margin (depicted border, fuzzy), shape (spherical, non-spherical), attenuation (subtle hypoattenuation, hypoattenuation), and the presence or absence of rim enhancement.

Results

FEN far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and a non-spherical shape (84% for both readers) than metastasis, for which the respective findings were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), but was recognized by both readers in 40% of metastases. For all parameters, the results were statistically significant (p < .01), and showed that both readers correctly differentiated FEN from metastasis in 78% of the patients (32/41). Interobserver agreement was, in addition, excellent (κ= 0.66).

Conclusion

When focal hepatic lesions with a fuzzy margin, non-spherical shape and subtle hypoattenuation without rim enhancement are found, the possibility of FEN should be considered even in patients with underlying gastrointestinal malignancy.