钆塞酸二钠增强MRI肝胆期高信号病变影像表现与特征分析

目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI肝胆期高信号病变的影像学特征并进行分型。 方法 回顾性纳入经手术病理或典型影像表现及临床随访证实为肝脏局灶性病变的病人124例,平均年龄（55.1±15.8）岁。分析肝脏局灶性病变124个,包括肝细胞癌（HCC）52个、胆管细胞癌（ICC）7个、混合型肝细胞癌-胆管癌（cHCC-CC）4个、转移瘤（HM）6个、局灶性结节增生（FNH）及FNH样变42个、肝腺瘤（HCA）2个、异型增生结节（DN）5个、肝海绵状血管瘤（CHL）6个。所有病人均行肝脏Gd-EOB-DTPA增强MRI检查,观察分析肝胆期高信号病变特征并对其进行分型。同一病变中不同分型间占比的比较采用Fisher确切概率检验。计算肝胆期病灶-肝脏信号强度比（LLR）,不同病变间LLR的比较采用Kruskal-Wallis检验。 结果 HCC、ICC、HM、FNH/FNH样变和DN病变中不同分型间占比的差异均有统计学意义（均P<0.05）。HCC病灶中28个可见包膜（53.85%）,各分型中Ⅱb型最多（23/52,44.23%）;ICC病灶中Ⅱa型和Ⅲ型最多（均为3/7,42.86%）;HM病灶中Ⅱa型最多（4/6,66.66%）,且均为胃肠道转移瘤;FNH/FNH样变中Ⅳa型最多（32/42,76.19%）;DN病灶中Ⅰa型最多（4/5,80.00%）。肝胆期不同高信号的病变间LLR的差异有统计学意义（P<0.05）,HCC的LLR低于FNH/FNH样变（P<0.05）。 结论 Gd-EOB-DTPA增强MRI肝胆期高信号病变的影像特征分型对肝脏局灶性病变的诊断具有一定价值。

Imaging characteristics of hyperintense lesions on Gd-EOB-DTPA-enhanced hepatobiliary phase MRI

Objective To investigate the imaging features and classification of hyperintense lesions on Gd-EOB-DTPA-enhanced hepatobiliary phase MRI. Methods A total of 124 patients (mean age 55.1±15.8 years) with focal liver lesions confirmed by surgical pathology or typical imaging findings and clinical follow-up were retrospectively, and 124 cases of focal liver lesions were analyzed. There were hepatocellular carcinoma (HCC, n=52), intrahepatic cholangiocarcinoma (ICC, n=7), combined hepatocellular cholangiocarcinoma (cHCC-CC, n=4), hepatic metastases (HM, n=6), focal nodular hyperplasia (FNH) and FNH-like lesions (FNH/FNH-like lesions, n=42), hepatocellular adenoma (HCA, n=2), dysplastic nodule (DN, n=5), and cavernous hemangioma of liver (CHL, n=6). All patients underwent Gd-EOB-DTPA-enhanced MRI, the characteristics of hyperintense lesions at hepatobiliary phase were analyzed and classified. Fisher’s exact test was used to compare the proportions of different lesion types within the same lesion. Lesion-liver signal intensity ratios (LLR) at hepatobiliary phase were calculated and compared with Kruskal-Wallis test among different lesions. Results There were significant differences in the proportions of lesion types among HCC, ICC, HM, FNH/FNH-like lesions and DN (all P<0.05). Capsules were visible in 28 HCC lesions (53.85%), among which the most common type was Ⅱb (23/52, 44.23%). Type Ⅱa and type Ⅲ were the most common in ICC lesions (both 3/7, 42.86%). Type Ⅱa was the most common in HM lesions (4/6, 66.66%), and all of them were gastrointestinal metastases. Type Ⅳa was the most common in FNH/FNH-like lesions (32/42, 76.19%). Type Ⅰa was the most common in DN lesions (4/5, 80.00%). The difference in LLR between different lesions of hepatobiliary hyperintense was statistically significant (P<0.05). The LLR of HCC was lower than that of FNH/FNH-like lesions (P<0.05). Conclusion Gd-EOB-DTPA-enhanced MRI imaging features of hyperintense lesions at hepatobiliary phase have certain value in the diagnosis of focal liver lesions.