超声造影在肝局灶性结节增生诊断和鉴别诊断中的价值

[目的]探讨超声造影在肝局灶性结节增生（FNH）的诊断以及与原发性肝癌（PHC）鉴别诊断中的价值。[方法]经病理学检查证实的原发性肝癌22例和肝局灶性结节增生病变16例,采用GE-LOGIQ9彩色多普勒系统,具有CPS（contrast pulse sequence）造影专用程序和造影剂Sonovue进行超声造影成像,造影时记录肝实质及病灶的充填过程、充盈方式及增强程度。[结果]22例原发性肝癌的造影方式均呈典型的快进快退型。16例FNH在动脉期呈强回声,而门脉相呈等回声。在延迟相,15/16例（94%）FNH病灶呈等回声或稍高回声,1/16例（6%）较肝实质回声稍低;11/16例（69%）病灶在门脉和延迟相可见中央瘢痕。[结论]超声造影能清楚显示肝局灶性结节增生和原发性肝癌的造影充填过程及充填方式,在两者的诊断和鉴别诊断中具有重要意义。     

肝脏局灶性结节性增生的超声表现

目的 总结肝脏局灶性结节性增生(FNH)的超声表现,探讨超声检查的诊断价值.方法 14例肝脏局灶性结节性增生患者均经病理证实,共16个病灶接受了二维灰阶超声及彩色多普勒超声检查.结果 14例16个病灶的二维灰阶超声检出率为100%.二维灰阶超声显示10个病灶位于肝右叶,5个病灶位于肝左叶,1例病灶位于肝左叶与右叶之间.6个病灶表现为等或稍低回声,8个病灶为低回声,2个病灶为高回声.12个病灶探及较丰富彩色多普勒动脉频谱,4个病灶血流呈现轮辐状;峰值流速为26.1～121.6cm/s,均值为58.5 cm/s;阻力指数(RI)为0.36～0.81,均值为0.51.所有患者的AFP均为阴性.结论 肝脏局灶性结节性增生具有较为特殊的超声表现,结合其AFP为阴性,可提高超声检查的诊断率.     

常规超声及超声造影对结节性肝癌及肝局灶性结节性增生的鉴别诊断价值

目的 分析结节性肝癌及肝局灶性结节性增生(FNH)的超声特征及超声造影特征.方法 回顾性分析40例结节性肝癌患者(结节性肝癌组)及40例FNH患者(FNH组)的临床资料,所有患者均接受常规超声及超声造影检查,观察两组患者的超声特征及不同时相的超声造影特征.结果 结节性肝癌组患者门静脉癌栓(22.5％vs 0)、肝硬化(60.0％vs 15.0％)及淋巴结肿大(20.0％vs 2.5％)的发生率高于FNH组,中心瘢痕(15.0％vs 62.5％)的发生率低于FNH组,病灶位于肝包膜下的比例(22.5％vs 52.5％)低于FNH组,差异均有统计学意义(P﹤0.05).两组患者的超声动脉相均以高增强为主,动脉相增强模式比较,差异无统计学意义(P﹥0.05);对于门脉相及延迟相,结节性肝癌组患者均以低增强为主,FNH组患者均以等低增强为主,两组患者的门脉相及延迟相增强模式比较,差异均有统计学意义(Z=2.754、3.556,P﹤0.01).结节性肝癌组患者的上升时间(RT)[(21.9±8.7)s vs(27.8±9.2)s]、达峰时间(TTP)[(29.6±9.3)s vs(36.1±11.8)s]及平均通过时间(mTT)[(102.1±37.7)s vs(136.2±42.1)s]均明显短于FNH组,灌注指数(PI)[(122.8±31.6)vs(85.9±22.2)]明显高于FNH组,差异均有统计学意义(P﹤0.01).结论 结节性肝癌和FNH具有较为典型的超声特征及超声造影特征,可对两者进行较准确的鉴别诊断.     

肝局灶性结节增生24例诊治分析

目的探讨肝肝脏局灶性结节增生（focal nodular hyperplasia,FNH）的临床、诊断及治疗。方法回顾性分析24例FNH的临床表现、影像学检查、病理学检查及治疗方法。结果我院近10年来收治24例FNH,大多数无临床症状,占75.0%（18/24）,CT扫描有中央星状瘢痕14例,占63.6%（14/22）,影像学检查符合率：B超33.3%（6/18）,超声造影60.0%（3/5）,CT77.3%（17/22）,MRI50.0%（2/4）,DSA88.8%（8/9）,PET-CT100%（5/5）,手术切除8例,术后随访1～3年无复发。B超引导下射频消融治疗2例,随访1年,1例病灶消失,1例明显缩小。肝动脉硬化栓塞治疗5例,其中1例破裂出血急诊介入治疗,随访6个月至3年,1例病灶消失,明显缩小4例。继续观察9例,随访1～3年无明显增大。结论 FNH的诊断主要依据影像学检查,对无症状的FNH可继续密切随访,定期观察,对诊断不明或不能排除肝癌者应手术治疗,对诊断明确、有症状或要求治疗者可采用射频消融或肝动脉硬化栓塞治疗,肝动脉硬化栓塞治疗尤其适用于FNH破裂出血。     

肝局灶性结节样增生的临床病理学研究

目的：探讨肝局灶性结节样增生（FNH）的病理学形态学特点。方法：分析7例FNH患者的临床资料。采用HE染色，结合免疫组织化学方法观察其形态特点，并利用流式细胞仪进行DNA倍体分析。结果：男性4例，女性3例，年龄18－44岁，肝功能、血清AFP均正常，结节直径为2．7－8．0cm，大体检查；5例有特征性中央星状瘢痕，由致密的纤维结缔组织、畸形的脉管和增生的胆管构成，伴有淋巴细胞浸润。免疫组化；AFP及c-erbB-2均阴性。5例DNA倍体分析；4例为二倍体，1例为异倍体。7例随访6个月－11年，未见复发及恶性病变。结论：FNH是1种肝细胞对局部血管异常的反应性增生。     

结节性肝癌与肝局灶性结节性增生的常规超声及超声造影对比及鉴别诊断

目的：对比分析结节性肝癌（ｎｏｄｕｌａｒｈｅｐａｔｏｃｅｌｌｕｌａｒｃａｒｃｉｎｏｍａ,ＮＨＣＣ）及局灶性结节性增生（ｆｏｃａｌｎｏｄｕｌａｒｈｙ ｐｅｒｐｌａｓｉａ,ＦＮＨ）的常规超声及超声造影特征,分析超声造影的鉴别诊断价值。方法：采用回顾性分析,纳入我院 ２０１７ 年 １月至 ２０２１年 ６月期间收治的 ４２例 ＮＨＣＣ患者和 ４２例 ＦＮＨ患者,收集其影像学等资料,对比 ＮＨＣＣ与 ＦＮＨ患 者二维超声特征和超声造影特征的差异。结果：ＮＨＣＣ患者淋巴结肿大、肝硬化、门静脉癌栓占比较 ＦＮＨ患者高,中 心瘢痕、病灶位于肝包膜下的发生率均较 ＦＮＨ组患者低,差异均有统计学意义（Ｐ＜０．０５）。ＮＨＣＣ组患者门脉相以 低增强为主,ＦＮＨ组则以等增强为主,差异有统计学意义（Ｐ＜０．０５）;两组患者延迟相均以低增强为主,但 ＮＨＣＣ组 低增强发生率较 ＦＮＨ组更高,差异有统计学意义（Ｐ＜０．０５）。ＮＨＣＣ组患者 ＰＩ较 ＦＮＨ组大,ｍＴＴ、ＴＴＰ、ＲＴ均较 ＦＮＨ组低,差异均有统计学意义（Ｐ＜０．０５）。超声造影诊断 ＮＨＣＣ的灵敏度为 ９５．２４％、特异性为 ９５．２４％。结论： ＮＨＣＣ与 ＦＮＨ患者在常规超声特征和超声造影特征上有明显差异,增加超声造影参数分析能进一步鉴别此二种病变,为临床治疗提供指导。     

肝脏局灶性结节增生的诊断及治疗

目的　探讨肝脏局灶性结节增生的临床特点及诊治方法。方法　回顾性分析 15例经手术切除、病理学检查证实的肝脏局灶性结节增生患者的临床资料。结果　该病多发生于中青年 ,6例女性患者均无服用避孕药史 ,全组患者肝功能、AFP水平均正常 ,86.7% (13 / 15 )的患者血清乙型、丙型肝炎病毒指标水平正常 ;术前综合影像正确诊断率为 3 3 .3 % (5 / 15 ) ;13例为单发病灶 ,其余 2例各有 2个病灶。 11例行不规则肝切除术 ,4例行肝段切除术。 2例出现并发症 ,其中 1例为术后肝创面活动性出血 ,另1例为切口感染。结论　肝脏局灶性结节增生影像学表现有一定特征 ,综合临床及影像学检查能提高术前确诊率。确诊病例无需手术治疗 ;疑为肝腺瘤、恶性肿瘤以及病灶发展迅速者应行手术治疗。     

肝局灶性结节增生的MRI动态增强与DSA影像表现

背景与目的:肝局灶性结节增生(focal nodular hyperplasia,FNH)是肝脏少见的良性肿瘤样病变,其影像学诊断仍有因难.本研究拟探讨FNH的MRI动态增强和数字减影血管造影(digital subtraction angiography,DSA)表现,以提高FNH影像学诊断水平.方法:回顾分析30例经病理证实的FNH的MRI和DSA影像资料.MRI检查26例,其中,平扫后普通增强扫描11例,动态增强扫描15例;DSA检查10例.结果:MRI动态增强扫描15例18个病灶动脉期呈显著强化,强化持续至延迟期仍高于或等于肝实质.11个病灶显示中央瘢痕.中央瘢痕在门脉期开始强化并持续至延迟期.动态增强时间-信号强度曲线18个病灶均为动脉期迅速升高,门脉期至延长期缓慢下降,呈速升-缓降型.DSA检查10例13个病灶表现为动脉血供丰富.8个病灶供血动脉分支进入病灶后呈辐射状向周围发散.结论:MRI动态增强扫描更能敏感显示FNH中央瘢痕组织信号.FNH的动态增强时间-信号强度曲线特征表现为速升-缓降型.FNH的DSA特征为供血动脉分支进入病灶后呈辐射状向周围发散.MRI动态增强和DSA检查可提高FNH诊断的准确率.     

肝局灶性结节状增生的诊断与治疗

肝局灶性结节状增生(focal nodular hyperplasia，FNH)为仅次于肝血管瘤的一种少见的肝脏良性占位性病变，曾命名为局灶性硬化、局灶性结节性硬化、孤立增生性结节或孤立结节状再生性增生等，由Rogers 1981年首次报道。本病无恶变倾向，预后良好。本文就肝局灶性结节状增生的病因病理、临床表现、诊断与鉴别诊断以及治疗综述如下。     

肝局灶性结节增生患者的典型与不典型螺旋CT征象分析

背景与目的：肝局灶性结节增生（focal nodular hyperplasia,FNH）是一种少见的肝脏肿瘤样病变。本研究旨在探讨该病典型与不典型的螺旋CT征象．从而提高对该病的影像学诊断水平。方法：对中山大学肿瘤防治中心病理证实或临床确诊的32例FNH患者的37个病灶的螺旋CT征象,包括病灶数目、大小、边缘情况、密度、强化形式、中央瘢痕、假包膜等进行比较分析。结果：在37个病灶中,有14个病灶最大径≤3cm,有23个病灶最大径〉3cm;有20个病灶位于肝包膜下;有7个病灶周边存在假包膜,这7个病灶最大径〉3cm;有22个病灶存在中央瘢痕,其中有20个病灶最大径〉3cm。所有病灶在动脉期均呈高密度．其中31个病灶肿瘤实质均匀强化,17个病灶周边可见异常增粗的血管影。结论：FNH典型的cT征象是动脉期明显均匀强化、存在中央瘢痕并延迟强化：FNH不典型的CT征象是动脉期不均匀强化、无中央瘢痕、存在假包膜。征象的多样性与病灶的病理类型和病灶的最大径相关。     

肝局灶性结节性增生11例病理组织学观察

[目的]探讨肝局灶性结节性增生(FNH)的病理形态学特点.[方法]回顾性分析11例肝局灶性结节性增生,采用HE染色并结合组织化学网状纤维染色及免疫组织化学EnvisionTM法观察其形态特点.[结果]肉眼病灶中央常有纤维瘢痕,组织学8例为经典型,2例为毛细血管扩张型,1例为混合型.[结论]FNH为肝脏良性增生性病变,组织学上应与肝腺瘤样增生结节、肝细胞腺瘤、AFP阴性的肝细胞肝癌和纤维板层层状肝细胞癌进行鉴别.     

肝脏局灶性结节性增生的诊断和处理

为了探讨对肝脏局灶性结节性增生诊治的合理方案,回顾性研究１９８４年～１９９８年经手术切除且经病理证实的６例肝局灶性结节性增生,并结合近期文献报道进行分析和探讨。６例肝局灶性结节性增生病人均无类固醇激素应用史,其中３例有临床症状,术前均未明确诊断而行手术切除,无手术死亡及术后并发症。肝局灶性结节性增生的准确诊断十分困难,但合理地联合应用多种影像学检查手段,可以提高诊断水平,对于无症状的确诊病例,可以采取密切随访及保守疗法;对于有症状的或生长迅速的或诊断不明确的病例应行外科手术切除     

Comparison of IDEAL-IQ and IVIM-DWI for Differentiating between Alpha Fetoprotein-Negative Hepatocellular Carcinoma and Focal Nodular Hyperplasia

Background: To compare the differential diagnostic value of iterative decomposition of water and fat with the echo asymmetrical and least-squares estimation quantitation sequence (IDEAL-IQ) with that of intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI) in differentiating between alpha fetoprotein (AFP)-negative hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH). Materials and Methods: A total of 28 AFP-negative HCC cases and 15 FNH cases were scanned using the IDEAL-IQ and IVIM-DWI magnetic resonance imaging (MRI) protocols. Two radiologists independently assessed the fat fraction (FF) and the iron level surrogate (R2*) derived from the IDEAL-IQ images and the apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) derived from the IVIM-DWI images. The intraclass correlation coefficients (ICC) were estimated to evaluate the agreement repeatability between the two readers. The area under the curve (AUC) of a receiver operating characteristics curve was used to compare the diagnostic efficiency of the parameters extracted from the two techniques. Results: The lesions in the HCC group had significantly higher FF than the FNH group (8.284 ± 5.756 vs. 2.559 ± 1.247, P < 0.05). ADC and D values were lower in the HCC lesions when compared with the FNH lesions (1.310 ± 0.253 and 0.909 ± 0.192, respectively, vs. 1.624 ± 0.304 and 1.230 ± 0.314; ×10⁻³ mm² /s). The FF parameter had the highest AUC (0.923) followed by D (0.864) and ADC (0.854). Conclusions: FF derived from IDEAL-IQ, and ADC and D derived from IVIM-DWI were able to differentiate AFP-negative HCC from FNH. IDEAL-IQ showed better performance for the differentiation of FNH from HCC than the IVIM-DWI-derived parameters.     

Studies on the role of oral contraceptive use in the etiology of benign and malignant liver tumors

Studies involving the role of OCs (oral contraceptives) in the etiology of benign and malignant liver tumors are reviewed. Although the number of reported cases is comparatively small (1 study cited an incidence rate of 1 case in 10,000 users after 5-10 years of contraceptive use), the available evidence strongly suggests that there is a relationship between the use of OCs and benign liver tumors. The acutal risk seems to be related to duration of usage, age of the woman, and type of contraceptive steroid used. 1 study showed the risk to be greater for those users who took pills with high doses of estrogens and progestogens. Analysis of liver tumors histologically showed the tumors among nonusers to be distributed among all the histologic types; there was a preponderance of hepatic cell adenomas (HCA) and focal modular hyperplasia (FNH) among users. Further evidence for an etiologic role for OCs in liver tumor formation can be derived from several cases of tumor regression or dormancy following OC discontinuance. Further etiologic studies should focus on other factors, e.g., female hormone balance, number of pregnancies, and liver disease. It is possible that FNH develops in women susceptible to hormonal stimulation. The malignant potential of benign tumors should also be studied.     

青年人原发性肝癌63例误诊分析

通过对63例青年人原发性肝癌误诊分析,提示HBsAg阳性慢性肝病患者发现AFP阳性,难治性肝脓肿,非典型肝脏临近脏器良恶性病变要高度警惕原发性肝癌可能。同样,影象学诊断与临床相结合和动态观察AFP与SGPT是早期发现原发性肝癌的一条捷径。     

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

Background: This study was conducted to investigate whether apparent diffusion coefficient (ADC) measurements by dividing the liver into left and right hepatic lobes may be utilized to improve the accuracy of differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 269 consecutive patients with 429 focal liver lesions were examined by 3-T magnetic resonance imaging that included diffusion-weighted imaging. For 58 patients with focal liver lesions of the same etiology in left and right hepatic lobes, ADCs of normal liver parenchyma and focal liver lesions were calculated and compared using the paired t-test. For all 269 patients, ADC cutoffs for focal liver lesions and diagnostic accuracy in the left hepatic lobe, right hepatic lobe and whole liver were evaluated by receiver operating characteristic curve analysis. Results:For the group of 58 patients, mean ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. For differentiating malignant lesions from benign lesions in all patients, the sensitivity and specificity were 92.6% and 92.0% in the left hepatic lobe, 94.4% and 94.4% in the right hepatic lobe, and 90.4% and 94.7% in the whole liver, respectively. The area under the curve of the right hepatic lobe, but not the left hepatic lobe, was higher than that of the whole liver. Conclusions: ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. Optimal ADC cutoff for focal liver lesions in the right hepatic lobe, but not in the left hepatic lobe, had higher diagnostic accuracy compared with that in the whole liver.