超声造影鉴别诊断肝硬化背景下的小肝癌与不典型增生结节

目的观察肝硬化背景下小肝细胞癌(SHCC)与不典型增生结节(DN)的CEUS灌注增强特点,探讨CEUS的鉴别诊断价值。方法对肝硬化背景下42个SHCC病灶和21个DN病灶进行术前CEUS检查,观察病灶CEUS各时相的增强水平,比较其增强模式。结果 SHCC与DN各时相的增强水平及整体增强模式差异均有统计学意义(P均<0.05)。动脉相SHCC以高增强为主,DN以低增强为主;SHCC的增强模式主要为动脉相高增强、门脉相及延迟相呈低增强,DN的增强模式复杂多样。结论肝硬化背景下SHCC与DN有不同的CEUS灌注增强特点,CEUS有助于鉴别诊断。     

Detection of hepatocellular carcinoma in cirrhotic patients: sensitivity of CT and ultrasonography.

Patients with cirrhosis are at increased risk for the development of hepatocellular carcinoma. The heterogeneous hepatic parenchyma produced by cirrhosis makes detection of hepatomas more difficult. The purpose of this study was to determine the sensitivities of CT and ultrasonography for detecting hepatomas in cirrhotic patients. A retrospective analysis was performed of 733 patients who underwent liver transplantation at our institution. A study population of 21 patients was selected who met our inclusion criteria. The inclusion criteria required a pathologic diagnosis of hepatocellular carcinoma, pathologic evidence of cirrhosis, and contrast-enhanced CT and sonographic examinations performed within 1 week of each other. The sensitivities of CT and ultrasonography were determined by comparing the imaging findings with pathology findings from serially sectioned total hepatectomy specimens. A total of 40 hepatomas were detected pathologically in the 21 patients in our study population. CT identified 12 of 21 patients with hepatomas and detected 18 of 40 individual lesions (patient detection sensitivity = 57%, lesion detection sensitivity = 45%). Ultrasonography identified 14 of 21 patients with hepatomas and detected 21 of 40 individual lesions (patient detection sensitivity = 67%, lesion detection sensitivity = 51%). Combining the findings of CT and ultrasonography allowed identification of 17 of 21 patients with hepatomas and detection of 24 of 40 individual lesions (patient detection sensitivity = 80%, lesion detection sensitivity = 60%). We conclude that CT and ultrasonography have a low sensitivity for the detection of hepatocellular carcinoma in patients with cirrhosis.     

Imaging of dysplastic nodules and small hepatocellular carcinomas: experience with explanted livers

Differentiation of benign from malignant nodules in the end-stage cirrhotic liver can be challenging, due to the presence of fibrosis, necrosis and altered blood supply. Whole liver explant pathologic correlation provides a unique opportunity to evaluate the sensitivity and specificity of current imaging modalities for the diagnosis of HCC and dysplastic nodules in the cirrhotic liver. This chapter will explore and critique the imaging literature with an emphasis on studies performed with timely explanted liver correlation.     

肝硬化基础上低度和高度不典型增生结节的超声造影表现

目的 探讨肝硬化背景下低度与高度不典型增生结节的超声表现.方法 经病理确诊的17个低度和16个高度不典型增生结节接受了二维超声和超声造影检查.采用实时超声造影技术,造影剂为声诺维.结果 低度和高度不典型增生结节的二维超声和超声造影表现差异均无统计学意义(均P>0.05).造影后10个(30.3%)不典型增生结节表现为动脉期高增强,延迟期高或等增强;10个(30.3%)表现为动脉期开始为低增强,动脉晚期为等增强,并持续至延迟期;8个(24.3%)表现为动脉期高增强,延迟期低增强;4个(12.1%)表现为三期等增强;1个(3.0%)表现为动脉期等增强,延迟期低增强.结论 低度和高度不典型增生结节的超声表现相似;不典型增生结节的超声造影表现复杂,其主要超声造影表现与肝硬化结节及肝细胞肝癌不同,超声造影有助于诊断肝硬化背景下的不典型增生结节.     

Pitfalls in the imaging diagnosis of hepatocellular nodules in the cirrhotic and noncirrhotic liver

Contrast-enhanced CT and MR are the most commonly used modalities for objective evaluation of hepatocellular nodules. Various types of pseudolesions as seen on CT or MR have been reported, which are attributable to either focal alteration in hemodynamics or parenchymal metabolism, or to both. Pseudolesions specifically seen in cirrhotic liver include arterio-portal shunt, regenerating or hyperplastic nodules, and confluent fibrosis. In noncirrhotic liver, transient focal compression to the liver, third inflow other than normal hepatic arterial and portal venous flow, and vessel compromise are the causes of pseudolesions. To understand the characteristic features of these pseudolesions, and their underlying mechanism as well, is important for proper diagnosis of true hepatocellular lesions.     

MRI纹理分析鉴别诊断肝硬化背景下小肝癌与增生结节

目的 探讨常规MRI纹理分析鉴别诊断肝硬化背景下小肝癌与增生结节的价值。方法 回顾分析经病理证实的33例小肝癌和19例肝增生结节患者的MRI资料。采用MaZda软件手工勾画ROI,提取T1WI、T2WI、频率选择性预脉冲脂肪抑制T2WI及T1WI增强扫描图像中病变的纹理特征。通过Fisher系数、分类错误概率联合平均相关系数（POE+ACC）、交互信息（MI）及三者联合（FPM）的方法选择最佳纹理参数集合。使用原始数据分析（RDA）、主要成分分析（PCA）、线性判别分析（LDA）和非线性判别分析（NDA）进行纹理分类。同时由2名MRI诊断医师共同评估所有影像学资料。比较纹理分析与医师鉴别诊断两种病变结果的差异。结果 52例中,共60个病灶。鉴别小肝癌与增生结节的纹理特征主要来自T2WI,误判率最小为8.33%（5/60）。纹理特征选择方法中,FPM的误判率（8.33%~26.67%）均低于MI （20.00%~38.33%）、Fisher （18.33%~41.67%）和POE+ACC （8.33%~40.00%）。纹理特征分类方法中,NDA判别两种病变的误判率（8.33%~20.00%）均低于RDA （26.67%~41.67%）、PCA （28.33%~43.33%）和LDA （21.67%~45.00%）。影像医师的误判率为23.33%（14/60）,高于采用纹理分析鉴别两种病变的误判率（5/60,8.33%;χ²=58.73,P=0.002）。结论 常规MRI纹理分析可用于鉴别肝硬化背景下小肝癌与增生结节。     

glypican-3表达可鉴别小肝癌与肝良性结节性病变（英）

随着影像学检查技术的进步，肝结节性病变越来越常见。然而，仅凭影像学特征常难以确定病灶性质。小肝癌与癌前病变（低级别异型增生和高级别异型增生结节）及肝良性局灶性病变难以鉴别的情况为数不少。为此，欧洲肝脏研究学会推荐对肝脏结节性病变进行穿刺活检和诊断病理学检查。但是，仅根据组织形态学特征常难做出明确诊断，迄今亦无理想的免疫组化标记物可用来鉴别分化好的肝细胞癌与癌前病变及非癌病变。该作者对磷酸酰肌醇蛋白聚糖-3基因（glypiean-3，GPC3）在肝结节性病变中的表达进行研究，探讨其对肝结节性病变的定性诊断价值。[第一段]     

Small hepatocellular carcinomas: ultrasonography guided percutaneous radiofrequency ablation

Current guidelines advocate percutaneous radiofrequency (RF) ablation as a standard treatment of early stage hepatocellular carcinoma (HCC) for up to three tumors ≤3 cm in diameter. The local efficacy evaluated with short-term radiological examination may be overrated, whereas that assessed by histopathological measure might be underestimated. Long-term clinical follow-up studies guarantee the effectiveness of RF ablation for small HCC, which is now almost comparable in benefits to surgical resection. US is the most common guiding modality for percutaneous RF ablation for small HCC. However, the technical feasibility is often limited due to poor conspicuity of the index tumor on US. Implementation of artificial ascites, contrast-enhanced harmonic US, and fusion imaging of US with CT/MR can be helpful to enhance the technical feasibility of US-guided RF ablation of small HCC.     

肝硬化患者检测腹水电解质和肾功能的临床意义

目的:探讨钾、钠、氯、钙、尿素氮和肌酐(K+、Na+、Cl-、Ca2+、Urea、Cr)等生化指标在肝硬化患者腹水和血液中的相关性.方法:采集40例肝硬化患者腹水和血液标本,检测两者中K+、Na+、Cl-、Ca2+、Urea和Cr的水平.结果:K+、Ca2+和Cr在腹水中的浓度分别低于其在血液中的浓度[分别为(3.80±0.51)mmol/L和(3.93±0.54)mmol/L,(1.78±0.34)mmol/L和(2.06±0.31)mmol/L,(102.88±36.31)mmol/L和(110.05±40.06)mmol/L],两者间比较均有统计学差异(JP<0.05);而Na+、Cl-和Urea在腹水中的浓度分别高于其在血液中的浓度[分别为(141.45±5.87)mmol/L和(140.35±5.88)mmol/L,(113.59±7.29)mmol/L和(103.61±5.32)mmol/L,(8.24±6.19)mmol/L和(7.33±5.01)mmol/L],两者间比较均有统计学差异(P<0.05).K+、Na+、Cl-、Ca2+、Urea和Cr在腹水中的浓度与其在血液中的浓度的相关系数分别为0.96、0.92、0.89、0.81、0.91和0.97,所有检测指标均有统计学意义(P<0.05).结论:K+、Na+、Cl-、Ca2+、Urea和Cr在腹水中的浓度与其在血液中的浓度呈显著正相关.如果血液标本无法获得而肝硬化诊断明确.可通过腹水检查监测患者治疗中的电解质和肾功能水平.     

MRI鉴别诊断肝硬化退变结节与小肝癌

目的探讨高场强MRI对肝硬化退变结节和小肝癌诊断与鉴别诊断价值.方法对经临床和病理证实18例24个肝硬化退变结节(DN)和15例26个小肝细胞癌(sHCC)的磁共振影像资料作回顾性对比分析.结果18例24个DN中,同、反相位T1WI上呈等信号者4个,呈稍高信号者20个,占DN的83%(20/24);26个HCC结节中,同相位T1WI上呈稍高信号者6个,其中3个在反相位T1WI上呈低信号;同、反相位T1WI上均呈等-低信号者19个结节,占76%(19/25).抑脂T2WI上DN组24个结节均为低信号;而小HCC组26个结节中,呈稍高或不均匀等-高信号者24个,占92%(24/26),2个在T2WI上为低信号.Gd-DTPA动态增强扫描,14例中15个DN呈缓升速降型14个,占93%;14例中24个HCC呈速升速降型19个,占79%(19/24);HCC包膜强化率占增强病灶中的70%(17/24),而13个DN见不规则纤细网状纤维隔强化,占86%(13/15),仅1个DN呈假包膜样强化.结论综合分析高场强MR不同序列及动态增强像特点,能够区别绝大多数大DN和HCC.     

Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre-liver transplant patients: radiologic-histopathologic correlation of explanted livers

BACKGROUND: Hyperattenuating nodules detected by arterial phase helical computed tomography (HCT) in patients with cirrhosis usually are believed to represent hepatocellular carcinomas (HCCs). We correlated HCT morphology of hyperattenuating hepatic nodules detected during arterial phase scans with the histopathology of explanted livers of patients with hepatic cirrhosis undergoing liver transplantation. METHODS: Three hundred fifty-four patients had arterial and portal phase HCT performed before subsequent hepatic transplantation. Each patient received 180 mL of contrast by power injection at 5 mL/s. All hyperattenuating nodules detected on arterial phase HCT were assessed for morphology and evidence for contrast enhancement. Explanted livers in all patients were then sectioned at 10-mm intervals, and the histology of the nodules was correlated with the HCT findings. RESULTS: Sixty-one hyperattenuating nodules were detected on the arterial phase HCT in 43 patients: 41 nodules were benign regenerating nodules (RN), three were dysplastic nodules (DP), and 17 were HCCs. Most RN/DP nodules were 5-20 mm in diameter, had distinct margins, were homogeneous, and were isoattenuating on precontrast, portal, and delayed scans. Thirty-six showed positive contrast enhancement and displayed a wide range of attenuation profiles. HCC nodules were 6-50 mm. All showed positive contrast enhancement and displayed a wide range of attenuation profiles. CONCLUSION: Hyperattenuating nodules seen on arterial phase HCT are likely to be RN/DP nodules. In many cases, it is not possible to distinguish between RN/DP and HCC. Thus, clinical decisions regarding inclusion criteria for transplantation based on CT morphology of liver lesions may be tenuous.     

Noninvasive imaging of unusual regenerating nodules in the cirrhotic liver

Despite the common occurrence of regenerating liver nodules, little has been written regarding their ultrasound or computed tomographic appearance. In the great majority of cases, they have an echo texture and CT number identical to surrounding hepatic parenchyma. Exceptionally, as in the 2 cases described, they can mimic a malignant neoplasm. Because radionuclide imaging almost always demonstrates uptake over a regenerating nodule, this modality should be used in suspicious cases in conjunction with either ultrasound or computed tomography in order to exclude a malignancy.     

Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre–liver transplant patients: radiologic–histopathologic correlation of explanted livers

Background: Hyperattenuating nodules detected by arterial phase helical computed tomography (HCT) in patients with cirrhosis usually are believed to represent hepatocellular carcinomas (HCCs). We correlated HCT morphology of hyperattenuating hepatic nodules detected during arterial phase scans with the histopathology of explanted livers of patients with hepatic cirrhosis undergoing liver transplantation. Methods: Three hundred fifty-four patients had arterial and portal phase HCT performed before subsequent hepatic transplantation. Each patient received 180 mL of contrast by power injection at 5 mL/s. All hyperattenuating nodules detected on arterial phase HCT were assessed for morphology and evidence for contrast enhancement. Explanted livers in all patients were then sectioned at 10-mm intervals, and the histology of the nodules was correlated with the HCT findings. Results: Sixty-one hyperattenuating nodules were detected on the arterial phase HCT in 43 patients: 41 nodules were benign regenerating nodules (RN), three were dysplastic nodules (DP), and 17 were HCCs. Most RN/DP nodules were 5–20 mm in diameter, had distinct margins, were homogeneous, and were isoattenuating on precontrast, portal, and delayed scans. Thirty-six showed positive contrast enhancement and displayed a wide range of attenuation profiles. HCC nodules were 6–50 mm. All showed positive contrast enhancement and displayed a wide range of attenuation profiles. Conclusion: Hyperattenuating nodules seen on arterial phase HCT are likely to be RN/DP nodules. In many cases, it is not possible to distinguish between RN/DP and HCC. Thus, clinical decisions regarding inclusion criteria for transplantation based on CT morphology of liver lesions may be tenuous.     

Metabolic effects of liver transplantation in cirrhotic patients.

To assess whether liver transplantation (LTx) can correct the metabolic alterations of chronic liver disease, 14 patients (LTx-5) were studied 5+/-1 mo after LTx, 9 patients (LTx-13) 13+/-1 mo after LTx, and 10 patients (LTx-26) 26+/-2 months after LTx. Subjects with chronic uveitis (CU) and healthy volunteers (CON) were also studied. Basal plasma leucine and branched-chain amino acids were reduced in LTx-5, LTx-13, and LTx-26 when compared with CU and CON (P < 0.01). The basal free fatty acids (FFA) were reduced in LTx-26 with respect to CON (P < 0.01). To assess protein metabolism, LTx-5, LTx-13, and LTx-26 were studied with the [1-14C]leucine turnover combined with a 40-mU/m2 per min insulin clamp. To relate changes in FFA metabolism to glucose metabolism, eight LTx-26 were studied with the [1-14C]palmitate and [3-3H]glucose turnovers combined with a two-step (8 and 40 mU/m2 per min) euglycemic insulin clamp. In the postabsorptive state, LTx-5 had lower endogenous leucine flux (ELF) (P < 0.005), lower leucine oxidation (LO) (P < 0.004), and lower non-oxidative leucine disposal (NOLD) (P < 0.03) with respect to CON (primary pool model). At 2 yr (LTx-26) both ELF (P < 0.001 vs. LTx-5) and NOLD (P < 0.01 vs. LTx-5) were normalized, but not LO (P < 0.001 vs. CON) (primary and reciprocal pool models). Suppression of ELF by insulin (delta-reduction) was impaired in LTx-5 and LTx-13 when compared with CU and CON (P < 0.01), but normalized in LTx-26 (P < 0.004 vs. LTx-5 and P = 0.3 vs. CON). The basal FFA turnover rate was decreased in LTx-26 (P < 0.01) and CU (P < 0.02) vs. CON. LTx-26 showed a lower FFA oxidation rate than CON (P < 0.02). Tissue glucose disposal was impaired in LTx-5 (P < 0.005) and LTx-13 (P < 0.03), but not in LTx-26 when compared to CON. LTx-26 had normal basal and insulin-modulated endogenous glucose production. In conclusion, LTx have impaired insulin-stimulated glucose, FFA, and protein metabolism 5 mo after surgery. Follow-up at 26 mo results in (a) normalization of insulin-dependent glucose metabolism, most likely related to the reduction of prednisone dose, and, (b) maintenance of some alterations in leucine and FFA metabolism, probably related to the functional denervation of the graft and to the immunosuppressive treatment.     

Magnetic resonance imaging and expression of vascular endothelial growth factor in hepatocellular nodules in cirrhosis and hepatocellular carcinomas

We summarized and discussed our previous research results on correlation between magnetic resonance (MR) imaging findings and vascular endothelial growth factor (VEGF) expression in benign or borderline hepatocellular nodules in cirrhosis, hepatocellular carcinomas (HCCs), and in the surrounding liver. Magnetic resonance images were retrospectively correlated quantitatively and qualitatively with VEGF expression in hepatic nodules and in the surrounding liver. By immunohistochemistry, hepatic nodules with moderate to strong immunoreactivity for VEGF showed higher T1 signal intensity, and those with intense immunoreactivity for VEGF showed higher T2 signal intensity. By Western blotting, HCC-to-liver contrast-to-noise ratio correlated with VEGF indices (VEGFs) of hepatocellular carcinomas inversely on opposed-phase T1-weighted, directly on T2-weighted, and marginally and inversely on gadolinium-enhanced hepatic arterial-phase images. On T2-weighted images, standard-deviation ratio of hepatocellular carcinomas correlated directly with VEGFs of hepatocellular carcinomas. Heterogeneities of hepatocellular carcinomas on MR images correlated directly with VEGFs of HCCs on opposed-phase T1-weighted, T2-weighted, hepatic arterial-phase, and equilibrium-phase images. Our results may reflect that MR signal intensity, hepatic arterial vascularity, and heterogeneity of hepatocellular nodules on MR images are closely related to the intensity of VEGF expression as up-regulated by hyper- or hypoxia in the nodules. Gadolinium-enhanced MR imaging may be useful to monitor ischemic state of hepatocelluar nodules. Although real impacts of our results on radiologic practice have been still debatable, we believe that our results may help future radiologic practice in conjunction with biomolecular or genetic treatments for hepatocellular carcinomas.     

ESWAN在检测肝硬化铁沉积结节中的价值

目的：探讨ESWAN技术在检测肝硬化铁沉积结节（SN）中的价值。方法：使用GE Signa HD 1.5T双梯度超导MR仪对30例肝硬化患者进行T1WI、T2WI、T2^＊WI和ESWAN检查,比较各序列对SN的检出率以及SN与肝实质对比度。结果：30例肝硬化患者ESWAN序列显示SN总数最多,与其它几个序列相比均具有统计学意义（P〈0.05）,ESWAN图像上SN信号更低,与肝实质背景信号强度对比更加明显。结论：1.5T磁共振中ESWAN序列较常规序列能更敏感地检出肝硬化SN,有望能成为肝硬化磁共振检查的常规序列。     

超声造影定量分析技术评价肝癌肿瘤血管生成的临床研究

目的 探讨实时超声造影定量分析技术评估肝癌肿瘤血管生成的可行性.方法 对33例经手术病理证实的原发性肝癌于术前1周进行超声造影,造影时仪器预设置和造影剂用量保持一致,动态影像经专用软件脱机分析和数学模型拟合,获得基础强度、强度增量(ASI)、峰值减半斜率(a2),上升斜率(a3)、显影时间(AT)、达峰时间(TTP)、上升时间(ACT)、峰值强度(PI)和曲线下面积(AREA)等参数.肝癌手术标本进行CD34抗体染色,由计算机读片记录肿瘤微血管密度(MVD),统计其与各超声造影参数的相关性.结果 肝癌病灶区的ASI、a2、a3、AT、TTP、PI和ACT与肝实质相应参数比较,差异均有统计学意义(P＜0.01);肿瘤区参数a2与MVD均值有相关性,肿瘤区标化的ASI和AREA参数与MVD均值有相关性,均为P＜0.05.结论 超声造影定量分析能客观地显示肝癌微循环的血流灌注情况,从而无创评估肝癌的肿瘤血管生成情况.     

彩色多普勒超声检查诊断甲状腺结节的效果观察及准确率分析

目的:分析彩色多普勒超声检查诊断甲状腺结节的效果及准确率.方法:选取2019年4月—2020年3月在本院接受治疗的甲状腺结节患者当中抽选158例作为本研究中的观察对象.所有患者均经过临床病理诊断确诊,依据病理诊断结果,良性患者占108例(良性组),恶性患者占50例(恶性组),采用彩色多普勒超声检查为患者实施诊断,统计诊...