肝脏增强CT与肝脏MRI在诊断肝癌准确率方面的对比研究

选取我院肝胆外科2016年6月-2016年10月期间就诊的患者100例,经肝胆彩色B超初步筛查确定为肝脏中、小型占位病变。100例患者均分别实施肝脏增强CT和MRI影像学检查,最终经病理学诊断确诊,对比研究两种影像学检查的临床诊断准确率情况。结果 MRI检查的准确度93.0%、灵敏性92.6%、阴性预测值77.3%明显高于肝脏增强CT检查,差异具有统计学意义(P0.05);两种影像学检查共诊断阳性病例60例,肝脏增强CT诊断阳性而MRI诊断为阴性的病例2例,肝脏增强CT诊断阴性而MRI诊断为阳性的病例9例,两种影像学检查共同诊断为阴性的病例为18例,两者相比较,差异具有统计学意义(X2=41.81,P0.05)。结论肝癌采用肝脏MRI检出的准确率高于肝脏增强CT,值得临床推广应用。     

原发性肝癌螺旋CT多期扫描和MRI研究

经手术和病理证实原发性肝癌69例,术前均行螺旋CT多期扫描和MRI检查。本文研究了螺旋CT多期扫描和MRI对原发性肝癌的影像学特征。结果表明原发性肝癌行螺旋CT多期扫描的确诊率为95％,行MRI平扫加顺磁增强的确诊率为100％。结论：螺旋CT多期扫描和MRI均为原发性肝癌诊断的安全和有效的手段,后者比前者更优越。     

肝脏局灶性结节增生CT、MRI征象和病理特点的综合分析

目的探讨肝脏局灶性结节增生（FNH）的CT、MRI征象和病理特点。方法回顾性分析经手术切除病理证实为FNH病例15例,其中7例术前行多层螺旋CT平扫及多期增强扫描,另8例行MR平扫及多期增强扫描。结果15例病灶多呈类圆形、椭圆形,少数呈分叶状;病灶直径3．0～8．0cm;病灶的边界在平扫时显示模糊,增强后显示清楚;CT平扫病灶多呈稍低或等密度,中心部分瘢痕结构呈更低密度,增强后动脉期病灶实质部分多明显均匀强化,瘢痕结构未见强化,门静脉期和延迟期实质部分强化程度下降呈稍低或等密度,瘢痕结构延迟强化,其中4例瘢痕结构可见;MRI平扫病灶呈稍长或等T1WI及T2WI信号,瘢痕结构于T2WI上呈特征性高信号,增强后三期信号变化特点类似CT三期增强特点,其中5例瘢痕结构可见;9例增强后病灶内或周围可见增粗、扭曲的动脉,在T2WI上表现为血管流空。结论熟悉FNH多种影像征象,可提高FNH术前诊断率。CT和MRI能够反映FNH病理特点及血供血管情况,可为临床选择手术方案提供重要参考。     

螺旋CT三期增强扫描在肝脏肿瘤鉴别诊断中的价值

目的:评价螺旋CT三期扫描在肝脏肿瘤鉴别诊断中的价值,重点探讨动脉期、门静脉期及延迟期扫描的意义,以进一步提高CT诊断的正确性.方法:100例肝脏肿瘤[38例肝血管瘤,28例原发性肝癌,23例肝转移瘤,4例肝脏局灶性结节性增生(FNH),5例肝脓肿,2例肝母细胞瘤]行螺旋CT三期增强扫描.一次屏气完成全肝扫描,观察肿瘤三期强化的方式和特征.结果:38例肝血管瘤准确定性36例,2例诊断不典型血管瘤可能;28例肝癌误诊4例;23例肝转移瘤中多发性转移瘤无1例误诊,1例单发转移瘤误诊;4例FNH中有1例误诊为纤维板障型肝癌;肝脓肿及肝母细胞瘤均诊断明确.结论:螺旋CT三期扫描在肝脏肿瘤鉴别诊断中具有重要价值,是肝脏肿瘤鉴别诊断的最佳方法,应作为肝脏肿瘤的常规扫描方法.     

B超诊断小肝癌和CT对照分析

探讨小肝癌的超声和CT表现及其诊断。 16例住院病例均行超声和CT检查。 16例小肝癌其中转移癌2例均经手术及病理证实 ,共有 19个病灶 ,其中肝右叶 12个 ,左叶 6个 ,尾叶 1个 ,B超和CT复查均全部检出。B超多表现为低回声或略低回声可有浅淡暗环 ;常规CT平扫表现呈低密度 ,无特异性 ,动态增强表现为快速增强、快速降低。常规B超联合彩色多普勒诊断符合率 90 % ,CT诊断符合率 93%。常规B超联合彩色多普勒和CT增强扫描可提高小肝癌的诊断正确性。     

肝动脉造影对常规影象学检查难于判断肝癌的诊断价值

目的探讨肝动脉造影对CT和MRI难于诊断的疑似肝癌的临床价值。方法对26例行CT或MRI检查未能诊断的疑似病例进行肝动脉造影检查。结果26例肝硬化患者被诊断为肝癌21例,其中18例为单发病灶,3例为多发;另5例被排除肝癌。结论肝动脉造影对肝硬化并发的小肝癌的诊断价值优于CT或MRI检查。     

肝脏局灶性结节性增生和甲胎蛋白阴性肝细胞癌患者的影像学特点分析

目的：探讨肝脏局灶性结节性增生（FNH）和甲胎蛋白（AFP）阴性肝细胞癌（HCC）患者的 MRI 和 CT 平扫及动态增强表现。方法回顾性分析2012年4月－2014年4月北京市密云县医院收治的124例肝脏肿瘤患者的临床资料。结果74例 FNH患者中,54例患者接受 CT 检查,其中38例患者接受三期动态增强扫描,16例患者仅接受平扫;62例患者接受 MRI 检查,均接受平扫及增强扫描,其中应用钆贝葡胺（Gd －BOPTA）造影剂42例。50例 AFP 阴性 HCC 患者中,40例患者接受 CT 检查,其中10例患者只接受平扫;46例患者接受 MRI 平扫及增强扫描,其中采用 Gd －BOPTA 造影剂30例,30例30个病灶中延迟1～2 h 扫描均呈低信号。结论FNH 和 AFP 阴性 HCC 患者的 MRI 和 CT 平扫及动态增强表现各具特点,多种检查方法联合应用能够促进二者诊断率的显著提升。     

原发性肝癌合并胆管梗阻的影像诊断与介入治疗

目的　探讨原发性肝癌合并胆管梗阻的影像诊断与介入治疗价值。方法　对 2 6例原发性肝癌合并胆管梗阻者进行回顾性分析 ,所有患者均行超声和CT检查 ,18例行MRI检查 ,11例行PTC检查 ,10例行ERCP检查 ,12例行胆道内支架置入术 ,2 2例经肝动脉化疗栓塞 (TACE)治疗。结果　 2 6例患者经超声、CT、MRI、PTC和ERCP等影像学检查后获得正确诊断。 12例患者分别置入了 4枚塑料内支架和 8枚金属支架 ,技术成功率为 10 0 % ,均有明显的减黄效果 ,患者术后 1周的血清胆红素水平由术前的 ( 2 96± 67) μmol/L降至 ( 10 4± 5 2 ) μmol/L(P <0 .0 5 )。 2 2例患者成功地进行了TACE治疗。结论　超声、CT、MRI和胆管造影检查对原发性肝癌合并胆管梗阻有较高的诊断价值 ,其相互补充有助于本病的正确诊断。胆道内支架置入术与TACE等介入治疗是其有效的治疗方法。     

超声造影对诊断早期肝硬化合并小肝癌的价值

目的：了解超声造影对肝硬化合并小肝癌的诊断价值。方法选取2010年5月至2013年6月收治的患者96例,进行超声造影检查,从而评价小肝癌的增强变化,并与动态增强 MRI 以及动态增强CT 进行对比。结果超声造影下的小肝癌表现出动脉期增强,静脉期降低,以增强期或者低增强为标准,最终诊断的正确率为85．4％（82/96）,进一步结合延迟期肝癌的低增强的指标,诊断的正确率达到94．8％（91/96）,假阳性率为5．2％（5/96）。结论超声造影在诊断早期肝硬化合并小肝癌方面有着较为理想的价值。     

多排螺旋CT与MRI对乙型肝炎肝硬化背景小肝癌检出的比较研究

目的:比较多排螺旋计算机断层扫描(CT)与磁共振成像(MRI)对乙型肝炎肝硬化背景小肝癌的检出准确性和诊断价值。方法:将2014年1月~2016年12月我院收治的120例乙型肝炎肝硬化背景疑似小肝癌患者纳入研究,所有患者均接受多排螺旋CT和MRI检查,分析多排螺旋CT和MRI检查结果,以手术病理诊断结果为金标准,计算和比较多排螺旋CT、MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度、准确性。根据手术病理诊断结果,将确诊乙型肝炎肝硬化背景小肝癌按照病灶直径分为微小肝癌(1cm)和小肝癌(1~3cm),比较CT、MRI对不同大小病灶的检出情况。结果:120例纳入病例中,共有88例患者经手术病理诊断确诊为乙型肝炎肝硬化背景小肝癌,包括35例微小肝癌、53例小肝癌。经计算,MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度、准确性分别为96.59%、96.88%、96.67%,均高于CT诊断的86.36%、75.00%、83.33%(P0.05)。MRI对微小肝癌、小肝癌的诊断符合率分别为97.14%、96.23%,均明显高于CT诊断的80.00%、81.13%(P0.05)。结论:相比于多排螺旋CT,采用MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度和准确性均更加优越,可有效检出微小肝癌病灶。     

多层螺旋CT平扫及增强扫描在肝脏局灶性结节性增生中的诊断价值

目的探讨多层螺旋CT平扫及增强扫描在肝脏局灶性结节性增生(hepatic focal nodular hyperplasia,FNH)中的诊断价值。方法选择FNH患者及肝细胞癌患者各30例,均接受螺旋CT平扫及增强扫描。观察肝细胞癌与FNH大小及分布情况,比较肝细胞癌与FNH的螺旋CT平扫及增强扫描特征。结果 1 FNH位于肝包膜下16例(53.33%),显著高于肝细胞癌(20.00%),差异具有统计学意义(P0.05)。2肝细胞癌平扫表现为等或略低密度,内部可显示低密度囊变坏死区及高密度出血。FNH平扫表现为等或略低密度,其中心显示星芒状低密度区。肝细胞癌及FNH呈快进快出强化,FNH中心星芒状瘢痕区域于延迟期强化。与肝细胞癌比较,FNH存在中心瘢痕的比例更高,伴有门静脉癌栓及肝硬化的比例更低,其差异均具有统计学意义(P0.05)。结论螺旋CT可以清晰显示FNH的影像学特征,有助于诊断和鉴别诊断。     

Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation

The contribution of radio-guided transcutaneous biopsy in the diagnosis of focal nodular hyperplasia (FNH) of the liver was compared with the findings on surgical specimens to assess its contribution in clinical and radiologic atypical cases. This retrospective study involved 30 patients with atypical tumors on imaging who underwent liver biopsy and then surgery. All surgical specimens were diagnosed as FNH, either classical (n = 18) or nonclassical (n = 12). Imaging data were reviewed according to 4 radiologic criteria on magnetic resonance imaging (MRI) and/or computed tomography (CT) scan (hypervascularity, homogeneity, nonencapsulation, and presence of a central scar), and classified depending on the number of criteria found (group I, 4 of 4; group II, 3 of 4; group III, 2 or fewer). Histologic assessment of ultrasound (US)-guided liver biopsy recorded major diagnostic features (fibrous bands, thick-walled vessels, reactive ductules, and nodularity) and minor features (sinusoidal dilatation and perisinusoidal fibrosis). "Definite FNH" (3 or 4 major features) was diagnosed in 14 biopsies, "possible FNH" (2 major and 1 or 2 minor features) in 7 cases, and "negative for FNH" (2 or fewer major features without minor features) in 9 cases. The diagnosis of FNH on biopsy was reached in 14 cases (58.3%) in patients with 2 or fewer imaging criteria (group III; n = 24). Biopsies with a diagnosis of "possible FNH" corresponded to a large proportion of telangiectatic-type FNH on the specimen. In conclusion, liver biopsy does not appear to be necessary in cases in which imaging is typical. However, the absence of radiologic diagnostic criteria in FNH does not preclude a positive diagnosis on liver needle biopsy. Using the proposed histologic scoring system, surgical management may be avoided in these cases.     

Diagnostic sensitivity of hepatocellular carcinoma imaging and its application to non-cirrhotic patients

Background and Aims: The American Association for the Study of Liver Disease issued guidelines that proposed that hepatocellular carcinoma (HCC) can be diagnosed if a mass is larger than 2 cm in a cirrhotic liver and shows typical features of HCC at triphasic liver computed tomography (CT) or dynamic magnetic resonance imaging (MRI). In non‐cirrhotic livers, the criteria were not applicable. The aim of the present study was to retrospectively analyze the sensitivity of imaging by samples of definite HCC postoperatively and test their application to diagnose HCC in non‐cirrhotic livers. Methods: From January 2006 to November 2008, a total of 343 pathologically‐diagnosed HCC patients via surgical resection were reviewed. Among the 343 patients, 204 patients had undergone liver CT examination, and 80 patients underwent MRI examination; serum α‐fetoprotein had been checked for all 343 patients prior to operation. The diagnostic sensitivity of HCC by imaging was evaluated and compared in patients with/without cirrhosis by ultrasound and histology. Results: The diagnostic sensitivity of HCC by single imaging was approximately 65–80% (liver CT or MRI). A higher sensitivity of HCC diagnosis was found in patients with ultrasound‐diagnosed cirrhosis than non‐cirrhosis, but the difference in sensitivity disappeared after histologically‐cirrhotic validation. The results indicated that regardless of the presence or absence of cirrhosis (histology), a typical vascular pattern could diagnose HCC with equally high sensitivity. Conclusions: We provide evidence that the sensitivity of HCC diagnosis by imaging is not influenced by the cirrhotic background. Further study is needed to validate the specificity and accuracy.     

Focal nodular hyperplasia of the liver in 86 patients

Introduction Focal nodular hyperplasia (FNH) of the liver is a rare liver cell-derived benign tumor. It is well described in its classical form, characterized bya stellate central scar and hyperplastic nodules since it was first introduced by Edmondson in 1958.[1] Most FNH are asymptomatic and are discovered incidentally during physical examination, abdominal surgery, or autopsy, but some large FNH may be associated with significant symptoms.[2] To this day, the nature and pathogenesis of …     

CT灌注值分析及CT灌注成像鉴别肝细胞癌和肝局灶性结节增生的诊断价值

目的对肝细胞癌和肝局灶性结节增生的CT灌注值进行分析,以研究CT灌注成像对二者的鉴别作用,探讨其临床诊断价值。方法将张家港市第一人民医院在2015年3月至2015年11月期间收治的肝细胞癌患者24例作为实验组,肝局灶性结节增生患者17例作为对照组。应用CT扫描仪对所有研究对象进行平扫及全肝灌注扫描,对两组的实性部分的CT灌注值(肝动脉灌注量、门静脉灌注量、总肝灌注量、肝动脉灌注指数)进行分析比较;对肝细胞癌的实性成分、灶周组织及远处肝组织的CT灌注值进行分析比较;对肝局灶性结节增生的实性部分与远处肝组织的CT灌注值进行分析比较。结果与对照组相比,实验组的实性成分肝动脉灌注量为(43.32±19.56)mL/(min·100 mg)、肝动脉灌注指数为(67.86±11.62)%均较低,但门静脉灌注量较高(22.30±13.44)mL/(min·100 mg),差异均具有统计学意义。在实验组中,与灶周、远处肝组织相比,病灶的肝动脉灌注量(43.321±19.66)mL/(min·100 mg)、肝动脉灌注指数(67.86±11.62)%较高,但门静脉灌注量较低(22.30±13.44)mL/(min·100 mg),差异均具有统计学意义。在对照组中,与远处肝组织相比,病灶的肝动脉灌注量(67.69±23.54)mL/(min·100 mg)、肝动脉灌注指数(88.46±5.62)%较高,而门静脉灌注量较低(9.30±7.44)mL/(min·100 mg),差异均具有统计学意义。但上述情况的总肝灌注量的差异均无统计学意义。结论通过对肝细胞癌和肝局灶性结节增生CT灌注值的分析与比较,可知CT灌注成像对于二者的鉴别诊断具有重要的临床价值。     

Focal nodular hyperplasia or focal nodular hyperplasia-like lesions of the liver: a special emphasis on diagnosis

Background and Aim: Focal nodular hyperplasia (FNH) and FNH‐like lesions are hypervascular masses that can mimic hepatocellular carcinoma (HCC). We have investigated the clinical, radiological and pathological features of FNH and FNH‐like lesions of the liver, with particular focus on the aspect of diagnosis. Methods: A total of 84 patients, 77 with pathologically‐proven FNH and seven with FNH‐like lesions of the liver, were analyzed retrospectively. Results: Of the 84 patients, seven had underlying liver cirrhosis, including two with Budd‐Chiari syndrome and one with cardiac cirrhosis. These cases were therefore classified as having FNH‐like lesions. Two of the remaining 77 patients without underlying liver cirrhosis were positive for hepatitis B surface antigen. Seven of 50 (14.0%) patients evaluated by four‐phase computed tomography (CT) showed portal or delayed washout, and three of 28 (10.7%) patients analyzed by three‐phase CT showed washout on the portal phase. Collectively, three of nine (33.3%) patients with risk factors for HCC could have been wrongly diagnosed with HCC based on the non‐invasive diagnostic criteria for HCC. A central scar was observed in 30 patients (35.7%) radiologically. Among 62 patients who underwent percutaneous needle biopsy, four patients (6.5%) were misdiagnosed as having HCC and two patients (3.2%) had inconclusive results by a first needle biopsy. Conclusions: The presence of a hepatic lesion with arterial hypervascularity and/or portal/delayed washout is not necessarily diagnostic of HCC, particularly in patients without risk factors for HCC. These radiological findings can also occur in cirrhotic patients with FNH‐like lesions, including those with hepatic outflow obstruction.     

应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究*

目的 探讨应用肝脏影像报告与数据管理系统(LI-RADS)诊断肝细胞癌(HCC)的价值,以规范化HCC的影像学诊断。方法 对200例存在慢性乙型肝炎或/和肝硬化、酗酒、血清甲胎蛋白升高的HCC高风险人群行CT和MRI常规平扫和增强检查,依据LI-RADS v2017分级标准进行评定,由两名放射科医师进行盲法评定,1个月后,再由同一名医生进行再次评定,评估两次评定的同一性。在LI-RADS分级中,LR-1、LR-2被看作是良性病变,LR-4、LR-5和LR-5TIV为恶性病变,以组织病理学检查作为诊断的金标准,计算LI-RADS诊断的敏感性、特异性和准确性。结果 在200例肝脏病变患者,病理学检查诊断125例为HCC,27例为肝内胆管细胞癌,9例为肝转移癌,39例为良性病灶;运用LI-RADS分级,CT诊断17例为良性,151例为恶性,而MRI诊断17例为良性,169例为恶性;CT诊断两次评级的Kappa值为0.912 (P < 0.001),而MRI诊断图像的数据显示,两次评级的Kappa值为1.000 (P < 0.001),说明在MRI检查运用LI-RADS分级判断HCC的准确度比CT高;运用LI-RADS分级标准,CT诊断HCC的灵敏度、特异度和准确性分别为95.4%、81.2%和90.2%,而MRI诊断HCC的灵敏度、特异度和准确性分别为100%、85.4%和92.4%。结论 在CT和MR检查中应用LI-RADS分级评估可以提高诊断HCC的准确度,且可重复性好。在CT检查评定分为LR-3的病变,可能为HCC,建议重新检查MRI或随访,而经MRI检查仍然评定为LR-3的病变则需要密切随访。     

The Histopathological Features and CT/MRI Imaging Performances in Hepatic Angiomyolipoma Patients

AimTo evaluate the diagnostic value of dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the differential diagnosis of hepatic angiomyolipoma (HAML) and hepatocellular carcinoma (HCC) and to clarify the relationship between histopathological features and CT or MRI imaging performances in HAML.Material and methodsSix HAML and 33 non-cirrhotic HCC patients confirmed by histopathology were retrospectively analyzed. The serum biomarkers, CT and MRI examinations were conventionally performed before the confirmatory histological diagnosis. The clinical data from their medical records was also analyzed.ResultsSix HAML patients were annotated as two types according to CT and MRI imaging characteristics, including hypovascular type (n = 1) and hypervascular type (n = 5). The imaging performances of the 33 HCC patients were hypervas-cular type. Moreover, all the 5 hypervascular type HAML patients were misdiagnosed as HCC by CT or MRI. We also found that the hypervascular type of HAML patients contained more vessels and less fatty tissues in histopathology than hypovascular type of HAML patients. However, the clinical features included HCC high risk factors (hepatitis B or C), non-specific symptoms, male and increased serum alpha fetoprotein (AFP) were more common in HCC patients than HAML patients (P < 0.05, respectively).ConclusionsThe CT or MRI imaging performances of HAML patients containing more vessels and less fatty tissues in histopathology resemble the imaging performance of HCC patients. These clinical features may be of great help in the differential diagnosis in the current clinical practices.     

肝脏局灶性结节性增生与甲胎蛋白阴性肝癌的鉴别诊断

目的探讨肝脏局灶性结节性增生（focalnodularhyperplasia,FNH）与AFP阴性肝癌的鉴别诊断。方法回顾性分析本所1996年3月～1999年３月三年间经手术病理证实的18例FNH及254例AFP阴性肝癌的临床、影像学资料。结果FNH多见于青壮年（40岁以下占66.7%）、多无症状（66.7%）、肝炎背景多阴性（83.3%）、肝功能多正常（72.0%）;71.4%在彩色多普勒超声见到特征性的粗大中央血管（1～3mm）,血液流速高、阻力系数低;CT动态扫描85.7%早期显著增强,53.3%强化均匀,部分有中央星状疤痕,73.3%静脉相等密度;MRI检查中央疤痕在T2WI呈高信号,83.3%增强后早期明显强化,66.7%信号均一。而AFP阴性肝癌多见于中老年（40岁以上85.8%）,多有症状（74.0%）,多有肝炎背景（87.4%）,肝功能多异常（66.1%）;彩色多普勒超声示动脉血流高流速、高阻力,常见晕圈、门静脉栓子;CT动态扫描早期强化明显但不均匀（96.6%）,89.7%静脉相低密度;MRI早期明显强化,信号不均一（91.7%）。结论FNH在临床及影像学上有一定特征,多种检查方法联合应用并与临床相结合,部分病人可与AFP阴性肝癌鉴别。