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1.
Nodular regenerative hyperplasia of the liver in Budd–Chiari syndrome: CT and MR features 总被引:1,自引:0,他引:1
We report the imaging findings of spiral computed tomography (CT), magnetic resonance (MR) imaging, and MR angiography in
a patient with nodular regenerative hyperplasia of the liver associated with Budd–Chiari syndrome. Spiral CT showed multiple
enhancing nodules during the hepatic arterial and portal venous phases. MR images showed multiple hyperintense nodules on
T1-weighted images and hypointense or isointense nodules on T2-weighted images. MR angiography showed thrombotic occlusion
of three hepatic veins, suggesting Budd–Chiari syndrome.
Received: 25 June 1999/Revision accepted: 22 September 1999 相似文献
2.
M. Kanematsu H. Hoshi T. Yamada T. Murakami T. Kim M. Kato R. Yokoyama H. Nakamura 《Abdominal imaging》1999,24(1):47-55
Purpose: The purpose of this study was to assess the imaging findings of pathologically-proved small hepatic nodules 2 cm in size
or smaller detected with ultrasonography in cirrhotic patients with suspected hepatocellular carcinoma (HCC).
Materials and Methods: We evaluated sonographically detected 32 small hepatic nodules which were pathologically confirmed in 23 consecutive cirrhotic
patients who were suspected of having HCC. Twenty-six lesions were confirmed with ultrasonographically-guided aspiration needle-core
biopsy, and six with definitive surgery. Ultrasonographic examination records were retrospectively reviewed. CT, and MR images
obtained with various imaging techniques were retrospectively reviewed by two radiologists in a blind fashion.
Results: The 32 hepatic nodules were comprised of seven focal fatty changes, two large regenerative nodules, three low-grade dysplastic
nodules, five high-grade dysplastic nodules, and fifteen HCCs. Ultrasonography showed various echogenicity for the hepatic
nodules. The signal-intensity characteristics with T1-weighted spin-echo, in-phase gradient-recalled-echo, and dynamic MR
imagings may be useful in distinguishing HCC from nonHCC nodules.
Conclusions: Nearly half of small hepatic nodules detected with ultrasonography were nonHCC nodules. Ultrasonographic findings may not
be reliable in characterizing small hepatic nodules in cirrhosis. CT and MR imaging obtained with the various techniques are
still insensitive to these hepatic nodules.
RID="ID="<e5>Correspondence to:</e5> M. Kanematsu
Received: 25 August 1997/Revision accepted: 19 November 1997 相似文献
3.
Magnetic resonance of focal liver lesions in hepatic cirrhosis and chronic hepatitis. 总被引:2,自引:0,他引:2
Julio Martín Jordi Puig Anna Darnell Lluis Donoso 《Seminars in Ultrasound, CT and MRI》2002,23(1):62-78
Detection of focal liver nodules in patients with cirrhosis continues to be a radiologic challenge despite progressive advances in liver imaging in the past 2 decades. Patients with hepatic cirrhosis have a high predisposition to develop hepatocellular carcinoma (HCC), and the early detection and diagnosis of this tumor is very important because the most effective treatment is surgical resection, transplantation, or local ablation therapy when the tumor is small. Cirrhotic livers are mainly composed of fibrosis, together with a broad spectrum of focal nodular lesions ranging from regenerative nodules to premalignant dysplastic nodules to overt HCC. Awareness of such lesions and interpretation of imaging studies in these patients requires a critical review to detect subtle tumors, and a thorough understanding of the imaging appearance of the malignant and benign masses that can occur in the cirrhotic liver. Although the recent advances in liver imaging techniques, especially computed tomography (CT) and magnetic resonance (MR), have facilitated the detection and characterization of focal liver nodules in cirrhotic patients, discriminating between HCC and precancerous nodules remains problematic with all available imaging techniques. Nevertheless, MR imaging appears to have more potential than other imaging techniques in the study of cirrhotic patients and MR may be more appropriate than the other imaging modalities for the detection of small HCCs. In this article we review the imaging characteristics of nodular focal lesions that arise in cirrhotic livers, with special attention to MR imaging features. 相似文献
4.
Dysplastic nodules of the liver: imaging findings 总被引:2,自引:0,他引:2
Background: To verify characteristic features of hepatic dysplastic nodules at different imaging modalities.
Methods: Twenty-eight patients with 37 dysplastic nodules of the liver (0.8–3.0 cm) underwent sonography (28 patients), computed tomography
(CT; 24 patients), magnetic resonance (MR; 11 patients), and angiography (12 patients). Each nodule was analyzed for echogenicity,
attenuation, signal intensity, and vascularity.
Results: Echogenicity of nodules was high in 16 (43%), homogeneous in two (6%), and low in 19 (51%) of 37 nodules. Attenuation of
nodules was high in one (7%), homogeneous in four (26%), and low in 10 (67%) of 15 nodules on the arterial-phase CT images;
homogeneous in five (33%) and low in 10 (67%) of 15 nodules on the portal-phase CT images; and high in four (17%), homogeneous
in six (26%), and low in 13 (57%) of 23 nodules on the delayed-phase CT images. Signal intensity of nodules was high in 15
(94%) and homogeneous in one (6%) of 16 nodules on T1-weighted MR images and was homogeneous in seven (44%) and low in nine
(56%) of 16 nodules on T2-weighted MR images. Vascularity of nodules was avascular in 14 (88%) and slightly vascular in two
(12%) of 16 nodules.
Conclusions: Hepatic dysplastic nodules show diverse imaging characteristics with different imaging techniques; however, common imaging
findings of hepatic dysplastic nodules are low echo, low attenuation, and high, low, or homogeneous intensity on T1- and T2-weighted
MR, and avascularity.
Received: 13 May 1998/Accepted: 1 July 1998 相似文献
5.
6.
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. 相似文献
7.
Primary malignant fibrous histiocytoma of the liver: imaging features of five surgically confirmed cases 总被引:9,自引:0,他引:9
Background: The purpose of the present study was to describe the various imaging features of primary malignant fibrous histiocytoma (MFH)
of the liver, a rare tumor of mesenchymal origin.
Methods: Sonography (n= 5), computed tomography (CT; n= 5), magnetic resonance (MR) imaging (n= 2), and hepatic arteriography (n= 3) in five patients who underwent partial hepatectomy for tumor resection were retrospectively reviewed and correlated with
pathologic findings.
Results: All tumors were clearly demarcated from surrounding hepatic parenchyma in sectional imaging with (n= 2) or without (n= 3) a fibrous capsule, which was pathologically verified. Internal architecture of abundant fibrosis, myxoid degeneration,
and/or hemorrhagic necrosis reflected the sonographic, CT and MR imaging findings. Marginal tumor staining without definite
tumor vasculature was the main feature of hepatic arteriography. There was no intratumoral calcification. All three tumors
involving the right lobe of the liver invaded the right hemidiaphragm.
Conclusion: Although there were no unique findings of primary hepatic MFH, a combined interpretation of various imaging modalities may
elucidate the malignant nature of the tumor.
Received: 20 May 1998/Accepted after revision: 1 July 1998 相似文献
8.
J. H. Won M.-J. Kim B. M. Kim H. Ji J. J. Chung H. S. Yoo J. T. Lee Y. N. Park S. W. Hong 《Abdominal imaging》1999,24(4):369-372
We present three cases of focal eosinophilic infiltration in the liver that mimicked hepatic malignancy on computed tomography
during hepatic arteriography (CTHA) and computed tomography during arterial portography (CTAP). In all patients, focal eosinophilic
liver infiltration appeared as a solitary nodule or as two nodules without hepatosplenomegaly and showed homogeneous hyperattenuation
on CTHA and hypoattenuation on CTAP.
Received: 10 June 1998/Revision accepted: 26 August 1998 相似文献
9.
T. C. L. Soong R. C. Lee H. C. Cheng J. H. Chiang H. S. Tseng C. W. Lin M. M. H. Teng 《Abdominal imaging》1998,23(5):515-519
Background: To report the dynamic magnetic resonance (MR) imaging findings of hepatolithiasis.
Methods: Dynamic MR images (fast spoiled gradient echo sequence with intravenous injection of gadopentate dimeglumine) and computed
tomography, cholangiography, or angiography of nine patients with hepatolithiasis are analyzed.
Results: All affected hepatic segments showed atrophic changes and contained dilated intrahepatic ducts. These segments showed either
iso- or hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging. Preferential enhancement was noted
throughout all phases of the dynamic study and persisted to delayed T1-weighted imaging in seven patients. In the last two
patients, severe atrophic changes made evaluating signal intensity differences and enhancement patterns difficult.
Conclusion: In addition to intrahepatic stones and biliary dilatation, segmental atrophy, signal intensity differences, and preferential
and persistent enhancement are important MR findings of hepatolithiasis.
Received: 18 June 1997/Accepted: 23 July 1997 相似文献
10.
We describe the unusual magnetic resonance (MR) findings of a case of Wilson's disease (WD) in an asymptomatic 2-year-old
girl. Preenhanced computed tomography revealed multiple hyperdense areas in the liver. These lesions were hyperintense on
T1-weighted and hypointense on T2-weighted MR images, results that might be ascribed to the paramagnetism of copper deposited
in liver at a relatively early stage of the disease before severe liver cirrhosis had evolved.
Received: 9/10/96/Accepted: 10/16/96 相似文献
11.
We present two rare cases of multifocal hepatic steatosis as a variant of fatty liver. Multifocal hepatic steatosis can cause
misleading findings in the differential diagnosis when using ultrasound and computed tomography. This case report describes
the atypical findings of focal fatty liver infiltrations, which were misdiagnosed as diffuse metastatic disease. The correct
diagnosis was established with magnetic resonance imaging using T1-weighted gradient-echo and T2-weighted Turbo spin-echo
sequences with spectral fat suppression. Multifocal hepatic steatosis was proven by biopsy.
Received: 28 December 2001/Accepted: 30 January 2002 相似文献
12.
Gabata T Matsui O Kadoya M Yoshikawa J Mitchell DG Ueda K Kawamori Y Takashima T 《Abdominal imaging》1999,24(2):153-156
Different imaging appearances of giant hyperplastic change of the caudate lobe of the liver are presented in a patient with liver cirrhosis. The mass like caudate lobe was isoechoic on ultrasound, hypodense on postcontrast computed tomography (CT), hyperintense on T1-weighted magnetic resonance, images and isointense on T2-weighted images. These imaging findings are similar to those of dysplastic nodule in cirrhotic liver. The caudate lobe received normal portal flow on CT during arterial portography, but superior mesenteric arteriography showed precocious or early division of the caudate portal branch. We suspect that caudate hyperplastic change may be correlated to anomalous caudate portal vein branch. 相似文献
13.
We report two cases of hepatic giant hemangiomas with capsular retraction of the liver adjacent to the tumor on computed tomography
and magnetic resonance images. Our cases show that the retraction of the liver capsule adjacent to the tumor is not a finding
specific to malignant hepatic tumors but can also be observed in benign hepatic tumors.
Received: 16 May 2000/Accepted: 14 June 2000 相似文献
14.
Liver cirrhosis is a major public health problem worldwide. Common causes of cirrhosis include hepatitis C virus, hepatitis
B virus, alcohol consumption, and nonalcoholic steatohepatitis. Cirrhotic livers are characterized by advanced hepatic fibrosis
and the development of hepatocellular nodules such as regenerative nodules, dysplastic or neoplastic nodules. Cirrhosis is
the strongest predisposing factor for hepatocellular carcinoma (HCC). For example, viral hepatitis is the main risk factor
for cirrhosis and is associated with the increased incidence (1%–4% per year) of HCC after development of cirrhosis. Currently,
a variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and
positron-emission tomography (PET) are used in noninvasive evaluation of patients with chronic liver disease and suspected
HCC. With technological development of MR scanners, MR imaging has emerged as an important imaging modality for assessing
cirrhosis and its complications such as HCC. The recent advance in MR is the introduction of faster sequences which have allowed
high-quality imaging of the entire liver with high intrinsic soft-tissue contrast, and also multiphasic dynamic MRI that is
essential for the detection and characterization of HCC. In addition, functional MRI including diffusion-weighted MRI, MR
elastography, and new MR contrast agent with dual function have been investigated for the clinical utility of detection and
characterization of HCCs. In this article, we provide an overview of the state-of-the-art MR imaging techniques being used
for noninvasive assessment of hepatocellular nodules including conventional dynamic imaging, liver-specific contrast-enhanced
MR imaging, diffusion-weighted imaging, MR spectroscopy, and MR elastography. 相似文献
15.
Sclerosed hemangioma of the liver 总被引:3,自引:0,他引:3
Aibe H Hondo H Kuroiwa T Yoshimitsu K Irie H Tajima T Shinozaki K Asayama Y Taguchi K Masuda K 《Abdominal imaging》2001,26(5):496-499
We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced
computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging
showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although
SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the
differential diagnoses of hepatic lesion with delayed enhancement.
Received: 22 May 2000/Revision accepted: 15 November 2000 相似文献
16.
Background: To evaluate the relationship between magnetic resonance (MR) imaging grading of iron deposition and serial serum ferritin
concentration in patients with chronic viral liver diseases.
Methods: In 80 patients with viral hepatitis and cirrhosis, MR images including T2*-weighted gradient echo images (echo time ≥ 6.5
ms) were reviewed. The grades of parenchymal iron deposition and iron-containing nodules in the liver and spleen and the liver-to-muscle
and spleen-to-muscle signal intensity ratios were compared with the most recent, the mean, the lowest, and the highest values
from all available serum ferritin levels.
Results: The serum ferritin concentration was significantly correlated with the grades of iron deposition in liver and spleen and
with the grades of iron-containing nodules seen on MR images (p < 0.05). Liver-to-muscle signal intensity ratio was weakly correlated with the ferritin concentrations. Among categories of ferritin
concentration, correlation with MR grades was highest for mean ferritin concentration (r = 0.487, p < 0.001).
Conclusion: MR imaging grades of hepatic iron and siderotic nodules correlate with serum ferritin, especially with the mean levels.
Received: 9 May 2000/Accepted: 28 June 2000 相似文献
17.
Clouet M Boulay I Boudiaf M Soyer P Nemeth J Kiselman R Rymer R 《Abdominal imaging》1999,24(3):258-261
We described the sonographic, computed tomographic (CT), and magnetic resonance (MR) imaging features of one atypical case of nodular regenerative hyperplasia of the liver. The presence of multiple hepatic nodules suggested the diagnosis of metastatic disease to the liver because of a peripheral rim of enhancement on CT obtained after intravenous administration of contrast material and a halo sign on T2-weighted spin-echo MR imaging. Examination of the pathologic specimen obtained after surgical biopsy showed that the nodules were made of hepatocytes, with a nodular arrangement surrounded by peliosis, without fibrosis or cirrhosis. These findings suggested that peliosis may cause peripheral rim of enhancement on CT and halo sign on MR imaging. In light of this case, nodular regenerative hyperplasia of the liver should be considered in the differential diagnosis of hepatic metastases. 相似文献
18.
Hepatic parenchymal enhancement in the cirrhotic liver: evaluation by triple-phase dynamic MRI 总被引:7,自引:0,他引:7
Background: To evaluate the changes of liver parenchymal enhancement in the cirrhotic liver by means of triple-phase dynamic magnetic
resonance (MR) imaging.
Methods: Triple-phase multisection dynamic MR imaging was performed in 32 patients with liver cirrhosis. The control group consisted
of 19 patients without liver cirrhosis. After precontrast images were obtained, arterial phase images were acquired 20 s after
the start of intravenous bolus administration of 0.10 mmol/kg of gadopentetate dimeglumine. Portal and delayed phase images
were then acquired 1 and 3 min, respectively, after the injection of contrast material. On each phase image, the signal-to-noise
ratio (S/N) from the liver parenchyma was measured by operator-defined regions of interest (ROIs). The contrast-enhanced ratio
(CER) on each phase was then obtained according to the following formula: [S/N(arterial or portal or delayed phase image)
− S/N(precontrast image)]÷ S/N(precontrast image). The portal perfusion index (PPI) also was obtained according to the following
formula: [S/N(portal phase image − S/N(arterial phase image)]÷ S/N(arterial phase image). The results were expressed as mean
± SD.
Results: The CERs of arterial, portal, and delayed phase images in patients with and without liver cirrhosis were 0.256 ± 0.211, 0.640
± 0.384, and 0.554 ± 0.318 and 0.132 ± 0.094, 0.404 ± 0.204, and 0.324 ± 0.144, respectively. The CERs were highest in the
portal phase and lowest in the arterial phase in patients with and without liver cirrhosis. The CER of the cirrhotic liver
was significantly higher than that of the normal liver in every phase (p < 0.05). PPIs with and without liver cirrhosis were 2.90 ± 4.03 and 3.86 ± 3.89, respectively. The PPI with liver cirrhosis was
significantly lower than that without liver cirrhosis (p < 0.05).
Conclusion: The enhancement of cirrhotic liver parenchyma is greater than that of the normal liver parenchyma at every phase of triple-phase
dynamic MR imaging.
Received: 17 August 2000/Revision accepted: 7 March 2001 相似文献
19.
CT and MR findings of torsion of greater omentum: a case report 总被引:1,自引:0,他引:1
We report a case of torsion of the greater omentum, which occurred in a 39-year-old man with an adhesive inguinal hernia.
Preoperative computed tomography and magnetic resonance (MR) imaging showed a characteristic whirling fatty mass occupying
the middle and lower abdomen anteriorly. MR imaging also showed difference of intensities in the twisted omentum, suggesting
the presence of the pathological conditions of edema or congestion.
Received: 25 May 1995/Accepted: 12 July 1995 相似文献
20.
Small hepatocellular carcinoma: differentiation from adenomatous hyperplasia with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging 总被引:4,自引:0,他引:4
Background: To investigate the usefulness of color Doppler ultrasound (US) and dynamic Gd-DTPA-enhanced magnetic resonance (MR) imaging
in the differentiation of small hepatocellular carcinoma (HCC) and adenomatous hyperplasia (AH).
Methods: Thirty-eight small (3 cm or less) nodular lesions (in 38 cirrhotic patients) with US features consistent with HCC underwent
evaluation with color Doppler US and MR imaging. Breath-hold T1-weighted rapid acquisition spin echo MR sequence after bolus
injection of 0.1 mmol/kg gadopentetate dimeglumine was used to evaluate dynamic enhancement. US-guided tissue-core percutaneous
biopsy established the diagnosis: HCC in 28 cases and AH in 10.
Results: Color signals with pulsatile or continuous Doppler spectrum were demonstrated in 19 of 28 HCCs (68%) but in none of the AHs.
Although there was considerable overlap in signal intensity between HCC and AH on both unenhanced T1- and T2-weighted images,
early enhancement on breath-hold T1-weighted images obtained 40 s after starting contrast administration was observed in 22
of 28 HCCs (79%) but in none of the AHs. In 26 of 28 HCCs (93%), pulsatile or continuous flow at color Doppler US, early enhancement
at dynamic MR imaging, or both were observed.
Conclusion: Findings with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging enable a reliable distinction between small HCC and
AH.
Received: 8 August 1994/Accepted after revision: 27 January 1995 相似文献