Atypical large well-differentiated hepatocellular carcinoma with benign nature: a new clinical entity

Based on intranodular hemodynamic studies of nodular lesions associated with liver cirrhosis using computed tomography (CT) during arteriography, CT during arterial portography (CTAP) and angiography under ultrasonography, relatively large hepatocellular nodules with portal perfusion have been depicted. We report 17 such nodules in a total of 663 patients who underwent CTAP. Large well-differentiated hepatocellular carcinomas (HCCs) are characterized by the presence of intranodular portal perfusion even if they measure more than 2.5 cm in diameter. Such nodules display a benign nature clinically as well as pathologically. These nodules, called 'atypical large well-differentiated HCC or dysplastic nodules', show extremely slow growth. Pathological study showed extremely peculiar findings; the nodules consisted of homogeneously hyperplastic or well-differentiated HCC without the component of moderately or poorly differentiated HCC, and without fibrous capsules, vessel invasion or intrahepatic metastasis, all of which are commonly found in typical overt HCC. The incidence of such nodules is not rare; it was 2.6% (17/663) in our HCC patients who underwent CTAP over a period of 7 years. During the 7-year observation period, none of 10 such nodules developed into arterial supply-dominant overt HCC. The recognition of these benign-nature nodules (or large low-grade malignant nodules) is extremely important for the following three reasons. First, the knowledge that such large atypical nodular lesions exist is important for clinicians. Second, regarding the treatment strategy for such nodular lesions, it should be kept in mind that these nodules show a benign nature, and rarely cause death. Finally, considering the etiology and clinical significance of such atypical large benign-nature nodules, the recognition of these nodules provides an important suggestion regarding the pathogenesis of progression from dysplastic nodule to early HCC and finally to overt HCC during multistep human hepatocarcinogenesis. These atypical large benign-nature nodules do not seem to be the nodules in a sequence of multistep progression. The early step of hepatocarcinogenesis includes mainly hyperplastic change, whereas the late step includes mainly an angiogenic process. Although the detailed molecular pathogenesis of both the early and late steps of hepatocarcinogenesis is not clear, it is speculated that these atypical benign-nature nodules do not undergo the phenotypic change of late-step hepatocarcinogenesis. In that sense, these atypical benign-nature nodules are suggestive for the clarification of the mechanism of multistep human hepatocarcinogenesis based on the intranodular vascular supply or hemodynamics. From the viewpoint of clinical practice as well as pathogenesis of human hepatocarcinogenesis, these nodular lesions should be managed as a different disease from overt HCCs; atypical large HCCs or dysplastic nodules with benign nature should be regarded as a new clinical entity.     

Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis

To understand the hemodynamics of hepatocellular carcinoma (HCC) is important for the precise imaging diagnosis and treatment, because there is an intense correlation between their hemodynamics and pathophysiology. Angiogenesis such as sinusoidal capillarization and unpaired arteries shows gradual increase during multi-step hepatocarcinogenesis from high-grade dysplastic nodule to classic hypervascular HCC. In accordance with this angiogenesis, the intranodular portal supply is decreased, whereas the intranodular arterial supply is first decreased during the early stage of hepatocarcinogenesis and then increased in parallel with increasing grade of malignancy of the nodules. On the other hand, the main drainage vessels of hepatocellular nodules change from hepatic veins to hepatic sinusoids and then to portal veins during multi-step hepatocarcinogenesis, mainly due to disappearance of the hepatic veins from the nodules. Therefore, in early HCC, no perinodular corona enhancement is seen on portal to equilibrium phase CT, but it is definite in hypervascular classical HCC. Corona enhancement is thicker in encapsulated HCC and thin in HCC without pseudocapsule. To understand these hemodynamic changes during multi-step hepatocarcinogenesis is important, especially for early diagnosis and treatment of HCCs.     

Magnetic resonance of focal liver lesions in hepatic cirrhosis and chronic hepatitis.

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.     

Imaging of early hepatocellular carcinoma and adenomatous hyperplasia (dysplastic nodules) with dynamic ct and a combination of CT and angiography: experience with resected liver specimens

Early hepatocellular carcinoma (HCC) as defined by the Liver Cancer Study Group of Japan would correspond to high-grade dysplastic nodules with small foci of HCC in the majority of cases, using the classification system proposed by the International Working Party. A large number of early HCCs were revealed to be hypo- or isovascular in the arterial phase of dynamic CT. Only 5% of the lesions evaluated were hypervascular, which contrasted with advanced small HCCs, of which 94% were hypervascular. CT arterial portography (CTAP) showed hypoattenuation in 66% of early HCCs and isoattenuation in 34%. CT hepatic arteriography (CTHA) demonstrated hypoattenuation in 55% of early HCC, isoattenuation in 30% and hyperattenuation in 15%. These findings suggest that most early HCCs receive equal or reduced blood supply from both portal and arterial flow compared with surrounding noncancerous parenchyma. In contrast, 97% of small HCCs are hypoattenuated on CTAP, and 93% are hyperattenuated on CTHA. For nodule-in-nodule type HCC (advanced HCC within early HCC), the CT attenuation of the central and peripheral portions revealed areas of isolated advanced HCC and isolated early HCC, respectively. Adenomatous hyperplasia (low-grade dysplastic nodules) was not readily differentiated using the various imaging modalities, mainly due to the smaller size of these lesions compared to early HCC and/or a portal and arterial blood supply very similar to that of the surrounding parenchyma. Hemodynamic changes in cirrhotic liver were similarly evaluated using CTAP and CTHA, and the treatment of early HCC is briefly discussed herein.     

超声造影与增强MRI对高分化肝癌和异型增生结节的诊断

目的探讨超声造影与增强MRI对高分化肝细胞癌和肝异型增生结节（DN）的诊断能力。 方法回顾性收集2012年1月至2018年12月在复旦大学附属中山医院同期行超声造影和增强MRI检查并获病理学证实的39例患者的39个高分化肝细胞癌病灶和7例患者的8个DN病灶，分析其超声造影和增强MRI表现特征。采用χ²检验，计算Kappa值，比较2种检查方法的诊断一致性；绘制不同检查方法的受试者操作特征（ROC）曲线，分析其诊断效能。 结果2种诊断方法中，69.2%（27/39）的高分化肝细胞癌的动脉期表现一致（Kappa=0.482），53.8%（21/39）的高分化肝细胞癌的延迟期表现一致（Kappa=0.168）。DN病灶在超声造影的主要表现呈“等增强-等增强”模式（87.5%，7/8），增强MRI主要表现为“高信号-低信号”模式（62.5%，5/8），所有DN病灶在超声造影延迟期均未出现廓清。超声造影、增强MRI、超声造影联合增强MRI（同时满足或只满足一种）4种检查方法中，超声造影联合增强MRI（只满足一种）诊断高分化肝细胞癌的敏感度（66.7%）和准确性（61.7%）最高，而超声造影诊断高分化肝细胞癌的特异度（100%）和ROC曲线下面积（0.658，95%CI：0.482~0.834）最高。 结论超声造影联合增强MRI有助于高分化肝细胞癌和肝DN的鉴别诊断，而超声造影具有更高的诊断特异度。     

Differentiating hepatocellular carcinoma from dysplastic nodules at gadobenate dimeglumine-enhanced hepatobiliary-phase magnetic resonance imaging

Purpose

We evaluated whether the addition of delayed phase imaging (DPI) gadobenate dimeglumine-enhanced MRI to dynamic postcontrast imaging improves the characterization of small hepatocellular carcinoma (HCC) and the differentiation between HCC, high grade dysplastic nodules (HGDN), and low grade dysplastic nodules (LGDN).

Methods

Twenty-five cirrhotic patients with 30 nodules (16 HCC, 8 HGDNs, and 6 LGDNs; maximum size of 3 cm) were included in this retrospective study. The diagnostic reference standard was histology. All the patients underwent MRI both prior to and following intravenous administration of gadobenate dimeglumine. The lesions were classified as hypointense, isointense, hyperintense on DPI for qualitative assessment. In the quantitative analysis the relative tumor-liver contrast to noise ratio (CNR) of the lesions on DPI was calculated.

Results

All HCCs were hypointense on DPI while only 8 (57.1%) of 14 DNs were hypointense and only 1 of 6 (16.6%) LGDNs was hypointense. There was a statistically significant difference in the hypointensity on DPI between HCCs and DNs (p = 0.003) in the qualitative analysis but not in the CNR values while there was a strong statistically significant difference in the hypointensity on DPI in the qualitative (p = 0.00001) and quantitative analysis (p < 0.05) between LGDNs and the group obtained by unifying HGDNs and HCCs.

Conclusion

DPI is helpful in differentiating HCCs and HGDNs from LGDNs. Demonstration of hypointensity on DPI should raise the suspicion of HGDN or hypovascular HCC in the case of nodules with atypical dynamic pattern.     

Glypican-3 and alphafetoprotein as diagnostic tests for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common types of malignant tumor. It is usually asymptomatic in the early stages and tends to be intravascularly and intrabiliary invasive. Therefore, most patients present with incurable disease at the time of detection and early diagnosis of HCC is critical for a good prognosis.The imaging-based diagnosis of small tumors is relatively inaccurate, as cirrhotic and dysplastic nodules mimic HCC radiologically. The availability of a suitable serological marker to distinguish between HCC and benign liver lesions would, therefore, be very useful for early diagnosis. The only serological marker currently widely used for the diagnosis of HCC is alphafetoprotein (AFP). However, the sensitivity of this marker is limited (41-65%). Given the high heterogeneity of HCC, it is currently thought that an optimal serological test for HCC will be based on the simultaneous measurement of two or three highly specific serological markers.Several laboratories have recently reported that glypican-3 (GPC3), a membrane-bound proteoglycan, is expressed by a large proportion of HCCs, but is undetectable in normal hepatocytes and non-malignant liver disease. Furthermore, various studies demonstrated that GPC3 could be used as a serological test for the diagnosis of patients with HCC. Although the specificity of the test was very high in the context of a population with chronic liver disease, the sensitivity was limited (within the same range as AFP). Interestingly, in most cases, elevated GPC3 values did not correlate with elevated AFP values. As a consequence, the serological level of at least one of the two markers was elevated in a large majority of HCC patients. These results suggest that the sensitivity of the diagnostic test can be significantly improved without compromising specificity with the simultaneous measurement of both GPC3 and AFP.     

Hepatocellular nodules in liver cirrhosis: contrast-enhanced MR

Nowadays, the diagnosis of hepatocellular carcinoma (HCC) is increasingly demanded to imaging techniques. Anyway, imaging cirrhotic patients still remains a challenging issue, since pre-neoplastic hepatocellular lesions, as dysplastic nodules (DNs), may frequently mimic small neoplasms. Differently from other imaging modalities, magnetic resonance (MR) can give an accurate evaluation of both intracellular and vascular changes occurring during the carcinogenetic pathway from dysplasia to full malignancy. Both DNs and HCC may in fact show a large variety of signal intensities, strictly reflecting nodules’ characteristics, such as lesion architecture, grading, stromal components, as well as intracellular contents. In these last years, the introduction of dedicated contrast media has increased MR diagnostic efficacy, permitting to explore both vascular as well as the pathological changes occurring in the biliary and reticuloendothelial systems during the carcinogenetic process. MR performed with tissue specific contrast agents (hepatobiliary and reticulo-endothelial) may thus give an insight on this “gray area”, in whom significant histological changes are already present without an evident nodule arterial supply. This peculiar MR prerogative permits to give predictive information about the evolution trend in a cirrhotic parenchyma and to identify patients at high risk for developing carcinoma who would benefit from well-timed treatments.     

Hepatocellular nodules in liver cirrhosis: contrast-enhanced ultrasound

Contrast-enhanced ultrasound (CEUS) using microbubble contrast agents has expanded the role of US in the diagnosis of liver nodules in high risk patients for hepatocellular carcinoma (HCC). HCC is typically characterized by arterial hypervascularity and later washout (negative enhancement). Washout in the portal phase is often not obvious until late (>90 s). Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial and portal venous phases. However, there are occasional cases with overlap of imaging features between benign and malignant nodules, including hypovascular HCC and hypervascular HCC without washout. CEUS is helpful to characterize potential mimickers of HCC on imaging such as nontumorous arterioportal shunt or hemangioma. CEUS is also useful for a guidance of percutaneous local therapy of HCC and post-procedure monitoring of therapeutic response. CEUS can be effectively used in the diagnostic algorithm of small (1–2 cm) newly detected nodules during HCC surveillance.     

Imaging of multistep human hepatocarcinogenesis by CT during intra-arterial contrast injection

Various types of hepatocellular nodules are seen in cirrhotic livers. In these nodules, two types of human hepatocarcinogenesis are now considered. One is de novo hepatocarcinogenesis and the other is the stepwise development from high-grade dysplastic nodule (DN), high-grade DN with well-differentiated HCC foci, and overt HCC. According to our analysis by CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and histological study, in accordance with the elevation of the grade of malignancy of the nodules, the portal tract including normal portal vein (intranodular portal supply) and hepatic artery (intranodular arterial supply through normal hepatic arteries) are decreased. On the other hand, abnormal artery (intranodular arterial supply through newly formed abnormal arteries) gradually increases. Therefore, we can estimate the grade of malignacy of the nodules from intranodular blood supply. To know this blood supply pattern is important for the early detection, characterization and treatment of early stage HCCs. We also revealed that there was a close correlation between the prognosis of the nodules and the blood supply patterns.     

Afferent and efferent vessels of premalignant and overt hepatocellular carcinoma: observation by color Doppler imaging

Afferent and efferent vessels of premalignant and overt hepatocellular carcinoma (HCC) were analyzed using color Doppler imaging. With afferent blood flow, constant waveform signals reflecting portal inflow are a characteristic finding in dysplastic nodules and early well-differentiated HCC. Among advanced HCCs lacking portal blood flow, inflow of arterial pulsatile blood flow signals is characteristic for advanced HCC with increased arterial vascularity. Efferent blood flow enters the hepatic vein of the lowest pressure system in dysplastic nodules and early well-differentiated HCC with afferent portal blood flow. Analysis of waveforms of efferent blood flow signals in advanced HCC detects in the opposite direction adjacent to an accompanying afferent arterial pulsatile blood flow signal. In conclusion, during multistep human hepatocarcinogenesis hemodynamics show characteristic changes; the state of afferent portal blood with low arterial vascularity loses the portal blood flow, and arterial vascularity gradually increases. The efferent blood flow pathway also changes with the pathological multistep development process.     

Candidate molecular markers for histological diagnosis of early hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. HCC occurs mainly in chronically diseased livers, e.g. following hepatitis B and C infection. These high-risk patients are closely followed up, and increasing numbers of small equivocal lesions are detected by imaging diagnosis. They are now widely recognized as precursor or early-stage HCCs and are classified as dysplastic nodule or early HCC. These lesions lack typical imaging and histology of ordinary HCC and do not show elevated serum markers of alpha-fetoprotein and PIVKA-II, for example. Molecular analysis of these lesions would help to develop molecular markers for objective histological diagnosis of early HCC and possibly new serum markers for early detection of HCC. It has been reported that HSP70, CAP2, glypican 3 and glutamine synthetase could serve as molecular markers for early HCC. Further analysis is expected to evaluate their usefulness in routine pathological diagnosis including biopsy diagnosis and also as serum markers for early detection of HCC.     

HBV相关肝硬化结节多步演变MR影像特征研究现状及最新进展

肝硬化结节经历了从再生结节（RN）、低级不典型增生结节、高级不典型增生结节,最后进展为肝细胞癌的多步骤癌变过程,早期鉴别肝硬化各阶段结节性质对诊断及预后具有重要意义。相对于常规CT检查,MRI作为一种无创性检查方法,在对整个肝脏进行评估方面取得了一定的突破,特别是DWI、SWI等新技术的应用,更有利于RN的诊断。作者就肝硬化结节多步演变过程进行综述。     

A sub-centimeter HCC with bright loop appearance diagnosed by contrast-enhanced ultrasonography

Detection of a hepatocellular carcinoma (HCC) in the early stage is critical, as clinical stage influences treatment selection and patient prognosis. Carcinogenetic development of an HCC is a multi-step process, and a differential diagnosis between a dysplastic nodule and a well-differentiated HCC is often difficult. A bright loop appearance is a significant finding that indicates disappearance of fatty deposition in the central area of the nodule during the progression toward HCC, however such a finding is rare in cases of sub-centimeter-sized HCCs. We encountered a case of HCC that developed a bright loop appearance on ultrasound (US) without enlargement approximately 2 years after diagnosis as a dysplastic nodule. Moreover, the hypoechoic area in the center of the nodule showed an HCC pattern in contrast enhanced US with Sonazoid?. Vascularity in the nodule could not be observed on dynamic contrast-enhanced CT or Gd-EOB-DTPA-enhanced MRI. When a change in the intranodular echo pattern is observed in sub-centimeter-sized nodules, examination of intranodular vascularity by contrast-enhanced US is important to evaluate borderline lesions.     

Recent advances in tumor markers of human hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most devastating malignancies in the world and is the third most common cause of cancer-related death in Korea. Because most HCC are accompanied by chronic liver disease that results from hepatitis B or C viruses, prognosis is still poor even after surgical resection of the tumor. Moreover, diagnosis of advanced HCC still leads to an extremely bleak prognosis. Earlier detection of HCC, therefore, could improve patient survival. Accordingly, the development of tumor markers that can detect HCC at even earlier stages is essential. The functions of tumor markers include prediction of prognosis or therapeutic response as well as diagnosis or screening of cancer. Possible candidate tumor markers may be quantitative alterations in DNA-, RNA- or protein-based molecules in tumorous conditions assessed by various technologies, e.g. serological assays, microarrays, mass spectrometry and proteomics. However, validation and clinical implementation is needed after the discovery of novel genes. An ideal tumor marker for HCC would be sensitive and specific enabling to differentiate it at an early stage from premalignant lesions like dysplastic nodules. In addition, the marker should be easily measurable, reproducible and minimally invasive. Although it is important to identify new biomarkers for HCC, the validation and cost-effectiveness of those markers as diagnostic or prognostic tools need confirmation in large-scale studies in clinical practice.     

Small hepatic nodules in cirrhosis: ultrasonographic, CT, and MR imaging findings

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     

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.     

超声造影在肝硬化增生结节病变中的应用

目的 观察肝硬化背景下局灶性病变超声造影表现,分析增生癌变的增强特征及与肝细胞癌(HCC)、再生结节的鉴别.方法 141例经临床及影像学诊断为肝硬化患者超声检查发现163个直径1～3 cm局灶性病变,均行超声造影检查.之后采用18G粗针穿刺活检,特别对同一结节内的不同增强区域分别取材.结果 最终确诊增生癌变21个,HCC 45个,再生结节97个.21个增生癌变动脉期或门脉期表现为结节小部分区域增强,延迟期不同程度退出,结节其余部分与肝同步增强或延迟增强,少数23.8%(5/21)延迟期较肝提前退出.HCC 45个病灶中82.2%(37/45)动脉期或门脉期表现为整体增强,17.8%(8/45)不均匀增强,中心区呈不规则无回声;延迟期100%(45/45)退出.再生结节97个病灶中96.9%(94/97)动脉期与肝同步或延迟增强,3.1%(3/97)轻度增强,至延迟期25.8%(25/97)退出,74.2%(72/97)与肝同步.21个增生癌变穿刺活检组织病理学证实动脉期增强区域为癌变区域,而动脉期与肝同步或延迟增强区域为肝细胞增生.结论 超声造影可敏感反映肝硬化背景下局灶性病变的不同病理组织学特征,重视超声造影增强区域取材活检可提高确诊率及肝癌的早期诊断.     

彩色多普勒血流成像及高频超声成像对肝实性病灶的诊断价值

目的探讨彩色多普勒血流成像(CDFI)及高频超声对肝实性病灶的诊断价值.方法对73个肝脏实性病灶进行超声检查,记录肝脏背景及血流情况.结果高频超声可更细致地观察靠近肝脏表面病灶(<7 cm)内部的回声特点.小肝癌中80%可检测到动脉供血,60%有门静脉供血,46.7%为肝动脉及门静脉双重供血.2例发育不良结节可检测到门静脉供血.结论高频超声及CDFI可为肝实性病灶提供重要的鉴别诊断信息.肝硬化或慢性肝炎患者发现肝内实性低回声病灶,应警惕恶性可能.     

肝硬化癌变的CT、MRI表现及介入治疗

目的:探讨肝硬化癌变的CT、MRI的影像表现,提高对肝硬化癌变的诊断及介入诊疗水平。方法:对10例12个经病理证实的癌变灶的影像学病灶进行回顾分析,所有病例均接受螺旋CT三期增强扫描、MRI平扫及动态增强扫描。结果:螺旋CT增强扫描检出7个病灶,MRI平扫及动态增强扫描检出12个病灶;螺旋CT三期扫描显示,动脉早期7个病灶均出现中等度增强;MRI平扫在T1WI像上,12个病灶中,4个病灶略呈高信号,8个病灶呈略低信号,在T2WI像上9个病灶呈高信号影,增强动态扫描,动脉期9个病灶呈中度强化,3个病灶呈现小结节样强化;并对7例甲胎蛋白(AFP)升高的患者实施了介入治疗。结论:对于肝硬化癌变病灶的检出,MRI优于螺旋CT,MRI应作为肝硬化癌变检出的首选影像学方法。对影像学高度提示的肝硬化癌变病灶及早实施治疗具有十分重要的临床意义。