肝门胆管癌及邻近结构侵犯的MRI诊断价值

目的 探讨磁共振多序列成像诊断肝门胆管癌及邻近结构侵犯的价值.方法 采用T2WI横断面平扫、T1WI横断面平扫加增强扫描及冠状面增强扫描、真稳态自由进动快速成像序列冠状面扫描(true fast imaging with steady state procession,true FISP)、MRCP厚层T2加权成像、3D VIBE(volumetric interpolated breath-hold exalnination,VIBE)序列三期动态增强扫描,分析20例肝门胆管癌的大体类型及邻近结构侵犯情况,与手术及病理结果比较,评价术前扫描磁共振成像(magnetic resonance imaging,MRI)诊断价值.结果 ①肿块型7例,管壁浸润型11例,结节型2例,术前诊断准确率100%.②根据Bismuth-Corlette胆管受侵犯分型法,术前诊断准确率95%.③肝门血管受侵犯诊断准确率53.5%.④肝门淋巴结转移诊断准确率33.3%.结论 MRI在显示肝门部肿块大小、范围,沿胆管壁浸润方面,诊断价值较高;而显示血管侵犯及淋巴结转移方面诊断准确率较低.     

MRI对胆囊切除术后胆系并发症的评价

目的探讨MRI检查在胆囊切除术后胆系并发症的诊断和选择治疗方案中的作用。方法收集因“胆石症或慢性胆囊炎”行胆囊切除术后临床出现胆系并发症、MRI检查发现异常的病例共50例。全部病例均按标准的成像参数，行MRIT1wI横断面平扫和增强扫描、冠状面增强扫描，T2WI横断面平扫。True fisp冠状面平扫和MRCP。结果胆囊切除术后胆系常见并发症包括：胆系结石22例．继发性胆管炎和胆源性肝脓肿15例，肝总管与胆总管汇合处狭窄、中断分别为6例及3例，胆系肿瘤9例；其它并发症有胆汁漏、胆汁瘤、急性胰腺炎、残株胆囊炎等。结论MRI检查在肿囊切除术后并发症的诊断中可发挥重要作用，可准确判断引起胆系并发症的原因，胆道梗阻的部位、程度及原因，评估胆系肿瘤累及的范围及可切除性，因此，有助于明确诊断和选择治疗方案。此外，在腹腔镜胆囊切除术前，应对胆系和胰腺进行全面、详细的影像学评价，以避免漏诊。     

肛周脓肿的磁共振成像研究

目的探讨磁共振成像（MRI）对肛周脓肿的诊断价值。方法回顾性分析2007年7月至2009年3月间复旦大学附属金山医院收治的50例肛周脓肿患者的临床和MRI影像学资料。按以下步骤进行MRI检查：横断面T1WI,横断面、冠状面和（或）矢状面T2WI抑脂序列平扫,横断面、冠状面和（或）矢状面增强扫描。分析脓肿的部位、大小、形态、信号和增强特征。结果50例患者通过MRI共检出51个脓肿病灶．脓肿在T1WI表现为等或略低信号,T2WI抑脂脓腔呈明显高信号。增强见脓肿壁明显强化。脓肿最大径（3．4±1．7）cm,脓腔最大径（2．7±1．7）cm。脓肿呈类圆形26个,长圆形18个,新月形7个：脓腔单房41个,多房10个。脓肿位于肛提肌下方、括约肌间沟上方23例．位于括约肌间沟下方3例．跨肛提肌及括约肌间沟1例,跨肛提肌7例,跨括约肌间沟16例,肛提肌上方1例。结论MRI能无创、方便、准确地诊断肛周脓肿,清晰显示脓肿与肛管结构的解剖关系。     

3.0T MRI扩散加权成像在鉴别肝脏转移瘤与肝内胆管细胞癌中的价值

目的:分析研究扩散加权成像在鉴别肝脏转移瘤和肝内胆管细胞癌中的价值。方法:回顾性分析病理证实的肝脏转移瘤患者和肝内胆管细胞癌患者的MRI原始资料,包括DWI序列和常规MRI平扫序列(包括T1WI和T2WI)。两种病例各14例,测得其表观扩散系数(ADC)值、瘤/肝值,以及肿瘤与邻近肝实质之间的差异,并进行比较。结果:受检28例患者共28个肿瘤,所有肿瘤在ADC图上均呈现高信号,T2WI呈现稍高信号,T1WI呈现稍低信号,边界较为清楚。肝脏转移瘤平均ADC值为0.943±0.132,肝内胆管细胞癌平均ADC值为1.001±0.008,两者差异无统计学意义(t=0.695,P0.05)。肝脏转移瘤的瘤/肝值显著低于肝内胆管细胞癌(t=2.780,P0.05)。肝脏转移瘤和肝内胆管细胞癌的ADC值均低于邻近肝实质(t=6.143、8.545,P0.05)。结论:磁共振DWI序列中测得的瘤/肝值能够对肝内转移瘤和肝内胆管细胞癌的鉴别诊断提供有价值的信息。     

MRI不同序列在骨挫伤诊断中的应用价值

[目的]探讨MRI不同序列在骨挫伤诊断中的应用价值。[方法]对2006年8月～2006年12月间的45例骨挫伤患者行MRI检查，MRI扫描前均经CR、DR或CT扫描证实没有发生骨皮质的断裂与移位。临床主要表现为局部肿胀、疼痛及活动受限。使用SiemensNovus1．5T超导MRI机器，脊柱扫描使用肢体线圈，膝关节扫描使用膝关节线圈，行矢状位、冠状位及横断扫描。扫描序列包括自旋回波序列（SE）T1WI、快速自旋回波序列（TSE）T2WI、梯度回波序列（FL2D）T2WI、脂肪抑制序列T2WI。[结果]自旋回波序列（sE）T1WI检出44例，检出率为97．7％，快速自旋回波序列（TSE）T2WI检出37例，检出率82．2％，梯度回波序列（FL2D）T2WI检出24例，检出率75％，脂肪抑制序列T2WI检出45例，检出率100％。骨挫伤检出率脂肪抑制序列T2WI高于TSET2WI（P〈0．05），TSET2WI高于FL2DT2WI（P〈0．05）。骨挫伤高场MRI信号改变主要表现为T1WI呈低信号，rISET2WI呈等高信号，FL2DT2WI呈混杂稍高信号，脂肪抑制序列T2WI呈明显高信号。边界不清，信号不均匀。[结论]对于骨挫伤脂肪抑制序列T2WI检查好于TSET2WI及FL2DT2WI，与SE T1WI相结合能够更敏感的发现骨挫伤改变。     

垂体微腺瘤的MRI诊断

目的:评价MRI对垂体微腺瘤的诊断价值。方法:对32例行MRI检查的垂体微腺瘤对MRI平扫进行回顾性分析,其中18例行增强扫描(矢冠状T_1WI)。结果:垂体腺内出现局限性低信号及上缘凸起或鞍底凹陷侵蚀是微腺瘤的特征性表现,各间接征象具有不同的诊断价值,平扫冠状位T1WI为诊断垂体微腺瘤的首选序列,强化扫描不必要作常规应用。结论:MRI是诊断垂体微腺瘤有效方法。     

肝脏炎性肌纤维母细胞瘤的多层螺旋CT及MRI表现

目的探讨肝脏炎性肌纤维母细胞瘤（HIMT）的多层螺旋CT（MSCT）及MRI影像特点。 方法回顾性分析2015年2月至2017年11月乐山市人民医院经手术病理证实的6例HIMT,术前2例行MSCT平扫,4例行MSCT平扫+增强扫描,4例行MRI平扫+增强扫描,CT未增强者均行MRI平扫+增强扫描,对患者肿瘤的部位、大小、密度/信号、形态、囊变、强化程度和方式进行评估。 结果6例HIMT患者MSCT显示均为稍低密度,MRI信号不均匀;5例动脉期边缘模糊强化,1例无明显强化,6例门脉期及延迟扫描期均有明显强化。 结论MSCT及MRI成像均能够明确显示HIMT的形态学改变、强化程度及方式,MRI多序列成像更能初步判断肿瘤内部的可能构成成分,尤其是病灶内部坏死区在T2WI压脂序列呈低信号对诊断更有重要参考价值。     

磁共振信号强度与动脉早期强化模式诊断肝脏小结节病灶的价值分析

目的 分析磁共振常规 T2W、T1W平扫下病灶信号强度及相应的信噪比(SNR)、对噪比(CNR)结合病灶动脉早期强化模式在肝脏小结节病灶定性与鉴别诊断中的价值.方法 收集了2007年5月至2008年3月期间来四川大学华西医院作腹部MRI检查的肝脏小结节病灶患者68例,其中男46例,女22例; 年龄24～78岁,平均51岁.后经手术、病理、实验室检查、随访追踪及多种影像学综合检查确诊为小肝细胞癌28例(29个病灶),肝转移癌14例(33个病灶),肝血管瘤14例(22个病灶),肝囊肿12例(18个病灶),共计102个病灶.病灶直径2～30 mm,平均(21.1±6.8) mm.所有病例相继进行常规T2W、T1W平扫和VIBE序列的钆剂多期增强(动脉早期、动脉晚期和门脉期)扫描.以临床、手术病理结果为标准,重点观察各组病灶在平扫T2W、T1W的信号强度及相应的SNR、CNR和多期增强扫描中动脉早期病灶的强化模式.结果 MRI平扫T2W结节呈高信号者为100%,T1W呈低信号者为93.1%.T2W以肝囊肿的SNR、CNR值最高,其次为肝血管瘤、肝转移癌,最小为小肝细胞癌(P＜0.05); T1W以小肝细胞癌的SNR值及肝囊肿的CNR值最高,与其他3种病灶的差异有统计学意义(P＜0.05).动脉早期肝脏结节病灶的强化率占76.5%(78/102); 小肝细胞癌和肝转移癌的动脉早期强化率分别达100%(29/29)及87.9%(29/33),肝囊肿100%无强化; 最常见的强化模式是边缘强化,达35.3%(36/102),均匀与不均匀强化模式分别为21.6%(22/102)及19.6%(20/102).结论 MR信号强度的定性与定量研究和动脉早期病灶强化模式的结合有助于肝脏小结节病灶的定性与鉴别诊断.     

肝脏快速容积采集序列增强扫描评估兔VX2肝癌模型血供

目的探讨肝脏快速容积采集（LAVA）序列增强扫描评估兔VX2肝癌模型血供的价值。方法以40只新西兰大白兔建立兔VX2肝癌模型。于建模后2～3周对实验兔行腹部MR平扫及LAVA序列增强扫描,比较平扫T1 WI、T2 WI及LAVA序列增强扫描的病灶检出率,分析肿瘤MRI表现及强化特点;根据LAVA序列增强扫描肿瘤的强化特点,分为均匀明显强化、不均匀强化及环状强化三种强化方式（均匀明显强化组、不均匀强化组及环状强化组）,每组各处死2只实验兔进行病理检查。结果 32只建模成功,共32个病灶。LAVA序列增强扫描的病灶检出率（32/32,100%）高于平扫T1 WI（20/32,62.50%）及T2 WI（23/32,71.88%）的检出率（χ2=12.410、8.275,P均〈0.05）;平扫T1 WI与T2 WI的病灶检出率差异无统计学意义（χ2=0.638,P〉0.05）。MR平扫肿瘤呈类圆形或不规则形,T1 WI低、T2 WI高或混杂信号。LAVA序列增强扫描中,2个病灶表现为均匀明显强化,11个病灶不均匀强化,19个病灶环状强化。病理检查示均匀明显强化组及不均匀强化组肿瘤内毛细血管较多,而环状强化组肿瘤内毛细血管较少。结论 LAVA序列增强扫描对兔肝XV2肿瘤检出率高,且对肿瘤血管显示效果佳,可较为客观、全面地反映VX2肿瘤的生长特性。     

肝切除术式合理决策要点

切除病变肝组织是肝胆疾病有效的治疗手段，合理肝切除方案需要在彻底切除病灶、确保手术安全和病人最优预后等关键性治疗目标间取得平衡。肝胆恶性肿瘤肝切除术的决策要点在于合理的肝切除范围、肿瘤切缘以及对肝脏储备功能的准确评估。研究结果表明，肿瘤生物学异质性、肝段间血管交通支或流域重合的存在、肿瘤微环境新生血管等多个因素的影响可能会弱化肝细胞癌实施解剖性肝切除的治疗效应，而手术宽切缘是肝细胞癌预后获益的独立显著性因素；淋巴结转移是肿块型肝内胆管癌决策合理切缘的重要考量因素；除肿瘤累及右肝门者，扩大肝切除范围对pT2期及以上的胆囊癌并无生存优势；R1-vas切缘对肝细胞癌和结直肠癌肝转移以及肝门部胆管癌侵及肝动脉的治疗价值，值得更多探索性研究。基于保留更多功能性肝实质的理念，联合肝静脉主干切除的限制性肝切除对生长于第二肝门、肝静脉主干受侵的肝细胞癌，以及围肝门切除对于Bismuth-Corlette Ⅲ~Ⅳ型肝门部胆管癌，具有临床价值。     

肝癌肝动脉栓塞化疗后磁共振成像检查特征

Hepatocelular carcinoma ( HCC) is one of the most common causes of cancer death worldwide. Although surgical resection offers a better curative option than nonsurgical treatments, it is not an option for the majority of patients with poor hepatic function or at an advanced stage when diagnosed.Transcatheter arterial chemoembolization (TACE) is an alternative and effective nonsurgical treatment for HCC. Evaluation of the effect of TACE is important to develop a best therapeutic strategy. From January 2009 to December 2010, 28 patients with HCC received TACE at the PLA General Hospital, and the results of magnetic resonance imaging ( MRI) were analyzed. Fifty-one lesions were detected and the maximum diameter of the lesions was 14.7 cm. Twenty-eight lesions in 16 patients which showed variable signal intensity on T1- and T2 -weighted images and iso- or hypointensity on diffusion-weighted image ( DWI) had no enhancement. Five lesions of 10 tumors in four patients had focal enhancement in the first MRI after TACE that displayed hyperintensity on DWI. Eight patients had been found with tumor recurrence or metastasis when they received MRI for the second time. The recurrent, residual and intrahepatic metastatic tumors enhanced rapidly at dynamic early phase scanning and demonstrated hyperintensity on T2 -weighted images.     

肝癌手术治疗进展

The incidence of hepatocellular carcinoma (HCC) has increased worldwide over the past two decades. Surgical resection and liver transplantation have been demonstrated as potentially curative treatment options, which could be considered in 30% -40% of HCC patients. Recent advancements of surgical treatment have focused not only on the surgical techpiques, but also the hepatic functional reserve evaluation, resectability assessment and the effects of biological characteristics of tumor on prognosis. There is no single variable to evaluate the hepatic functional reserve accurately. Combined Child-Pugh classification, ICGI5, portal vein pressure detection and remanent liver volume measurement are required prior to liver resection. The 5-year survival rate after liver resection for HCC is about 50%. The results are acceptable for some selected patients that underwent tumor resection with thrombectomy, including HCC with portal vein tumor thrombus or bile duct thrombosis. The choice of local resection or regular hepatectomy is still controversial although the former is commonly performed to treat HCC with cirrhosis, and the latter is applied to HCC patients without liver cirrhosis. The results of liver transplanta-tion for HCC are better than liver resection, and the Milan criteria is generally accepted. Any attempts to expand the selection criteria should be cautious because of organ shortage. Salvage transplantation for intrabepatic recurrence after liver resection may be a good choice in some resectable HCC. The recurrence and metastasis after surgical treatment are the main obstacles to achieve better results. Identification of predictive factors could be helpful to develop prevention strategies. Due to the importance of biological characteristics in tumor recurrence and metastasis, a molecular classification to predict prognosis of HCC patients will lead to a more personalized medicine. Targeting key molecules of biological pathways could optimize the therapeutic modality in HCC.     

3.0TVIBE序列动态增强磁共振检查在评估经导管肝动脉化疗栓塞术治疗肝细胞癌疗效中的价值

目的评价3.0T磁共振VIBE序列动态增强在判断肝细胞癌经导管肝动脉化疗栓塞术治疗后肿瘤坏死、残存及发现肝内新病灶的价值。方法选择48例经TACE治疗后的HCC患者,于TACE治疗后1～2个月内行MR检查,MR检查后2～5天内行DSA检查。观察动态增强扫描各时相病灶的MR征象和时间-信号强度曲线,判断原发病灶有无肿瘤残存及有无新病灶,并与DSA相对照。结果48例病例共63个原发病灶,40个病灶MR3D动态增强扫描及DSA均显示有肿瘤残存,20个病灶无肿瘤残存,诊断符合率为95.24%（60/63）。19例患者MR3D动态增强扫描及DSA均显示有新病灶,27例未发现新病灶,诊断符合率为95.83%（46/48）。3D-VIBE发现HCC病灶（包括残癌和新病灶）的敏感度为91.7%,特异度为100%,准确度为93.4%。结论3.0TMRIVIBE序列动态增强能清楚显示HCC经TACE治疗后原发病灶肿瘤残存及新病灶,并可清晰显示病灶供血动脉、引流静脉及肝血管解剖,是评估TACE治疗HCC疗效和发现新病灶的可靠方法。     

肝细胞癌肝移植术后复发和转移的研究:单中心经验

目的 研究肝细胞癌肝移植术后复发和转移的临床特点及治疗方法.方法 回顾分析2003年1月至2005年11月收治的95例肝细胞癌肝移植术后肝癌复发转移病例的临床资料.结果 在随访期内,42例(43.2%)患者被诊断为肝癌复发.复发部位最多见于移植肝(32例)、肺(21例)、骨(7例).单因素分析结果显示,肿瘤大小、肿瘤分布、肝硬化背景、术前甲胎蛋白浓度、组织学分期、大血管侵犯6项因素对肝移植术后生存和(或)肝癌复发有明显影响.多因素分析结果显示,肿瘤分布、组织学分期、大血管侵犯是影响术后总体生存率和肝癌复发率的独立危险因素.肝癌复发后的介入治疗及内放疗可延缓肿瘤进展,选择合适病例行复发灶手术切除可最大限度地改善预后.结论 合理选择接受肝移植的肝癌患者可能可以大幅度降低移植术后肝癌的复发率.在现阶段,外科治疗应是目前移植术后复发性肝癌的首选治疗手段.     

肝内血管的三维重建及肝癌局部解剖性切除

目的 探讨肝内血管三维(3D)成像在肝癌局部切除中的意义.方法 将64排螺旋CT扫描获得的肝癌患者的肝脏二维图像数据,以DICOM文件格式导入3D模拟系统进行肝内血管3D重建;在重建的肝内血管3D图像指导下行肝癌局部肝切除.结果 (1)经过重建得到了清晰的肝内血管以及肝脏和肝癌的3D图像,该图像立体地显示了肝癌与周围诸血管的解剖关系.(2)在3D图像上模拟不同肿瘤切缘宽度得到肝癌周围肝动脉、门静脉和肝静脉的切断平面和各血管切断后所影响的肝组织体积.(3)分析肿瘤的切缘宽度与切肝体积间的关系,拟定出肝癌局部切除的最佳切肝平面.(4)按拟定的切肝平面行实际肝切除,切除标本体积为178 ml,肿瘤切缘为9 mm,结果与术前模拟完全吻合.结论 在肝内血管3D图像指导下,肝癌的局部切除可以按肿瘤周围血管的解剖精确进行;通过术前模拟可以找到最佳肝切除平面.     

Transplantation for hepatocellular carcinoma and cirrhosis: Sensitivity of magnetic resonance imaging

The sensitivity of magnetic resonance imaging (MRI) in patients who undergo transplantation for hepatocellular carcinoma (HCC) and cirrhosis is not known. We prospectively evaluated 24 patients with known HCC who underwent MRI and subsequent transplantation within 60 days (mean, 20 days). Using a phased-array coil at 1.5T, breath-hold turbo STIR and T2-weighted MR images were performed. Dynamic gadolinium-enhanced MRI was performed using a two- or three-dimensional gradient echo pulse sequence with images obtained in the hepatic arterial, portal venous, and equilibrium phases. The prospective interpretation of the MR study was directly compared with thin-section pathology evaluation of the explanted livers. All 24 patients had at least one HCC, and MR diagnosed tumor in 21 (88%) of these patients. On a lesion-by-lesion basis, MRI depicted 39 of 118 HCC for an overall sensitivity of 33%. MRI detected five (100%) of five lesions >5 cm, 20 (100%) of 20 lesions >2 cm but not exceeding 5 cm, 11 (52%) of 21 lesions between 1 and 2 cm, and three (4%) of 72 lesions <1 cm. Of the nine patients with carcinomatosis (innumerable lesions less than 1 cm), MR detected three lesions in one patient. Of the 15 dysplastic nodules found at pathology, MRI depicted a single 1.8-cm high-grade lesion, for a sensitivity of 7%. In conclusion, MRI is sensitive for the detection of HCC measuring at least 2 cm in diameter but is insensitive for the diagnosis of small HCC (<2 cm) and carcinomatosis. (Liver Transpl 2002;8:1156-1164.)     

Resection of Peritoneal Implantation of Hepatocellular Carcinoma after Hepatic Resection: Risk Factors and Prognostic Analysis

Peritoneal implantation from hepatocellular carcinoma (HCC) after hepatic resection is infrequent, and information on risk factors and long-term survival of such patients is lacking. The clinicopathologic features and risk factors of 16 HCC patients after hepatic resection who developed peritoneal implantation from an HCC and the prognosis after surgical resection of these HCC implants were assessed. The clinical features of 16 HCC patients after hepatic resection undergoing resection of peritoneal HCC implants (P-HCC) from 1986 and 2000 were reviewed. The clinical features and outcomes of 195 HCC patients undergoing hepatectomy without recurrence (NR-HCC) were used for comparison. During 1986 and 2000 a total of 749 HCC patients underwent hepatic resection. Of these 749 patients, 465 (62.1%) had HCC recurrence after hepatic resection during the follow-up period (median 26 months). Of the 465 patients, 26 (5.6%) developed peritoneal implants, and 16 of them underwent resection. Multivariate logistic regression analysis revealed that a high -fetoprotein (AFP) level and capsular invasion by the tumor cells may predispose posthepatectomy patients to peritoneal implantation from their HCCs. The overall survival of the P-HCC patients after peritoneal implant resection was similar to that of the NR-HCC patients. An elevated AFP level might be regarded as a significant prognostic factor for poor overall survival (p = 0.0577) after resection of peritoneal implants from HCCs. Peritoneal implantation occurs infrequently in posthepatectomy patients with an HCC. Elevated AFP values and capsule invasion by tumor cells may predispose posthepatectomy patients to peritoneal implantation from HCCs. Surgical resection of peritoneal implants from HCCs may prolong survival in selected patients. Elevated AFP levels may be regarded as a possibly significant prognostic factor for poor overall survival after resection of peritoneal HCC implants.     

肝癌病人手术期间不同部位血液AFP mRNA定量检测及其意义探讨

目的 研究肝细胞性肝癌(HCC)病人手术期间不同部位血液甲胎蛋白信使核糖核酸(AFP mRNA)的水平变化，分析其与临床病理学特征和复发转移的关系。方法 18例HCC和6例非HCC肝肿瘤病人，于切除肿瘤前后抽取门静脉、肝静脉和外周静脉血各5m1，肝炎、肝硬化病人各10例取外周血5m1。应用TaqMan实时定量逆转录—聚合酶链反应(RT—PCR)检测AFP mRNA水平。结果 术前外周血AFP mRNA相对HCC的灵敏度为72．2％，特异性为76.9％，准确率为75．0％。HCC病人术后各部位血液AFP mRNA水平明显高于术前相应部位水平。血液AFP mRNA水平与肿瘤大小、分化程度、有无肝内播散、包膜完整性以及血清AFP浓度均无关，而有门静脉癌栓的病人术后肝静脉血AFP mRNA水平明显高于无癌栓者。术后2个月内复发者，术后门静脉和外周静脉血AFP mRNA水平明显高于末复发者。结论 TaqMan实时定量RT—PCR法检测HCC病人血液AFP mRNA有较高的敏感性和特异性。手术可能促进部分HCC细胞和肝细胞脱落入血。动态监测外周血AFP mRNA水平对术后早期复发有预测价值。     

0.23 T开放性磁共振实时引导下经皮激光热消融术 治疗肝脏恶性肿瘤

目的 评价肝脏肿瘤在磁共振介入激光治疗中的热消融变化及光学器械追踪系统对激光纤维的精确定位和实时监测激光治疗中热消融变化的能力，观察激光消融治疗肝脏恶性肿瘤的可行性与安全性。方法 对经病理学活检证实的14例恶性肝脏肿瘤患者(4例为肝细胞癌，10例为肝转移瘤，共22个肿瘤)进行0．23T开放性磁共振成像系统与介入引导下经皮激光热消融治疗术。结果 全部病灶均被成功定位、靶定并消融治疗。肿瘤形态、术后瞬间及3天后热消融形成的凝固坏死灶均在磁共振图像上显示。除1例有部分残余外，所有热消融灶均大于各自原始肿瘤大小；术后3天热消融凝固灶大于术后瞬间凝固灶。结论 磁共振引导经皮肝脏肿瘤激光热消融术是可行和安全的；光学追踪系统引导与磁共振温度监测对准确估计热治疗效果是有用且可信赖的工具。     

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging predicts the histological grade of hepatocellular carcinoma only in patients with Child-Pugh class A cirrhosis

The aim of this study was to investigate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in predicting the histological grade of hepatocellular carcinoma (HCC) according to the hepatic function. Eighty-one consecutive patients with 122 histologically proven HCCs who underwent Gd-EOB-DTPA-enhanced MRI before resection (45 HCCs in 42 patients) or transplantation (77 HCCs in 39 patients) were analyzed retrospectively. We calculated the relative enhancement ratios (RER), which is the ratio of the relative intensity of a tumor versus the surrounding parenchyma on hepatobiliary phase images to the relative intensity on unenhanced MRI scans. We then analyzed the correlation between the RER and the tumor differentiation grade in patients with various degrees of hepatic function. The degree of tumor enhancement, which included the precontrast relative intensity ratio (RIR), the postcontrast RIR, and the RER, for well-differentiated (WD) HCCs was significantly higher than the degree of tumor enhancement for moderately differentiated and poorly differentiated (PD) HCCs (P = 0.001 and P = 0.001, respectively, for precontrast RIRs; P < 0.001 and P < 0.001, respectively, for postcontrast RIRs; and P = 0.01 and P = 0.001, respectively, for RERs). In a subgroup analysis based on liver function, the correlation between the histological grade and the enhancement ratio was demonstrated only in the group of patients with Child-Pugh class A cirrhosis. The accuracy of postcontrast RIRs for predicting WD and PD HCCs was favorable; the areas under the receiver operating characteristic curves were 0.896 [95% confidence interval (CI) = 0.817-0.974] and 0.769 (95% CI = 0.658-0.879), respectively. In conclusion, the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help to predict the differentiation of HCCs, especially in HCC patients with Child-Pugh class A cirrhosis before liver transplantation or resection.