Incidental liver lesions seen on Breast MRI: When is additional imaging warranted?

PurposeIncidental hepatic lesions identified on breast MR can be a diagnostic dilemma due to concern for liver metastases or other significant hepatic lesions. The purpose of this study was to identify the incidence and nature of liver lesions seen on breast MR, and determine if additional imaging is necessary.Methods and materialsImaging reports of all breast MR examinations performed at our institution from January 1, 2010 to December 31, 2011 were reviewed to identify reports with hepatic abnormalities. Lesion characteristics, subsequent diagnosis, duration of follow up and additional imaging results (if performed) were all recorded.ResultsOf 1664 breast MRs, incidental hepatic lesions were seen in 207 studies (12.4%) in 169 patients. In 154 of 169 patients (91.1%) the lesions were characterized as T2 hyperintense and clearly as bright as adjacent fat on T2-weighted or localizer sequences. 0 of these 154 lesions were clinically significant at clinical or radiological follow-up. In the remaining 8.9% (15 of 169), lesions were characterized as not as bright as adjacent fat on T2 weighted or localizer imaging. In two cases, lesions were confirmed as incidental hepatic metastatic disease.Conclusion91.1% of incidental hepatic lesions were circumscribed, T2 hyperintense lesions and characterised as clearly as bright as adjacent fat on T2 weighted imaging at additional review. None of which were clinically significant at clinical or radiological follow-up. We advocate that circumscribed T2 hyperintense lesions which are clearly as bright as adjacent fat on T2 weighted imaging are of unlikely clinical significance and follow-up imaging should not be recommended, reducing the rate of additional imaging from 37.3% to 5.3%.     

超顺磁性氧化铁（SPIO）对比剂肝脾MR成像的比较研究

目的 比较两种超顺磁性氧化铁（superparamagnetic iron oxide,SPIO)对比剂,Ferumoxides及SHU－555A在肝脾MR成像中的效应。材料与方法 36例已知为肝转移癌患者于SPIO造影前后进行T2WI快速自旋回波成像（T2WI TSE）及T1WI梯度回波快去速相位成像（T1WI FLASH）。扫描伪为1．0T MR机。18例患者行Ferumoxides增强后90分钟进行MR成像;另18例行SHU－55A快速团柱增强,注药后即刻、30秒及480秒行T1WI FLASH成像,10分钟行T2WI TSE成像。测量肝脾、肝转移癌SPIO增强前后的信号强度（signal intensity,SI),计算两种SPIO对比剂在肝脾、肝转移癌增强前后SI变化的百分比（percentage signal intensity change,PSIC)及病灶肝脏对比噪声比（lesion-to-liver contrast-to-noise ratio,CNR)及其变化（ΔCNR）。结果 在T2WI TSE图像上,两种SPIO对比剂造成的肝实质SI下降无显著性差异（P＞0．05）。Ferumoxides引的脾信号下降显著大于SHU－555A（P＜0．05）。两种SPIO对比剂均导致肝实转移癌SNR显著增高。T1WI FLASH图像上,两种对比剂均可导致延迟像上肝脏SI的轻度下降及肝转移癌CNR下降,两者肝脏SIC之间无显著性差异。T1WI上两种对比剂均可导致脾脏SI显著升高,两者脾脏PSIC之间无显著性差异（P＞0．05）。结论 两种SPIO在肝脏的TI及T2增强效应相似,而脾脏的T2增强效应,Ferumoxides强于SHU－555A。     

Wandering liver: multidetector CT features and the importance of multiplanar reformations

The terms wandering liver, hepatic torsion, and hepatic vagrancy have been applied to cases in which hepatic hypermobility results in displacement of the liver from its normal position within the right upper quadrant of the abdomen. This is thought to result from multiple factors, including the lack of normal hepatic suspensory ligaments, persistence of the ventral mesentery, and lack of inferior vena cava tethering Siddins and Cade (Aust N Z J Surg 60:400–403, 1990). A wandering liver has been described in both adults Siddins and Cade (Aust N Z J Surg 60:400–403, 1990), Tate (Am Surg 59:455–458, 1993), Chiavarini and Chang (Radiology 115:47–48, 1974), Cope and Levy (South Afr Med J 40:366–369, 1966), Sharov (Vestn Roentgenol Radiol 35:63–64, 1960), Puthenpurayil et al. (AJR 177:1113–1115, 2001), Fuentes et al. (AJR 188:331–333, 2007) and children Feins and Borger (AJR 188:331–333, 2007), Al-Ali et al. (Pediatr Radiol 27:287, 1997), and it is usually associated with bowel obstruction Siddins and Cade (Aust N Z J Surg 60:400–403, 1990), Tate (Am Surg 59:455–458, 1993), Chiavarini and Chang (Radiology 115:47–48, 1974), Cope and Levy (South Afr Med J 40:366–369, 1966), Sharov (Vestn Roentgenol Radiol 35:63–64, 1960), Fuentes et al. (AJR 188:331–333, 2007), Feins and Borger (AJR 188:331–333, 2007). We report a case of an incidental wandering liver in an adult without associated obstruction, diagnosed by multidetector computed tomography with multiplanar reformations.     

Benign liver lesions: differentiation by magnetic resonance

Optimal hepatic imaging involves both detection and characterization of focal lesions. Detection involves both determination of the presence of lesions and of their segmental extent of liver involvement. In the evaluation of hypervascular lesions, magnetic resonance imaging (MRI) has a greater impact on patient management than ultrasound (US) and computed tomography (CT). Most benign tumors are incidental findings and do not produce clinical symptoms. They must be accurately diagnosed without using aggressive procedures. Knowledge of their imaging features is essential to avoid unnecessary work-up and to minimize patient anxiety. In this article, the MR appearance, vascular and functional behavior of the most common benign liver tumors will be discussed.     

非肝硬化性肝叶萎缩的CT诊断及临床意义

本文分析丁23例不同病因所致肝叶萎缩的CT资料,认为肝动脉包埋在胆管癌致肝叶萎缩具有重要意义。探讨了不同病因所致肝叶萎缩的机制及鉴别诊断。     

Hepatic leiomyomas in two adult patients with AIDS: intravenous contrast-enhanced CT and MR imaging

Multiple opportunistic infections and neoplasms have been described in the AIDS population over the past 20 years. Four cases of AIDS-related hepatic smooth muscle tumors (leiomyomas) have been described, and of these, three were in children. The fourth case was in a single patient with two hepatic lesions. We describe the imaging features of two adult cases with biopsy-proven hepatic leiomyomas. In one of the cases, the gadolinium-enhanced MRI findings are described, which have not previously been reported. Electronic Publication     

肝移植后肝动脉血流障碍综合征的彩色多普勒超声分析

目的：探讨肝移植后超声对肝动脉血流障碍的早期诊断。方法：监测肝移植术后肝实质、胆管和各吻合血管的血流动力学改变。结果：38例中5例肝动脉血流障碍，其中肝动脉主干栓塞1例，局部梗塞2例，肝动脉流速减低2例，并伴随一系列异常声像图的综合征。结论：彩色多普勒超声可监测肝动脉血流障碍综合征，掌握其特征，有助于肝动脉并发症的早期诊断。     

肝细胞腺瘤（三例报告和文献复习）

肝细胞腺瘤为一少见肝脏良性肿瘤。本文报道的３例中２例为无长期服用避孕药或激素类药物的妇女，１例为老年男性。作者结合文献对其发病、病理和临床表现作了阐述，并着重对其放射性核素扫描、超声扫描、ＣＴ、ＭＲＩ和肝动脉造影的表现和诊断价值以及本病与局灶性结节性增生和巨块型原发性肝癌的鉴别要点作了讨论。     

DWI及ADC值在肝脏弥漫性疾病诊断中的应用价值

目的:探讨肝脏常见弥漫性疾病的ADC值及DWI上信号强度与相应血供相关性。方法:共110例(19例肝硬化癌变结节、20例肝转移性肿瘤、35例海绵状血管瘤和36例肝囊肿)弥漫性肝占位进行磁共振扫描并计算感兴趣区ADC值、信号强度及增强率。结果:癌变结节与DN及正常肝组织间ADC值相比明显高于后两者,P<0.05。肝囊肿、海绵状血管瘤、肝硬化癌变结节及转移性肝癌在DWI上均为明显高信号。结论:DWI及ADC值对于鉴别弥漫分布的肝脏恶性实质肿块与肝硬化再生结节及良性富水肿块(血管瘤及囊肿)有重要的诊断价值,尤其是在弥漫分布的肝硬化再生结节中发现癌变结节,有其重大的临床意义。     

胃左动脉参与肝细胞癌供血的双源CT血管成像研究

目的:探讨胃左动脉(LGA)参与肝细胞癌(HCC)供血的影响因素。方法:采用双源CT对91例左叶HCC患者进行血管成像扫描,采用MPR、CPR、MIP、VR等后处理技术重建LGA。分析LGA参与HCC供血与病灶大小、位置、假包膜的完整性及接受经导管动脉化疗栓塞(TACE)治疗的关系。结果:91例患者共计104个HCC病灶,23个病灶有LGA参与供血,发生率为22.1%。23个有LGA参与供血的HCC病灶中,19个为巨块型,4个为结节型,22个突破了肝被膜,17个接受了TACE治疗,23个病例均无完整假包膜。LGA参与供血的形式包括:通过左叶肝动脉供血3个,通过左叶副肝动脉供血5个,直接发出分支进入瘤体15个。结论:LGA是常见的左叶HCC肝外侧支动脉,其发生与肿瘤较大、突破肝被膜、缺乏完整假包膜和接受TACE治疗有关。     

Hemoretroperitoneum associated with liver bare area injuries: CT evaluation

In hepatic injury restricted to the postero-superior region of segment VII (bare area), hemoperitoneum may be absent and this condition may be associated with hemoretroperitoneum. The aim of this paper is to present the association between bare area injuries and hemoretroperitoneum evaluated by CT. The CT examinations of 32 patients with blunt liver trauma were reviewed and the number and location of lesions were evaluated. Right lobe involvement was identified, focusing on the bare area lesions. The presence of hemoperitoneum and hemoretroperitoneum were determined. In the 32 patients 44 parenchymal lesions were detected. Segment VII was involved in 16 cases: 5 patients presented an intraparenchymal lesion, 11 patients a lesion emerging to the liver surface. In 8 cases the lesion was localized in the bare area. In the 16 patients presenting a segment-VII lesion, hemoperitoneum was detected in 3 cases, hemoretroperitoneum in 4 cases, and both conditions in 4 cases. A traumatic hepatic lesion may be associated with hemoretroperitoneum rather than hemoperitoneum. This justifies the absence of clinical signals of peritoneal irritation; the negativity of both US scan and peritoneal lavage may cause an inappropriate therapeutic management. Computed tomography yields both the detection of the parenchymal damage and the correct localization of the intraperitoneal and retroperitoneal hemorrhage.     

肝局灶性结节增生及肝血管瘤的超声鉴别诊断

目的:研究二维及三维超声在肝局灶性结节增生(FNH)及肝血管瘤(HCH)鉴别诊断中的作用.方法:选择经手术病理证实、肝组织病理活检或增强CT/MRI证实肝内病变57例共72个病灶:其中肝局灶性结节增生13例13个病灶,肝血管瘤44例59个病灶,行二维及三维超声检查.分别记录灰阶图像特点、彩色多普勒特点及PSV、RI、VI.结果:典型的FNH及HCH二维图像有特征性的改变,血流速度FNH组高于HCH组,三维超声的血流指数FNH组高于HCH组.结论:三维超声可以定量研究病变的血流指数,FNH及HCH的血流指数特点在协助二维及彩色多普勒超声鉴别诊断方面有一定的作用,二维和三维相结合可以更好地鉴别诊断FNH及HCH.     

原位肝移植术后肝动脉并发症介入治疗患者的预后及其影响因素分析

目的 探讨介入治疗肝移植术后肝动脉并发症患者的预后及影响预后的相关因素.方法 回顾性分析21例肝移植术后发牛肝动脉并发症,并接受肝动脉溶栓、腔内血管成形术(PTA)和(或)肝动脉支架置入术等治疗患者的临床资料,根据移植肝脏预后分为预后不良组和预后较好组,比较2组胆道并发症、肝动脉再狭窄、早期并发症或是晚期并发症等15项变量,采用二值Logistic回归分析方法 筛选出影响介入治疗疗效的因素.结果 21例患者平均随访时间为436 d,中位随访时问464 d(3～1037 d).其中预后不良组11例(5例再次肝移植,6例死亡),平均存活时间191 d,中位存活时问为73 d(3～616 d);预后较好组10例,移植肝平均存活时间706 d,中位存活时间692 d(245～1037 d).单因素分析两组患者差异有统计学意义的因素有:胆道并发症、血总胆红素水平以及间接胆红素水平;经Logistic回归分析显示,主要危险因素是胆道并发症(P=0.027,OR=22.818). .结论 伴有胆道并发症,是影响肝移植术后肝动脉并发症患者介入治疗效果的主要因素.     

Diffusion-weighted MR imaging findings in a growing problem: Hepatic alveolar echinococcosis

Hepatic alveolar echinococcosis (AE) is a rare parasitic disease which simulates slow growing malignant processes. Cross-sectional imaging techniques play important role in differentiating between AE lesions and malignant processes such as cholangiocellular carcinoma (CCC) and hepatocellular carcinoma (HCC). Diffusion-weighted (DW) MRI is a non-invasive technique, which can be used for liver lesion detection and characterisation as benign or malignant in recent years. Both conventional MRI and non-contrast enhanced CT images may be insufficient the differential diagnosis in hepatic AE lesions particularly in solid components. In our study, we have performed to differentiate hepatic AE lesions from HCC and CCC lesions of the liver by using DW MRI and tried to define ADC value of hepatic AE lesions for differentiation from malignant hepatic lesions.     

获得性肝性脑部变性的MRI表现

目的 描述获得性肝性脑部变性的脑部ＭＲ表现,评价ＭＲ对该病的诊断价值。方法 对２６例（男１７例,女９例）各种原因引起的慢性肝病肝功能衰竭患者进行了脑部ＭＲ检查,８例同时进行了腹部ＭＲ数字减影血造影（ＭＲＤＳＡ）。其中２５例在ＭＲ检查后２周内测定血管氨水平并对血氨水平与信号强度做统计学分析。结果 ２６例中２２例脑部有阳性发现,表达为自旋回波（ＳＥ）序列双侧苍白球（２／２６）、豆状核（４／２６）、中脑     

多层面螺旋CT对肝移植术后肝动脉狭窄肝灌注的研究

目的　利用动态单层CT扫描对原位肝移植术后肝动脉狭窄肝灌注与未行肝移植、无肝脏病变者进行比较。资料与方法　对 30例肝移植术后肝动脉狭窄患者选取肝门 (包括肝、门静脉、主动脉和脾 )层面行动态单层CT扫描。高压注射器经肘静脉注射非离子型对比剂欧乃派克 4 0ml,流率 3ml/s,注射对比剂时即进行扫描 ,每间隔1s扫 1层 ,共扫描 35层。通过每一层面选定的ROI作CT值测量 ,绘制出时间 密度曲线 ,从而计算出相应灌注值并与未行肝移植、无肝脏病变者进行对照。结果　肝移植术后肝动脉狭窄 <5 0 %组 ,肝动脉灌注 (t=0 .5 ,P >0 .0 5 )、门静脉灌注 (t=1 ,P >0 .0 5 )与对照组间无显著差异 ;肝动脉狭窄≥ 5 0 % ,肝动脉灌注与对照组存在差异 (t =2 .1 4 ,P <0 .0 5 ) ,低于对照组 ,门静脉灌注与对照组有差异 (t=2 .6 3,P <0 .0 5 ) ,高于对照组。结论　肝移植术后肝动脉狭窄≥ 5 0 % ,肝动脉灌注降低而门静脉灌注升高。动态单层CT扫描对于评价肝移植术后肝脏灌注是有帮助的     

肝动脉与腹主动脉间架桥在肝移植中的作用

目的 改进肝动脉吻合方式，观察肝移植术后移植物恢复情况。方法 2例同种异体背驮式肝移植手术中，利用供体髂动脉进行肝动脉与腹主动脉问架桥，改善供肝动脉供血；观察患者术后肝功能等指标变化。排异反应预防采用FK506和泼尼松二联用药，其他同一般肝移植手术。结果 术后患者供肝恢复良好，2例患者均未出现急性排异反应，痊愈出院。结论 肝动脉与腹动脉吻合或利用供体的髂动脉进行架桥，是预防肝动脉狭窄及栓塞所致并发症的有效方法，值得在肝移植过程中予以选择性加以应用。     

菲立磁增强MRI检测肝脏局灶性病变的初步报告

目的 探讨菲立磁增强磁共振在肝脏局灶性病变中的诊断价值。材料与方法 对21例怀疑肝脏肿瘤的患者进行常规肝脏平扫和菲立磁增强扫描,分析增强前后T2WI检测病灶数目以及肝脏、病灶、脾脏信号强度的变化。结果 菲立磁增强明显降低正常肝脏的信号强度、而病灶的信号强度无明显变化,病灶－肝脏的信号强度比增加;菲立磁增强可清晰地显示病变并可发现更多的病变。结论 菲立磁增强在检测肝脏局灶性病变中敏感性高。     

肝癌的CT血管造影

目的：介绍三种螺旋ＣＴ肝脏血管造影的方法，评价其对肝癌诊断的作用。材料和方法：用三种螺旋ＣＴ肝脏血管造影的方法对４９例肝癌患者作５１次检查：肝脏动脉造影ＣＴ（ＣＴＡ）、经动脉门静脉造影ＣＴ（ＣＴＡＰ）和经术中植入门静脉的药物输入系统（ＤＤＳ）直接门静脉造影ＣＴ（ＣＴＰ）。结果：这些方法可发现直径３ｍｍ的病灶，明确显示肿瘤的血供情况。结论：ＣＴＡ，ＣＴＡＰ和ＣＴＰ有利于肝脏多发和小肿瘤病灶的检出以及其鉴别诊断，ＣＴＡ和ＣＴＡＰ虽为创伤性检查，因其敏感性很高，可在肝脏肿瘤外科手术前和需明确肿瘤的血供时选用；对植入ＤＤＳ的患者，术后复查宜常规ＣＴＰ检查。     

肝脏占位性病变的磁共振成像研究：超顺磁性氧化铁与钆喷替酸葡甲胺的比较

通过与常用造影剂钆喷替酸葡甲胺（Gd-DTPA）的配对实验来评价新型造影剂超磁性氧化铁（SPIO）对有肝占位的检出率和定性诊断能力。材料和方法：53个病例132个肝占位首日行平扫及Gd-DTPA的动态增强扫描,次日行SPIO增强扫描,对照病理及临床随访证实结果,探讨各种占位SPIO增强扫描的强化特点,比较平扫联合Gd-DTPA动态增强扫描与平扫联合SPIO增强扫描的病灶检出率和定性诊断率。结果：SPIO增强扫描良性肝占位的信号随肝实质降低,而恶性肝占位的信号保持不变。平扫联合SPIO增强扫描的病灶检出率和定性诊断率较平扫联合Gd-DTPA增强扫描的略高,但统计学上相差不显著。结论：SPIO强化的原理、强化方式直至临床应用方法、特点与Gd-DTPA均完全不同,两者可相互补充和印证,当Gd-DTPA动态增强扫描定性诊断困难时应积极行SPIO增强扫描。