肝局灶性结节性增生的影像诊断及病理对照研究

目的探讨肝局灶性结节性增生(focal nodu lar hyperp lasia,FNH)的影像学表现特点。方法经手术切除病理证实为肝局灶性结节性增生17例病例,术前均行螺旋CT平扫及动态增强扫描,其中10例又行MR平扫及动态增强扫描,分别进行影像学及病理学对照分析。结果17例FNH病灶均呈孤立结节或分叶状肿块,多数直径2~5 cm。平扫呈等或略低密度及信号,T2W I为略高信号。动态增强扫描,动脉期病灶均为明显的均质的强化,静脉期及延迟期12例仍略高于肝实质,6例略低于或等于肝实质。11例病灶内显示瘢痕,其中8例呈延迟强化。4例静脉期出现包膜样强化。病理观察:17例FNH均无包膜,增生的肝细胞形成肝板被纤维间隔分割呈结节状,瘢痕区域由纤维结缔组织及厚壁畸形血管组成。结论典型的FNH影像学可明确诊断,不典型的FNH应与肝细胞腺瘤、肝细胞癌、肝血管瘤相鉴别。

Comparative Study of Focal Nodular Hyperplasia:Radiologic and Pathologic Features

Objective To explore the pathological and imaging characteristics of focal nodular hyperplasia(FNH) of liver.Methods 17 cases of FNH proven pathologically underwent triphase spiral CT scan,of them,10 cases underwent fast MR imaging.The pathological andimaging features were comparatively analysed.Results All lesions were a solitary globular or lobulated mass,the majority of cases wasapproximately 2~5 cm in diameter.On plain CT and MRI,FNH was classically seen as a solitary,homogeneous and slightly hypoattenuating or isoattenuating area in comparison with normal liver,slightly hyper-or isointense on T_2WI,intense homogeneous enhancement during the arterial phase of enhanced imaging,and hyperattenuating in 12 cases,hypoattenuating or isoattenuating in 6 cases in comparison with normal liver during venous and delayed phase.The central scar was showed in 11 cases during delayed phase and 8 cases showed delayed enhancement,4 cases had pseudocapsular like enhancement in delayed images.In histology,17 cases of FNH were well limited but nonencapsulated,the hyperplastic parenchyma of the liver was subdivided into small nodules surrounded by the fibrous septa,there was a central scar composedof fibrous connective tissue and malformed vessels of various caliber.Conclusion The typical FNH can be easily diagnosed,while theatypical cases should be differentiated from hepatocelluar adenoma,hepatocellular carcinoma and hemangiomas.