CT和MRI不同强化方式对肝脏疾病的诊断意义

目的 探讨肝脏病灶在CT和MRI出现不同强化方式的原因及临床意义。方法 收集经临床和病理证实的35例肝内病灶，所有病例同期进行标准的三期CT和MRI增强检查，并由两名副主任医师评估肝内病灶不同的CT和MRI强化方式。结果 35例病例中：①肝癌15例，其中12例CT动脉期强化明显，门脉期呈相对低密度，而相同病灶MRI检查呈动脉期强化明显，门脉期仍有强化，呈相对高信号影；3例CT动脉期强化不明显，门脉期有强化，而MRI相同病灶在动脉期强化明显，门脉期呈相对低信号。②肝局灶性结节增生（FNH）3例，CT动脉期强化明显，门脉期呈等密度；而同一病灶MRI动脉期强化明显，门脉期呈相对高信号。③血管瘤7例，CT动脉期强化不明显，门脉期呈边缘持续强化；而MRI动脉期呈边缘结节状明显强化，门脉期呈持续强化。④肝脓肿8例，炎性假瘤2例，CT强化时，包膜或分隔在动脉期轻度强化，门脉期呈持续性强化，MRI对同一病灶强化明显。结论 增强CT和MRI对肝内病灶强化规律大部分一致，但是在个别病灶中，出现两者强化方式不同。所以，对肝内强化病灶，需结合CT和MRI检查后综合分析考虑。

The diagnostic significance of different strengthening methods of CT and MRI for liver disease

Objective To explore the cause and the clinical significance of liver diseases showing different strengthening way in CT and MRI. Methods Thirty-five cases operationally-and pathologically-proved liver lesions were collected. All cases had standard three periods CT and MRI enhanced scan contemporaneously and two deputy chief physicians gave assessment to different CT and MRI enhancement mode of hepatic lesions. Results ①Of the 35 cases, 15 cases were liver cancer, among which 12 cases arterial phase CT enhancement was obvious, and were relative low-density in the portal venous phase, while MRI examination of the same lesion artery showed markedly enhancement in the arterial phase, and the portal venous phase was also strengthened with relative high signal. 3 cases arterial phase CT enhancement was not obvious, and the portal venous phase was strengthened, while MRI examination of the same lesion artery showed markedly enhancement in the arterial phase and the portal venous phase showed relative low signal. ②Three cases hepatic focal nodular hyperplasia (FNH) showed obvious arterial phase CT enhancement and the same density in the portal venous phase, while MRI of the same lesion artery showed markedly enhancement in the arterial phase and the portal venous phase showed relative high signal. ③In 7 cases of hemangiomas, arterial phase CT enhancement was not obvious, and portal phase showed a continuous peripheral rim of enhancement; while MRI arterial phase showed a marginal nodular enhancement, and portal venous phase was continuously strengthened. ④In 8 cases of hepatic abscess and 2 cases of inflammatory pseudotumor, during the CT enhancement, the capsule or separation was strengthened mildly in arterial phase, and portal venous phase was continuously strengthened, and MRI showed obvious enhancement on the same lesion. Conclusion Enhancement regulation of CT and MRI on hepatic lesions is consistent in most cases, butindividual lesions show different strengthening way. Therefore, in hepatic enhancement lesion, if there is any single CT or enhanced MRI diagnostic doubt, we need to combine the two examinations and have a comprehensive analysis and consideration.