500例原发性肝癌的磁共振表现

背景与目的:磁共振成像(magneticresonanceimaging,MRI)是肝内恶性肿瘤的主要影像学诊断方法之一。本文总结了500例原发性肝癌的MRI表现,以评价钆-二乙烯三胺五乙酸(gadolinium-diethylenetriaminepentaacetic,Gd-DTPA)增强及超顺磁氧化铁(superparamagneticironoxideparticles,SPIO)增强扫描对小肝癌的诊断价值。资料与方法:收集我院行MR检查并经病理确诊为原发性肝癌的患者500例,分别行平扫、平扫+Gd-DTPA增强T1加权扫描、平扫+Gd-DTPA增强T1加权+SPIO增强重T2加权扫描。结果:500例原发性肝癌中,小肝癌有65例(13%),结节型肝癌81例(16.2%),块状型肝癌325例(65%),弥漫型肝癌29例(5.8%);单发310例(62%),多发190例(38%)。全组淋巴结转移率为12%;静脉癌栓率为31.4%。非弥漫型肝癌的肿块最大直径与子灶、异叶转移、淋巴结转移、癌栓之间存在正相关(P<0.05)。65例小肝癌的病灶总数为71个,平扫和增强、Gd-DTPA+SPIO增强和Gd-DTPA增强所发现病灶的平均数之间均存在显著差异(P<0.05)。结论:非弥漫型肝癌的肿块直径越大越容易发生子灶、异叶转移,淋巴结转移及癌栓。MRI诊断小肝癌,增强扫描比平扫有利于发现较多的病灶,而SPIO+Gd-DTPA增强比单纯Gd-DTPA增强发现的病灶多。

Magnetic resonance imaging manifestation of 500 patients with primary hepatic cell carcinoma

Background &Objective:Magnetic resonance imaging(MRI )is one of the main imaging diagnostic methods for primary hepatic cell carcinoma.This study was designed to summarize the MRI manifestation and to evaluate Gadolinium-diethylenetriaminepentaacetic acid(Gd-DTPA)and super paramagnetic iron oxide particles(SPIO)enhanced MRI in diagnosis of small hepatic carcin oma.Materials &Methods:Five hundreds patients diagnosed as primary hepatic cell carcinoma histologically were exam ined by MRI plain scan,plain scan +Gd-DTPA enhanced T1weighted imaging,and plain scan +Gd-DTPA T1weighted imaging +S PIO-enhanced heavy T2weighted imaging was performed,respectively.Results:In 500patients,there were 65(13.0%)small hepatic cell carcinoma,81(16.2%)nodular lesions,325(65.0%)lump lesions;29(5.8%)diffused lesions.310(62%)patients were single lesion and the r est were multiple lesions.Twelve percent of the cases was associated with lymp h nodes metastases,and 31.4%were complicated with vascular invasion.Diameter of the lesion was correlated positively to intro-hepatic metastases of the sam e or different lobe,the lymph nodes metastases and vascular invasion(P<0.05).Totally 71lesions were detected in the 65cases with small hepatic carcinoma.Enhanced scan detected more lesions than plain scan(P<0.05),and the lesions detected by Gd-DTPA+SPIO-enhanced scan were more than that by Gd-DTPA alone(P<0.05).Conclusion:With the diameter of the lesion incre ase,the possibility of intro-hepatic metastases,lymph node metastases,and vascular invasion increased.For the MRI diagnosis of small HCC,enhanced scan especially Gd-DTPA +SPIO enhanced s can could detect more lesions than plain scan.