在高海拔地区1.5T磁共振诊断肝泡状棘球蚴病的应用价值

目的：探讨高场磁共振MRCP、DWI和LAVA技术在肝泡状棘球蚴病（HAE）中的应用价值。方法：分析10例经手术病理或穿刺活检证实HAE患者的MRI常规平扫、DWI、MRCP及LAVA四期扫描资料,分析HAE在DWI、MRCP及LAVA中的表现并与病理对照。结果：10例共检出17个HAE病灶,其中肝右叶9个（9/17）,肝左叶5个（5/17）,跨叶生长有3个（3/17）。HAE的MRI表现为：巨块型5例（5/10）、坏死液化型3例（3/10）、混合型2例（2/10）。病灶正反相位和T2WI均为低信号,形态不规则,坏死液化型中心坏死液化区在正反相位为低信号,T2WI为高信号;LAVA增强扫描11个（11/17）病灶无强化,6个（6/17）病灶边缘有轻度强化,12个（12/17）病灶内部或边缘出现小囊泡征,病灶侵犯肝门3例（3/10）,肝静脉受侵3例（3/10）,门脉受侵4例（4/10）,肝外转移3例（3/10）;DWI示7例为略低信号（7/10）,ADC图为略高信号,ADC值=（1.82±0.13）×10-3mm2/s,3例（3/10）坏死液化型病变其边缘实性部分同前表现,而中心坏死液化区在DWI示为高信号,其在ADC图上呈高信号,ADC值=（2.20±0.12）×10-3mm2/s;MRCP显示肝内胆管扩张6例（6/10）,3例（3/10）可见不规则的残腔,12个病灶（12/17）显示小囊泡更为清晰。结论：联合运用LAVA、DWI和MRCP技术对肝泡状棘球蚴病（HAE）的定性诊断和合理治疗具有重要的临床应用价值。

Diagnostic Value of 1.5t Magnetic Resonance in Hepatic Alveolar Echinococcosis in Plateau

Objective:To deal with the applied value of magnetic resonance,MRCP,DWI and LAVA,in diagnosis of hepatic alveolar echinococcosis(HAE).Methods:Documents of ten cases of HAE,who were confirmed by surgical or biopsy pathology and who underwent examination of MRI plain,DWI,MRCP and LAVA,were retrospectively reviewed,and the data of magnetic resonance were compared with the pathologic results.Results:17 lesions of HAE were detected in 10 cases,including 9 lesions(9/17) with the right liver lobes,5 lesions(5/17) with the left liver lobes,3 with straddling lobes(3/17).MRI suggested having 5 giant mass types(5/10),3 liquefaction necrosis types(3/10),2 mixed types(2/10).The in-out phase and T2WI of lesions showed low signal and irregular shape.In the central necrosis liquefaction zone of liquefaction necrosis type lesions,phase showed low signal,but high T2WI.Non-enhancement found but 6 edge-enhanced lesions(6/17) in 11 lesions(11/17) scanning with LAVA enhancement scanning.12 of 17 lesions had vesicae in inter or on edge;there was 3,3,4 and 3 cases inferred to hepatic hilum,hepatic vein,portal vein and extra-hepatic metastases respectively;DWI of 7 cases(7/10) was lower signal,slight high signal in ADC and ADC =(1.82±0.13)×10-3mm2/s;DWI and ADC showed a high signal in 7 liquefaction necrosis type lesions in the center of liquefaction necrosis area;and ADC=(2.20±0.12)×10-3mm2/s;6 cases(6/10) showed intrahepatic bile duct dilatation on MRCP,3 cases(3/10) had irregular cavity,and 12 lesions(12/17) showed vesicles more clearly.Conclusions:The combined use of LAVA,DWI and MRCP technique has an important clinical value in qualitative diagnosis and rational treatment of the HAE.