肝硬化相关小肝癌的血供特点和MRI表现

目的:通过分析肝硬化相关小肝癌的MRI平扫及增强扫描的信号特点,结合其血供情况,总结小肝癌的MRI特点,提高小肝癌的诊断水平。方法:对经临床和病理证实的48个肝硬化相关小肝癌行MRI平扫及增强扫描,对其影像学资料进行回顾性分析。结果:48个肝硬化相关小肝癌中,T1WI以稍低、低信号(68.8%)为主,T2WI以稍高、高信号(70.8%)为主,其中10例在T1WI同相位呈等或高信号,在T1WI反相位呈等或低信号影;19例可见假包膜。动态增强扫描后,强化方式有5种:无强化、边缘轻度强化、速升速降、缓升速降及速升缓降;以速升速降(35个,72.9%)为主。结论:肝硬化相关小肝癌的血供方式有5种:动脉、门脉血供均减少;动脉、门脉血供正常或略增加;动脉血供增加,门脉血供减少;门脉血供增加;动脉、门脉血供均增加。其中以动脉血供增多、门脉血供减少为主要血供方式,结合MRI信号特点,可提高早期诊断与鉴别诊断水平。

Type of blood supply and the MR characteristics of small hepatocellular carcinoma with hepatic cirrhosis

Objective： To investigate the MR characteristics of small hepatocellular carcinoma （SHCC） with hepatic cirrhosis in the plain scan and dynamic enhanced scan, to compare with the blood supply, to raise diagnosis of SHCC. Methods： MR ima- ges of 48 SHCC with hepatic cirrhosis proved by clinic and pathology were reviewed retrospectively, which were perormed u- sing a 1.5 Tesla MRI unit with plain scan and dynamic contrast enhanced as well. Results： Of 48 SHCC with hepatic cirrhosis, slightly hypointense or hypointense was showed in 33 of 48 lesions on out phase T~ WI. On T2WI,34 SHCC were slightly hyper- intense or hyperintense, 10 of which were slightly hyperintense or isointense on in-phase T~ WI, and hypointense or isointense on out-phase T~WI. 19 SHCC had pseudo capsule. The artery feeding type was 72.8~. The portal venous supplied type was 10.4~/oo. Normal or slightly increased type was 6.3~/oo. Double blood supplied type and poor supply type was 6.3% and 4.2% respectively. Conclusion： There are 5 patterns in dynamic enhanced MR imaging in SHCC, which indicates different blood sup- ply, including essentially no enhancement, sustained enhancement slightly, rapid increase and rapid decrease, rapid increasing initially and decreasing slowly and slowly increasing initially and rapid decreasing, while 38（79.2 ~//00 ）SHCC showed obvious en- hancement during arterial phase. To combine the MR characteristics, it can provide definite basis for the early diagnosis of small hepatocellular carcinoma, differentiation may be available.