肝脏炎性假瘤的CT及MRI征象

目的:探讨肝脏炎性假瘤的CT和MRI表现。方法:8例经手术病理证实的肝脏炎性假瘤。男5例,女3例,年龄35~65岁,平均53岁。8例均作CT平扫及增强扫描,其中3例行MR对比检查。结果:CT表现为1 个病灶6 例,2个病灶2例,共发现病灶10个。平扫9个病灶表现为低密度,1 个病灶表现为稍高密度。动态增强扫描2 个病灶动脉期显著强化,门脉期及延迟期中度强化;8个病灶动脉期无明显强化,门脉期及延迟期有不同方式的强化,主要表现为周边完整或不完整的环形或结节状强化,中心核心样强化及线状或不规则分隔样强化。MRI表现为2 例病灶T1WI呈低信号,T2WI呈稍高信号,1例病灶T1WI及T2WI均为等信号,动态增强扫描与CT相仿。结论:肝脏炎性假瘤的CT及MRI表现因其病理阶段不同而表现各异,诊断需结合临床,确诊尚依靠病理检查。     

肝脏上皮样血管内皮瘤的CT和MRI表现

目的 总结肝脏上皮样血管内皮瘤(HEHE)的CT和MRI表现.方法 搜集经手术或穿刺活检后病理证实的HEHE 11例,所有的病例均行CT检查,其中5例行CT平扫及双期增强扫描(动脉期+门静脉期),其他6例行CT平扫及三期增强扫描(动脉期+门静脉期+延迟期).11例中有5例加做MRI平扫及动态增强扫描.回顾性分析病变的生长方式、分布特点、密度(信号)特点、强化方式及邻近组织情况.结果 11例均表现为肝内多发病灶,大部分病灶位于肝包膜下,根据生长方式分为三型:结节型(5例),匍匐生长型(1例)和混合型(5例).CT平扫,病灶均呈低密度,直径＞2 cm的病灶内见类圆形更低密度.MRI平扫:病灶呈T1WI低信号、T2WI高信号,直径＞2 cm的病灶信号不均匀(T1WI内见更低信号,T2WI内见更高信号).其他影像学征象包括“棒棒糖征”(6例)、包膜退缩征(6例).增强扫描:病灶直径＜1 cm的表现为轻度较均匀强化;病灶直径为1～2 cm主要表现为轻度较均匀强化;病灶直径＞2 cm的多为不均匀渐进性强化.结论 HEHE的CT和MRI表现具有一定的特征性,其强化方式与病灶的大小相关.     

肝脏炎性假瘤的影像表现与病理对照分析

目的探讨肝脏炎性假瘤(IPL)的影像学表现及病理特点,提高对它的认识。方法回顾性分析经病理证实的19例IPL患者的影像学表现与病理特点。14例行CT检查,3例MRI检查,2例同时CT和MRI检查。结果 19例患者中多发病灶5例,收集29个病灶。位于肝右叶15例;CT平扫均为低或等密度;5例MRI检查,T1WI呈低信号,T2WI呈低或稍高信号;动态增强强化方式多样:周边小结节状或厚薄壁环形强化8例;病灶内分隔状或结节状强化3例;全瘤强化8例;16例动态增强表现为动脉期不同程度强化,门脉期及延迟期以延迟强化为主。所有病灶镜下均见纤维组织增生伴不同程度坏死、炎症细胞浸润。结论 CT和MRI可以提供IPL的诊断线索,其影像学表现多样与病灶的病理基础有关。如果临床怀疑,病理诊断是必须的。     

节细胞神经瘤的CT、MRI诊断

目的 探讨CT和MRI在诊断节细胞神经瘤中的价值.方法 回顾性分析19例经病理证实的节细胞神经瘤患者的CT和MRI影像学表现及临床资料,其中15例行CT增强扫描,4例行MRI扫描(3例增强).结果 所有病灶均为单发.1例位于颈部,7例位于后纵隔,3例位于腹膜后间隙,8例位于肾上腺.边界均清楚,形态多呈椭圆形或不规则形.CT平扫呈均匀或不均匀低密度,动脉期无明显强化,静脉期呈渐进性不均匀强化.4例病灶内见斑点状、结节状钙化.MRI表现为T1WI低信号,T2WI不均匀高信号为主,增强后不强化或轻度强化.2例病灶内呈现"漩涡征".结论 节细胞神经瘤的生长方式及影像学表现具有一定的特征性,CT延迟增强及MRI扫描对其诊断和鉴别诊断有很大的价值.     

肝脏上皮样血管平滑肌脂肪瘤的影像学表现与病理对照分析

目的探讨肝脏上皮样血管平滑肌脂肪瘤(epithelial angiomyolipomas,EAML)的影像学表现及病理特征,提高对该病诊断的准确性。方法回顾性分析9例经病理证实的肝EAML的临床表现及影像学资料。其中3例行MRI平扫和多时相动态增强扫描,5例行CT平扫和三期动态增强扫描,1例同时行CT和MR检查。9例均误诊,其中6例术前误诊为肝癌,1例误诊为血管瘤,1例误诊为局灶性结节增生(FNH),1例误诊为转移瘤。结果 9例肝EAML均为单发的类圆形肿块,边界清楚;6例位于肝右叶,3例位于肝左叶。CT平扫呈稍低密度;MRI平扫T1WI呈稍低信号,T2WI呈稍高信号;增强扫描动脉期呈明显不均匀强化,少数可均匀明显强化,6例动脉期可见早期引流静脉,8例动脉期或门脉期中央或周边可见明显强化的粗大畸形的血管;强化方式为快进快出或快进慢出。结论 EAML影像学表现具有一定特征性,结合临床资料,对术前正确诊断具有重要意义,但诊断有赖于穿刺活检。     

肝脏炎性肌纤维母细胞瘤组织学分型与CT、MRI对比分析(附19例报告)

目的 探讨肝脏炎性肌纤维母细胞瘤(HIMT)CT、MRI特征与病理改变的关系,提高对其的诊断准确率.资料与方法 经手术及病理证实的HIMT患者19例,其中男12例,女7例,年龄27～79岁,平均46.7岁.18例行CT平扫及增强扫描;1例仅行CT平扫,7例同时行CT、MRI平扫及增强扫描.结果 19例中15例为单发病灶,4例多发,共26个病灶,位于肝左叶4个,肝右叶22个.组织学分型包括黄色肉芽肿型15例:CT平扫低密度12例,等密度3例;14例增强扫描,动脉期1例明显强化,门静脉期轻度强化10例,平衡期轻度强化4例.4例行MRI检查,T1WI呈等信号1例,低信号3例,T2WI均为高信号.增强扫描4例动脉期均无强化,门静脉期或平衡期轻度强化.浆细胞肉芽肿型3例:CT平扫呈稍低密度2例,等密度1例.增强扫描动脉期均无强化,门静脉期或平衡期轻度强化;行MRI检查2例,增强扫描呈壁结节强化.硬化型1例:CT平扫为等、低混杂密度影,增强扫描动脉期无强化,门静脉期呈均匀强化,平衡期病灶密度减低.MRI平扫T1WI为等信号,T2WI为高信号,增强扫描动脉期无强化,门静脉期轻度强化,延迟期强化明显.26个病灶中4个有假包膜.结论 CT及MRI平扫及增强扫描能够反映HIMT组织学变化特点,但对不同类型病变的CT、MRI鉴别诊断仍比较困难.     

肝脏孤立性坏死结节的CT、MRI表现与病理对照研究

目的:探讨肝脏孤立性坏死结节(SNN)的CT、MRI表现及其分型诊断价值和病理基础.方法:分析经临床和病理证实的肝孤立性坏死结节29例(所有病例均行MR检查,其中15例行CT检查),探讨SNN的CT、MRI表现及其分型诊断价值和病理基础.结果:①单纯凝固性坏死型(14例),T1WI、T2WI上均呈低或低-等信号,增强扫描病灶内凝固性坏死无强化,周围包膜呈延迟强化.其中8例行CT检查,CT平扫呈低或等密度,增强扫描无强化,5例可见包膜呈延迟期环形强化.②伴液化性坏死型(5例),T1WI上呈低信号,较大病灶内可见更低信号;T2WI上病灶呈低-等信号,其内液化性坏死呈点片状更高信号;增强后病灶无强化,周围包膜呈轻-中度强化.CT检查3例,CT平扫呈低或等密度,增强扫描无强化,2例周围包膜呈延迟期环形强化.CT不能反映病灶内液化性坏死.③多结节融合型(10例),T1WI呈低信号,其内可见低-等信号分隔;T2WI病灶以等-稍高信号为主,其内可见等或略高信号分隔,其中6例合并液化性坏死还可见裂隙状高信号.增强扫描病灶无强化,其内分隔及周围包膜呈轻-中度强化.CT检查4例,其中3例为低或等密度融合结节,增强扫描内部分隔及周围包膜呈延迟期强化.CT不能显示内部液化性坏死和病灶全部分隔.结论:CT、MRI能较好反映肝脏孤立性坏死结节的分型及各型的病理特征,MRI在多结节融合型和伴液化坏死型的诊断价值明显优于CT.     

CT finding of rare primary malignant tumor of the liver

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点.方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献.结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化.恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低.上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低.结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查.     

肝脏孤立性坏死结节的CT及MRI表现

目的:探讨肝脏孤立性坏死结节(SNN)的螺旋CT及高场强MRI表现,提高对SNN的诊断准确性。方法:回顾性分析30例(34个)经手术病理证实的SNN患者的影像学表现。其中10例行螺旋CT平扫和3期动态增强检查,20例行MRI平扫及增强检查。结果:CT发现11个病灶,MRI发现23个病灶。CT平扫示病灶均呈低或稍低密度,6例中央可见星芒状更低密度区,增强扫描动脉期病灶均无明显强化,延迟期4个病灶有边缘强化。MRT1WI示23个病灶均为低或稍低信号,10个病灶中心见点状、星状更低信号;T2WI示5个病灶呈稍低信号、18个为稍高信号;增强扫描动脉期所有病灶均未见明显强化,8个病灶门脉期及延迟期边缘强化。16个病灶中心更低密度/信号区均未见强化。结论:CT平扫和动态增强及MRI能较好地反映SNN的影像学特点,提高了对SNN的诊断准确性。.     

肝脏少见原发性恶性肿瘤的CT表现

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点。方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献。结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化。恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低。上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低。结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查。     

原发性腹膜后节细胞神经瘤影像分析

目的:分析腹膜后节细胞神经瘤的特征影像表现,提高其诊断准确率。方法:回顾性分析7例经手术病理证实的腹膜后节细胞神经瘤的影像表现。结果:所有肿块均边界清楚,其中3例呈铸型或嵌入生长,1例侵犯椎间孔;2例可见小斑点钙化;超声显示3例呈轻度不均匀性低回声,内可见条索状间隔回声;1例不均匀低回声内见血流信号。CT平扫呈均匀性低密度,CT增强扫描1例无明显强化;2例动脉期包膜轻度强化,其中1例无延迟强化,1例呈进行性延迟强化;2例动脉期包膜及间隔轻度强化,并见包膜及间隔轻度延迟强化。MRI T1WI呈均匀性低信号,T2WI呈不均匀性高信号,增强扫描后呈轻度强化。结论:CT、MRI诊断节细胞神经瘤优于超声;当其出现特征影像表现时,需要考虑节细胞神经瘤的诊断。     

不典型肝内胆管细胞癌合并脓肿的影像学诊断要点

目的 探讨不典型肝内胆管细胞癌合并肝脓肿的影像表现特征和诊断要点。方法? 回顾性分析1例经手术病理证实为肝内胆管细胞癌合并肝脓肿病人的临床资料、影像表现特征并复习相关文献。结果? MDCT平扫显示巨大不规则肿物,累及肝左叶及部分右前叶,肿物呈分叶状,内部密度不均,邻近血管无受侵、肝包膜无凹陷征;增强CT检查动脉期显示肿物呈多结节融合状,病灶边缘及内部各结节呈明显环形强化,门静脉期及平衡期肿物强化仍较明显。肝脏MRI平扫肿物呈不规则形稍长T1、稍长T2信号影,于DWI序列上显示不均匀较明显高信号,增强扫描表现类似于增强CT表现,另于MRI增强扫描门静脉期及平衡期可见肿物内局部区域呈分房状表现,增强程度更明显。结论? 不典型肝内胆管细胞癌合并肝脓肿兼具两种病变的影像表现。正确诊断需结合临床、实验室检查、超声表现并注重影像表现的细节信息。     

黄色肉芽肿性胆囊炎的影像学表现

目的：探讨黄色肉芽肿性胆囊炎（XGC）的CT和MRI表现。方法：回顾性分析8例经手术病理证实的XGC,总结其CT和MRI表现。结果：术前诊断为XGC2例,误诊为胆囊癌6例。CT表现：8例均有胆囊壁增厚,其中局限性增厚表现为动脉期环形强化1例,弥漫性增厚表现为夹心饼干征3例,4例表现为胆囊黏膜线完整;伴胆囊结石5例,胆总管结石1例,右肝内胆管细胞癌1例。MRI表现：3例T2WI表现为胆囊壁内高信号结节,2例门脉期及延迟期清晰显示明显强化的完整的胆囊黏膜线。结论：CT增强扫描表现环形强化和夹心饼干征;MRI扫描T2WI表现为胆囊壁内高信号结节,增强扫描显示明显强化的完整的胆囊黏膜线等表现,是提示XGC诊断的重要征象。     

Metastatic liver tumor from cystic ovarian carcinomas: CT and MRI appearance.

OBJECTIVE: The initial and follow-up CT and MRI images of ten patients with hepatic metastases from ovarian tumors were retrospectively analyzed to establish their features and sequential changes in appearance. MATERIALS AND METHODS: Ten patients with hepatic metastasis from ovarian tumors received initial and follow-up CT and MRI examinations. Six patients were followed up every two to three weeks before surgical tumor resection. Both CT and MR images were analyzed by two radiologists. RESULTS: A total of fourteen lesions were detected by CT and MRI in 10 patients. All 14 lesions were demonstrated as areas of marked hyperintensity on T2-weighted MRI. Eleven cyst-like tumors were demonstrated as round or oval low density lesions on CT and as areas of hypointensity on T1-weighted imaging. Three lesions were shown as solid masses with slightly low attenuation at the initial CT examination and slightly low or iso-intensity areas on T1-weighted imaging, and these lesions showed early peripheral globular enhancement and delayed enhancement on contrast-enhanced CT and MR imaging. Cystic formation was observed two to three weeks later after initial study in all the 3 solid lesions. Rapid subcapsular effusion, which showed obvious enhancement on delayed Gd-DTPA enhanced MR imaging, was observed in two patients. CONCLUSION: The hepatic metastatic tumor from cystic ovarian carcinoma may manifest as a well-defined cystic lesion or as a solid mass, and the solid mass shows delayed enhancement on contrast-enhanced CT and MR imaging. Furthermore, rapid cystic formation and rapid subcapsular extension is frequently seen.     

肝脏炎性假瘤的影像学诊断现状与进展

肝脏炎性假瘤(IPL)是一种少见的良性肿瘤样病变，其影像学表现多样化。超声检查：表现为低回声不均质结节，形态不规则，后方无声能衰减现象。彩色多普勒血流显像(CDFl)多无明确彩色血流信号。CT检查：平扫表现为低密度灶；增强扫描，多数病例动脉期不强化，门静脉期及延迟期可呈现多种强化方式，表现为周边环形强化、整个病灶不均匀强化、病灶内结节状强化及肿块周边和内部高密度分隔等。炎症过程的动态变化及不同程度的纤维组织增生、炎性细胞浸润、凝固坏死是产生多种强化类型的病理基础。MRI检查：由于病灶病理阶段的不同，平扫中T1WI及T2WI信号强度不一，可表现为长T1、长T2或长T1、等T2信号。GD-DTPA增强扫描部分病灶动脉期可见快速明显强化，门静脉期及延迟扫描强化方式与CT增强扫描大致相同。肝脏特异性对比剂增强扫描病灶无明显强化。     

Castleman病的影像表现与病理对照

目的探讨Castleman病的CT及MRI影像表现,提高对其的认识。方法回顾性分析9例经手术病理证实的Castleman病的CT及MRI资料,并与病理结果对照分析。结果颈部3例,纵隔3例,腹膜后2例,肠系膜1例,临床类型为局限型8例,弥漫型1例,病理分型为透明血管型8例,浆细胞型1例。CT平扫与肌肉相比呈等密度;动态增强CT扫描透明血管型8例,肿块动脉期明显强化,强化程度接近同层面大动脉,静脉期及延迟期均表现为持续强化,5例病灶周围或(和)病灶内可见增粗迂曲血管影。浆细胞型1例表现为肠系膜多个软组织结节,伴有肝脾肿大,呈轻度强化表现。MRI检查3例均为透明血管型,T1WI病灶呈稍低信号,T2WI呈高信号,增强表现与CT近似。结论影像表现与病理分型关系密切;局限性边缘清楚的等密度结节,增强扫描动脉期明显强化,且强化延续时间长,灶周增粗迂曲血管影,分支状或斑点状钙化等为透明血管型相对影像学特点,弥漫浆细胞型无特征性影像学表现,确诊依赖组织病理学。     

原发性肝透明细胞癌的影像学表现与临床病理对照

目的探讨原发性肝透明细胞癌(PCCCL)的影像学表现。方法回顾性分析12例经手术病理证实的PCCCL患者的临床及影像学资料,并复习文献。7例行CT平扫和动态增强扫描,8例行MR T1WI,T2WI,DWI和动态增强扫描。结果 12例患者均为男性;10例有乙肝病史,HBsAg(+);6例甲胎蛋白(AFP)阳性,11例为单发病灶,其中10例位于肝右叶,1例位于肝左叶,1例肝内播散;病灶多呈类圆形,边界较为清楚,以实性成分为主。CT平扫呈不均匀等或低密度影,其中2例病灶内部见不规则的更低密度影。增强后动脉期均呈不均匀强化,2例病灶有无强化的低密度区,门静脉期强化程度下降,呈相对低密度,延迟期病灶密度进一步减低。MRI T1WI上病灶多呈低信号,T2WI呈等或不均匀高信号,DWI呈高信号。增强动脉期呈较为明显不均匀强化,动脉期强化较为明显,门静脉期强化程度相对下降,其中2例病灶见环形强化的假包膜。延迟扫描病灶呈低信号。免疫组织化学结果,肿瘤细胞PAS、Hep Par1染色均为阳性,CD10,CA-50多数阳性,但p53及CerbB-2染色均为阴性。结论 PCCCL的影像学表现较为复杂,诊断需结合相关临床资料,确诊依赖病理。     

肝脏原发性神经内分泌肿瘤影像学表现及病理对照

目的 探讨肝脏原发性神经内分泌肿瘤(PHNET)的CT、MRI表现及其病理基础.方法 收集经手术病理证实的PHNET 14例(14例均行CT检查,其中9例行MR检查),分析病灶的CT、MRI表现,探讨形成影像表现的病例基础.结果 PHNET呈单发(8例)或多发结节(5例),弥漫性全肝分布1例.CT平扫呈低密度,1例可见液-液平面病理为内部出血;动脉期呈结节状或环形强化,1例呈弥漫性强化,门静脉期或延迟期强化减低.MRI呈长T1长T2信号,出血呈短T1短T2信号,强化形式与CT相同.随病理分级的提高,病灶由G1单发实性-G2实性或囊实性-G3弥漫性分布或出现肝内转移.扩散加权成像(DWI)呈扩散受限改变.结论 CT、MRI能够显示出PHNET的影像学特殊表现和组织学特征.     

Triple arterial phase dynamic MRI with sensitivity encoding for hypervascular hepatocellular carcinoma: comparison of the diagnostic accuracy among the early, middle, late, and whole triple arterial phase imaging

OBJECTIVE: We assessed and compared the diagnostic accuracy of the early, middle, late, and whole triple arterial phase MRI with sensitivity encoding (SENSE) for the detection of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty-one patients with 102 HCCs underwent dynamic MRI with SENSE. The findings of CT examinations, combined with those of visceral angiography or histopathologic examination, were used as the gold standard. After acquisition of T1- and T2-weighted images, gadolinium-enhanced triple arterial, portal, and delayed phase images were obtained. Acquisition of the triple arterial phase imaging was started at the timing of peak aortic enhancement and completed within a single breath-hold. Acquisition time for each phase was 8.4 sec. Four image sets including the early, middle, late, and whole triple arterial phase imaging were interpreted separately by four observers. The mean values of area under alternative-free-response receiver operating characteristic (AFROC) curve and of sensitivity were compared among the four image sets. RESULTS: The mean values of area under AFROC curve were 0.52, 0.66, 0.53, and 0.68 and of sensitivity were 45%, 64%, 48%, and 65% for the image sets with the early, middle, late, and whole triple arterial phase imaging, respectively. Both mean values were significantly higher for the image sets with the middle and whole triple arterial phase imaging than for those with the early and late arterial phase imaging. CONCLUSION: The middle arterial phase imaging with k-space centered at 12.6 sec after the peak aortic enhancement was optimal for detecting HCC and showed diagnostic accuracy equivalent to that of the whole triple arterial phase imaging.     

肝脏局灶结节性增生的CT、MRI诊断

目的:评估CT、MRI对肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断价值.材料和方法:回顾性分析9例FNH(6例经病理证实,3例经磁共振特异性对比剂Resovist证实)的CT、MRI表现和术前或穿刺前诊断.结果:8例为单发病灶、1例为3个病灶.10个病灶呈稍低密度,其中7个T1WI为稍低信号、T2WI稍高信号,3个病灶T1WI和T2WI为稍高信号;1个病灶为等密度和等信号;CT动脉期明显增强、门静脉期轻度增强或无增强;MRI的增强方式与CT相似,但10个病灶存在明显的延迟增强.7个病灶检出瘢痕,T1WI呈低信号、T2WI高信号,动脉期和门静脉期无增强、延迟期轻至中度增强.8例单发病灶均正确诊断为FNH.结论:CT和MRI能显示FNH的特征性改变并提高诊断的准确性.