CAJ | 학술논문

目的探讨常规磁共振成像(MRI)与磁共振弥散加权成像(DWI)在不同分化程度小肝癌(sHCC)的影像学特征及诊断价值.方法经病理结果证实的40例sHCC瘤灶分为4组:高分化组(n=6)、高中分化组(n=5)、中分化组(n=27)和中低分化组(n=2).所有患者均行常规MRI和DWI(1.5T,b=0和600 s/mm2)检查,对sHCC瘤灶的影像学特征进行观察,测量其ADC值并进行统计学分析.结果 sHCC瘤灶T1WI上呈稍低/低信号有32例,呈稍高/高信号有4例(高分化组),呈等信号有4例(高中=2,中分化=2).T2WI上呈稍高/高信号有39例,高分化组中1例呈等信号.瘤灶脂肪变为17例(17/40,42.5％,高=4,高中=1,中=12).伴有包膜形成有67.5％(27/40,高=4,高中=3,中=18,中低=2).增强扫描动脉期瘤灶呈多血供有32例,少血供有8例(高=3,中=4,中低=1).DWI上除高分化组中3例呈等信号外(50％,3/6),其余37例均呈稍高/高信号.高、高中、中和中低分化组的sHCC病灶的平均ADC值分别为(1.757±0.337)×10-3、(1.917±0.574)×10-3、(1.816±0.545)×10-3和(1.723±0.217)×10-3,4组之间差别无统计学意义.结论常规MRI上高中、中、中低分化sHCC影像学表现较典型,DWI上均呈高信号;但部分高分化sHCC常规影像表现不典型,DWI上可呈等或高信号,此时动态密切随访至关重要.总之,常规MRI联合DWI检查有助于sHCC的早期诊断,尤其是不典型sHCC.
목적 탐토상규자공진성상(MRI)여자공진미산가권성상(DWI)재불동분화정도소간암(sHCC)적영상학특정급진단개치.방법 경병리결과증실적40례sHCC류조분위4조:고분화조(n=6)、고중분화조(n=5)、중분화조(n=27)화중저분화조(n=2).소유환자균행상규MRI화DWI(1.5T,b=0화600 s/mm2)검사,대sHCC류조적영상학특정진행관찰,측량기ADC치병진행통계학분석.결과 sHCC류조T1WI상정초저/저신호유32례,정초고/고신호유4례(고분화조),정등신호유4례(고중=2,중분화=2).T2WI상정초고/고신호유39례,고분화조중1례정등신호.류조지방변위17례(17/40,42.5％,고=4,고중=1,중=12).반유포막형성유67.5％(27/40,고=4,고중=3,중=18,중저=2).증강소묘동맥기류조정다혈공유32례,소혈공유8례(고=3,중=4,중저=1).DWI상제고분화조중3례정등신호외(50％,3/6),기여37례균정초고/고신호.고、고중、중화중저분화조적sHCC병조적평균ADC치분별위(1.757±0.337)×10-3、(1.917±0.574)×10-3、(1.816±0.545)×10-3화(1.723±0.217)×10-3,4조지간차별무통계학의의.결론 상규MRI상고중、중、중저분화sHCC영상학표현교전형,DWI상균정고신호;단부분고분화sHCC상규영상표현불전형,DWI상가정등혹고신호,차시동태밀절수방지관중요.총지,상규MRI연합DWI검사유조우sHCC적조기진단,우기시불전형sHCC.
Objective To study the imaging apperances and the diagnostic value of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating histopathological types of small hepatocellular carcinoma (sHCC).Methods 40 sHCC confirmed by histopathology were classified into 4 groups according to their degree of differentiation:well (n=6),well-moderate (n=5),moderate (n=27) and moderate-poor (n =2).All patients received conventional MRI and DWI (1.5T,b =0 and 600 s/mm2) before the operation.The ADC values of the sHCC were measured and compared.Results On T1WI,32 lesions showed hypointensity,4 hyperintensity (well) and 4 isointensity (well-moderate =2,moderate =2).On T2WI,hyperintensity was observed in 39 lesions and isointensity in 1 lesion (well).Steatosis in the sHCC was seen in 17 of 40lesions (17/40,42.5 ％,well=4,well-moderate=1 and moderate=12).A pseudocapsule was seen in 67.5 ％ sHCC (27/40,well=4,well-moderate=3,moderate=18 and moderate-poor=2).32 lesions showed hypervascularity on arterial phase,and 8 lesions showed hypovascularity (well=3,moderate =4,moderate-poor=1).On DWI,37 lesions showed hyperintensity,except for 3 lesions with welldifferentiated sHCC which showed isointensity (50％,3/6).The mean ADC values±S.D.of sHCC in the well,well-moderate,moderate and moderate-poor groups were (1.757 ± 0.337) × 10-3,(1.917±0.574)×103,(1.816±0.545)×103 and (1.723±0.217)×10-3,respectively.There were no significant differences among the 4 groups.Conclusion The imaging appearances of wellmoderate,moderate and moderate-poor sHCC on conventional MRI were classical which make diagnosis easy.Hyperintensity on DWI contributed to diagnosis.However,the imaging appearances of some well-differentiated sHCC were atypical.The lesions could be isointensity or hyperintensity on DWI.The combination of conventional MRI and DWI contributed to better diagnosis of sHCC,especial for atypical sHCC.