中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
4期
288-293
,共6页
盛若凡%曾蒙苏%饶圣祥%纪元%陈伶俐
盛若凡%曾矇囌%饒聖祥%紀元%陳伶俐
성약범%증몽소%요골상%기원%진령리
肝肿瘤%肝细胞癌%胆管细胞癌%磁共振成像%对比分析
肝腫瘤%肝細胞癌%膽管細胞癌%磁共振成像%對比分析
간종류%간세포암%담관세포암%자공진성상%대비분석
Liver neoplasms%Hepatocellular carcinoma%Cholangiocarcinoma%Magnetic resonance imaging%Comparative study
目的 探讨小肝细胞癌(sHCC)及肿块型肝内小胆管细胞癌(sIMCC)的MRI表现特征.方法 回顾性分析经手术病理证实的318例sHCC患者(351个病灶)及42例sIMCC患者(47个病灶)资料,所有患者均行肝脏MR平扫及动态增强扫描检查.对2组患者病灶T2WI及动态增强各期的MR信号特点、强化模式、伴随征象进行分析.采用x2检验或Fisher精确概率检验对2组间MRI扫描特征比较,单因素分析中具有统计学意义的影像指标进行多因素逻辑回归分析;同时根据甲胎蛋白(AFP)值对sHCC进行亚组分析,采用x2检验比较AFP正常及升高组强化模式.结果 MR扫描特征中,强化模式及伴随征象中的肿瘤(假)包膜、肝包膜回缩是鉴别sHCC和sIMCC的主要指标,对比剂廓清(276/351)伴肿瘤(假)包膜的显现(275/351)高度提示sHCC,而填充进展的强化模式(27/47)伴肝包膜回缩(8/47)有助于sIMCC的诊断(P＜0.01).相较于AFP正常组,填充进展(4例)及持续稳定(32例)强化模式多见于AFP升高组sHCC中,2组间动态增强模式差异具有统计学意义(x2 =8.241,P＜0.05).结论 动态增强模式及肿瘤(假)包膜、肝包膜回缩征象是鉴别sHCC及sIMCC最重要的影像指标;同时,AFP正常sHCC患者的病灶强化方式相对典型,有利于临床正确诊断.
目的 探討小肝細胞癌(sHCC)及腫塊型肝內小膽管細胞癌(sIMCC)的MRI錶現特徵.方法 迴顧性分析經手術病理證實的318例sHCC患者(351箇病竈)及42例sIMCC患者(47箇病竈)資料,所有患者均行肝髒MR平掃及動態增彊掃描檢查.對2組患者病竈T2WI及動態增彊各期的MR信號特點、彊化模式、伴隨徵象進行分析.採用x2檢驗或Fisher精確概率檢驗對2組間MRI掃描特徵比較,單因素分析中具有統計學意義的影像指標進行多因素邏輯迴歸分析;同時根據甲胎蛋白(AFP)值對sHCC進行亞組分析,採用x2檢驗比較AFP正常及升高組彊化模式.結果 MR掃描特徵中,彊化模式及伴隨徵象中的腫瘤(假)包膜、肝包膜迴縮是鑒彆sHCC和sIMCC的主要指標,對比劑廓清(276/351)伴腫瘤(假)包膜的顯現(275/351)高度提示sHCC,而填充進展的彊化模式(27/47)伴肝包膜迴縮(8/47)有助于sIMCC的診斷(P＜0.01).相較于AFP正常組,填充進展(4例)及持續穩定(32例)彊化模式多見于AFP升高組sHCC中,2組間動態增彊模式差異具有統計學意義(x2 =8.241,P＜0.05).結論 動態增彊模式及腫瘤(假)包膜、肝包膜迴縮徵象是鑒彆sHCC及sIMCC最重要的影像指標;同時,AFP正常sHCC患者的病竈彊化方式相對典型,有利于臨床正確診斷.
목적 탐토소간세포암(sHCC)급종괴형간내소담관세포암(sIMCC)적MRI표현특정.방법 회고성분석경수술병리증실적318례sHCC환자(351개병조)급42례sIMCC환자(47개병조)자료,소유환자균행간장MR평소급동태증강소묘검사.대2조환자병조T2WI급동태증강각기적MR신호특점、강화모식、반수정상진행분석.채용x2검험혹Fisher정학개솔검험대2조간MRI소묘특정비교,단인소분석중구유통계학의의적영상지표진행다인소라집회귀분석;동시근거갑태단백(AFP)치대sHCC진행아조분석,채용x2검험비교AFP정상급승고조강화모식.결과 MR소묘특정중,강화모식급반수정상중적종류(가)포막、간포막회축시감별sHCC화sIMCC적주요지표,대비제곽청(276/351)반종류(가)포막적현현(275/351)고도제시sHCC,이전충진전적강화모식(27/47)반간포막회축(8/47)유조우sIMCC적진단(P＜0.01).상교우AFP정상조,전충진전(4례)급지속은정(32례)강화모식다견우AFP승고조sHCC중,2조간동태증강모식차이구유통계학의의(x2 =8.241,P＜0.05).결론 동태증강모식급종류(가)포막、간포막회축정상시감별sHCC급sIMCC최중요적영상지표;동시,AFP정상sHCC환자적병조강화방식상대전형,유리우림상정학진단.
Objective To compare the MR features of small hepatocellular carcinoma (sHCC) and small intrahepatic mass-forming cholangiocarcinoma (sIMCC) (≤ 3 cm) and improve the accuracy in diagnosis.Methods Imaging studies of 318 patients with 351 sHCCs and 42 patients with 47 sIMCCs were retrospectively reviewed.Signal intensity on T2WI and on each phase of dynamic enhanced imaging,enhancement patterns,and accompanying findings of the two groups were compared by qualitative and quantitative studies.The qualitative imaging features of tumors were compared by the x2 test and the Fisher exact test,and the statistically significant variables obtained from univariate analysis were used to conduct multivariate stepwise logistic regression analysis.Enhancement pattern between sHCCs with elevated AFP and normal AFP were assessed by thex2 test.Results Multivariate analysis indicated that signal features of enhancement pattern and the accompanying findings of tumor capsule and hepatic capsule retraction were key predictors in differentiating sHCC from sIMCC:Wash-out pattern (276/351) with enhanced tumor capsule (275/351) highly indicated sHCC,while progressive enhancement pattern (27/47) with hepatic capsule retraction (8/47) indicated the diagnosis of sIMCC (P ＜ 0.01).Compared with sHCC with normal AFP,atypical patterns as progressive (n =4) and stable enhancement (n =32) were more commonIy seen in lesions with elevated AFP,dynamic enhancement pattern was different between the two subgroups (x2 =8.241,P ＜ 0.05).Conclusions Enhancement patterns and the accompanying tumor capsule and hepatic capsule retraction were the most important predictors in differentiating sHCC from sIMCC.In addition,enhancement pattern was relatively more typical in sHCCs with normal AFP which provided valuable information in diagnosis for clinicians.
