目的 探讨CT及MRI对肝脏局灶性结节增生(focal nodular hyperplasia,FNH)的诊断价值.方法 回顾性分析16例经病理证实的FNH的CT及MRI检查资料.所有病例均行CT平扫及动态增强扫描,9例行MRI平扫及动态增强扫描.结果 (1)16例共19个病灶,位于肝左叶8个,肝右叶5个,跨叶4个,尾叶2个.病灶形态规则,15个病灶边界清晰,4个边界模糊.瘤体直径2.2～9.6 cm,平均4.3 cm.(2)16例均行CT检查,平扫5例为等密度,11例为稍低密度,7例见裂隙状、星芒状低密度中央瘢痕.9例行MRI检查,T2WI呈稍高信号6例,等信号3例;T1 WI呈稍低信号4例,等信号3例,稍高信号2例,反相位1例局部信号减低.6例病灶见中央瘢痕,T2WI呈高信号,T1WI呈低信号.(3)CT增强:动脉期15例呈明显强化,1例轻度强化,所有病灶中心瘢痕均未见强化,其中5例见明显强化增粗迂曲的动脉;门脉期强化程度均不同程度减低,12例呈稍高密度,3例呈等密度,1例呈低密度,其中3例中央瘢痕轻度强化;延迟期病灶实质部分强化程度持续下降,3例呈稍高密度,9例呈等密度,4例呈稍低密度,7例中央瘢痕延迟期强化呈稍高密度.9例行MRI增强三期信号变化特点类似CT增强特点,但动脉期强化幅度高于CT,门静脉期4例中央瘢痕开始强化,延迟期6例均持续强化呈稍高信号;1例较大病灶延迟期出现持续延迟强化包膜.(4)6例DWI呈不均匀稍高信号,中心见裂隙状低信号区,3例呈等信号.病变区ADC值:(1.31±0.08)×10-3mm2/s,正常肝实质ADC值(1.22±0.14)×10-3mm2/s,两者差异无统计学意义.结论 CT和MRI平扫及动态增强扫描能全面、准确显示FNH的病理特征及血供特点.FNH的CT和MRI征象具有特征性,两者均能对其做出准确诊断,MRI较CT略有优势,二者相结合对FNH的诊断及鉴别诊断具有重要临床应用价值.
目的 探討CT及MRI對肝髒跼竈性結節增生(focal nodular hyperplasia,FNH)的診斷價值.方法 迴顧性分析16例經病理證實的FNH的CT及MRI檢查資料.所有病例均行CT平掃及動態增彊掃描,9例行MRI平掃及動態增彊掃描.結果 (1)16例共19箇病竈,位于肝左葉8箇,肝右葉5箇,跨葉4箇,尾葉2箇.病竈形態規則,15箇病竈邊界清晰,4箇邊界模糊.瘤體直徑2.2～9.6 cm,平均4.3 cm.(2)16例均行CT檢查,平掃5例為等密度,11例為稍低密度,7例見裂隙狀、星芒狀低密度中央瘢痕.9例行MRI檢查,T2WI呈稍高信號6例,等信號3例;T1 WI呈稍低信號4例,等信號3例,稍高信號2例,反相位1例跼部信號減低.6例病竈見中央瘢痕,T2WI呈高信號,T1WI呈低信號.(3)CT增彊:動脈期15例呈明顯彊化,1例輕度彊化,所有病竈中心瘢痕均未見彊化,其中5例見明顯彊化增粗迂麯的動脈;門脈期彊化程度均不同程度減低,12例呈稍高密度,3例呈等密度,1例呈低密度,其中3例中央瘢痕輕度彊化;延遲期病竈實質部分彊化程度持續下降,3例呈稍高密度,9例呈等密度,4例呈稍低密度,7例中央瘢痕延遲期彊化呈稍高密度.9例行MRI增彊三期信號變化特點類似CT增彊特點,但動脈期彊化幅度高于CT,門靜脈期4例中央瘢痕開始彊化,延遲期6例均持續彊化呈稍高信號;1例較大病竈延遲期齣現持續延遲彊化包膜.(4)6例DWI呈不均勻稍高信號,中心見裂隙狀低信號區,3例呈等信號.病變區ADC值:(1.31±0.08)×10-3mm2/s,正常肝實質ADC值(1.22±0.14)×10-3mm2/s,兩者差異無統計學意義.結論 CT和MRI平掃及動態增彊掃描能全麵、準確顯示FNH的病理特徵及血供特點.FNH的CT和MRI徵象具有特徵性,兩者均能對其做齣準確診斷,MRI較CT略有優勢,二者相結閤對FNH的診斷及鑒彆診斷具有重要臨床應用價值.
목적 탐토CT급MRI대간장국조성결절증생(focal nodular hyperplasia,FNH)적진단개치.방법 회고성분석16례경병리증실적FNH적CT급MRI검사자료.소유병례균행CT평소급동태증강소묘,9례행MRI평소급동태증강소묘.결과 (1)16례공19개병조,위우간좌협8개,간우협5개,과협4개,미협2개.병조형태규칙,15개병조변계청석,4개변계모호.류체직경2.2～9.6 cm,평균4.3 cm.(2)16례균행CT검사,평소5례위등밀도,11례위초저밀도,7례견렬극상、성망상저밀도중앙반흔.9례행MRI검사,T2WI정초고신호6례,등신호3례;T1 WI정초저신호4례,등신호3례,초고신호2례,반상위1례국부신호감저.6례병조견중앙반흔,T2WI정고신호,T1WI정저신호.(3)CT증강:동맥기15례정명현강화,1례경도강화,소유병조중심반흔균미견강화,기중5례견명현강화증조우곡적동맥;문맥기강화정도균불동정도감저,12례정초고밀도,3례정등밀도,1례정저밀도,기중3례중앙반흔경도강화;연지기병조실질부분강화정도지속하강,3례정초고밀도,9례정등밀도,4례정초저밀도,7례중앙반흔연지기강화정초고밀도.9례행MRI증강삼기신호변화특점유사CT증강특점,단동맥기강화폭도고우CT,문정맥기4례중앙반흔개시강화,연지기6례균지속강화정초고신호;1례교대병조연지기출현지속연지강화포막.(4)6례DWI정불균균초고신호,중심견렬극상저신호구,3례정등신호.병변구ADC치:(1.31±0.08)×10-3mm2/s,정상간실질ADC치(1.22±0.14)×10-3mm2/s,량자차이무통계학의의.결론 CT화MRI평소급동태증강소묘능전면、준학현시FNH적병리특정급혈공특점.FNH적CT화MRI정상구유특정성,량자균능대기주출준학진단,MRI교CT략유우세,이자상결합대FNH적진단급감별진단구유중요림상응용개치.
Objectives To study the value of CT and MRI in diagnosing focal nodular hyperplasia (FNH).Methods The CT and MRI findings of 16 patients with FNH confirmed histopathologically were analyzed retrospectively.Both plain and dynamic enhanced CT scannings were performed in all the patients.Plain and dynamic enhanced MRI were carried out in 9 patients.Results (1) There were 16 patients with 19 lesions,and 8 lesions were in the left lobe,5 lesions in the right lobe,4 lesions between the left/right lobes and 2 lesions in the caudate lobe.The morphology of the lesions showed 15 lesions to have clear boundaries and 4 lesions to have fuzzy boundaries.The tumor diameters varied from 2.2 to 9.6 cm,(average 4.3 cm).(2) Sixteen patients underwent CT examination.On plain CT,the lesions were isotonic (n＝ 5),or slightly low-density (n=11).In 7 lesions,there was a slit-like,stellate-shaped low density central scar.Nine patients underwent MRI examination.On T2WI,6 lesions showed slightly higher signal while the remaining 3 lesions showed iso-signal.On T1WI,4 lesions showed slightly lower signal,3 lesions showed iso-signal and 2 lesions showed slightly higher signal while in 1 lesion the local signal showed reduction in anti-phase 1.A central scar was seen in 6 lesions which showed high signal on T2WI,and low signal on T1WI.(3) Enhanced CT: 15 lesions were significantly enhanced and 1 lesion showed mild enhancement at the arterial phase.For the patients with mild enhancement,the scar in the center of the lesion showed no enhancement.In all lesions,the central scar did not enhance.In 5 lesions,enhancements of thickened and torturous arteries were seen.In all the lesions with enhancement,the enhancement was reduced at the portal venous phase,with 12 lesions showing slightly higher density,3 lesions isodensity and 1 lesion low-density.Three lesions showed mild enhancement of the central scar.All the substantial parts of the lesions with enhancement declined at the delay phase,with 3 lesions showing slightly higher density,9 lesions of isodensity and 4 lesions slightly low density.In 7 lesions with central scar delayed enhancement,they showed slightly higher density.Nine patients underwent MRI enhancement and the enhancement characteristics were similar to CT,but the arterial phase magnitude was higher than that of CT.In 4 lesions,the central scar began to enhance at the portal venous phase,while 6 lesions continued to enhance,thus showing slightly higher signal at the delay phase.In a large lesion,there was persistent delayed enhancement in the capsule.(4) On DWI,6 lesions showed inhomogeneous,slightly hyperintensity with the center showing a slit-like low signal area.Three lesions showed iso-signal.The ADC values of the lesions were (1.31±0.08)× 10-3 mm2/s,and the normal liver parenchyma were (1.22± 0.14)× 10-3 mm2/s,(difference not statistically significant).Conclusions CT and MRI using plain and dynamic enhanced scans could show fully and accurately the pathological features and the characteristics of blood supply of FNH.The characteristic signs on both CT and MRI make an accurate diagnosis of FNH.MRI when compared with CT was slightly better.A combined use of both CT and MRI has an important value in the diagnosis of FNH.
