CAJ | 학술논문

目的探讨肝硬化结节癌变的磁敏感加权成像(SWI)表现.方法搜集临床拟诊慢性肝病、肝硬化或肝癌的患者资料,73例共83个病理证实的肝硬化相关结节纳入本研究,其中异型增生结节(DN)9例共9个病灶,DN癌变结节7例共15个病灶,肝细胞癌(HCC) 57例共59个病灶.术前行T1WI、T2WI、动态增强和SWI检查,在SWI图像上评价结节及背景肝脏的信号特征.术后标本行普鲁士蓝染色,评价其铁沉积程度及模式.结果 69例背景肝脏可见铁沉积.9个DN在SWI图像上呈低信号,病理均见铁沉积,7个铁沉积程度与背景肝脏一致,2个低于背景肝脏.SWI显示了14个DN癌变结节,呈均匀或不均匀高信号,其中6个可见局灶性增生活跃灶形成的亚结节,背景结节呈低信号,亚结节呈高信号,背景结节病理均见铁沉积,亚结节有1个见1级铁沉积,另5个无铁沉积.57例HCC患者中,SWI显示50例共55个HCC病灶背景肝脏有铁沉积,HCC在SWI图像上呈高信号,但17个病灶因瘤内出血见斑片状低信号区,病理上52个无铁沉积,3个见1或2级铁沉积.结论 SWI能够准确显示肝硬化结节内源性铁沉积改变.在SWI图像上,DN呈低信号,DN癌变结节及HCC呈高信号.
목적 탐토간경화결절암변적자민감가권성상(SWI)표현.방법 수집림상의진만성간병、간경화혹간암적환자자료,73례공83개병리증실적간경화상관결절납입본연구,기중이형증생결절(DN)9례공9개병조,DN암변결절7례공15개병조,간세포암(HCC) 57례공59개병조.술전행T1WI、T2WI、동태증강화SWI검사,재SWI도상상평개결절급배경간장적신호특정.술후표본행보로사람염색,평개기철침적정도급모식.결과 69례배경간장가견철침적.9개DN재SWI도상상정저신호,병리균견철침적,7개철침적정도여배경간장일치,2개저우배경간장.SWI현시료14개DN암변결절,정균균혹불균균고신호,기중6개가견국조성증생활약조형성적아결절,배경결절정저신호,아결절정고신호,배경결절병리균견철침적,아결절유1개견1급철침적,령5개무철침적.57례HCC환자중,SWI현시50례공55개HCC병조배경간장유철침적,HCC재SWI도상상정고신호,단17개병조인류내출혈견반편상저신호구,병리상52개무철침적,3개견1혹2급철침적.결론 SWI능구준학현시간경화결절내원성철침적개변.재SWI도상상,DN정저신호,DN암변결절급HCC정고신호.
Objective To investigate imaging characteristics of multistep hepatocarcinogenesis in cirrhotic livers on susceptibility-weighted imaging (SWI).Methods Seventy-three patients with 83 nodules in cirrhotic livers underwent hepatic MR imaging with SWI.Two radiologists reviewed MR images by consensus.Imaging characteristics of dysplastic nodules (DN),DN with malignant foci and hepatocellular carcinoma (HCC) were evaluated.Prussian blue staining was performed for semiquantification of hepatic iron content and above cirrhosis-associated nodules.Results Positive iron staining of background liver parenchyma was found in 69 of 73 patients and 4 HCC patients showed iron-negative staining of background liver parenchyma.Nine DNs appeared as hypointensity or isointensity with pathologically confirmed similar (n =7) or slightly decreased (n =2) iron deposition compared with background liver parenchyma.SWI detected 14 of 15 DNs with malignant foci.Seven patients appeared as homogeneous hyperintensity and 1 patient appeared as heterogeneous hyperintensity due to intratumoral hemorrhages.The remaining 6 patients demonstrated as nodule-in-nodule appearance with iron deposition in all background nodules,iron deposition with grade 1 in one internal HCC foci,and iron-free in 5 internal HCC foci.The remaining 50 patients with hepatic iron deposition had 55 HCC lesions.Three HCC lesions had iron deposition with grade 1 to 2 and the remaining 52 HCC lesions were pathologically iron-resistant.HCC appeared as hyperintensity compared with siderotic surrounding liver parenchyma.However,HCCs with diameter larger than 3 cm usually demonstrated heterogeneous hyperintensity due to intratumoral hemorrhage.Conclusions SWI could accurately demonstrate dynamic iron depletion on multistep hepatocarcinogenesis in cirrhotic livers.On SWI images,DNs appear as hypointensity due to siderosis and malignant nodules appear as hyperintensity due to iron depletion.