CAJ | 학술논문

目的：分析肝脏局灶性结节增生(FNH)的 MRI 表现并与30~36个月后 MRI 复查对比。方法13例(15个病灶)中12例(14个病灶)MRI 诊断 FNH 并经30~36个月后 MRI 复查证实。常规平扫后静脉团注钆喷酸葡胺(Gd-DTPA)动态增强扫描；另1病例常规平扫后使用普美显增强。分析病变大小、信号、强化方式,并与复查资料对比。结果93.33%(14/15)为经典型MRI 表现：T1 WI 等或稍低信号,T2 WI 等或稍高信号,Gd-DTPA 动态增强动脉期明显强化,门脉期、延迟期强化程度减低但仍高于周围肝实质或与其等信号,长 T1、长 T2信号的中心瘢痕强化、病变内小血管样强化、假包膜环形强化则在延迟期较明显；1例使用普美显增强的病例,动脉期、门脉期强化明显,肝细胞期病变稍高于正常肝实质信号,而长 T1、长 T2信号的中央瘢痕增强后始终呈低信号。6.67%(1/15)为非经典型：T1 WI 等信号,T2 WI 稍高信号,动脉期病变无强化,门脉期轻微强化,延迟期病变内小血管样强化。追踪观察30~36个月,92.86%(13/14)的病变无变化,1个直径10 mm 的病变消失。结论典型的 FNH 的 MRI 表现有一定的特征：呈等或稍长 T1、等或稍长 T2信号,动脉期明显强化,中心瘢痕强化及病变内小血管样强化在延迟期明显,具有鉴别诊断价值；随访观察大部分病变无变化。
목적：분석간장국조성결절증생(FNH)적 MRI 표현병여30~36개월후 MRI 복사대비。방법13례(15개병조)중12례(14개병조)MRI 진단 FNH 병경30~36개월후 MRI 복사증실。상규평소후정맥단주구분산포알(Gd-DTPA)동태증강소묘；령1병례상규평소후사용보미현증강。분석병변대소、신호、강화방식,병여복사자료대비。결과93.33%(14/15)위경전형MRI 표현：T1 WI 등혹초저신호,T2 WI 등혹초고신호,Gd-DTPA 동태증강동맥기명현강화,문맥기、연지기강화정도감저단잉고우주위간실질혹여기등신호,장 T1、장 T2신호적중심반흔강화、병변내소혈관양강화、가포막배형강화칙재연지기교명현；1례사용보미현증강적병례,동맥기、문맥기강화명현,간세포기병변초고우정상간실질신호,이장 T1、장 T2신호적중앙반흔증강후시종정저신호。6.67%(1/15)위비경전형：T1 WI 등신호,T2 WI 초고신호,동맥기병변무강화,문맥기경미강화,연지기병변내소혈관양강화。추종관찰30~36개월,92.86%(13/14)적병변무변화,1개직경10 mm 적병변소실。결론전형적 FNH 적 MRI 표현유일정적특정：정등혹초장 T1、등혹초장 T2신호,동맥기명현강화,중심반흔강화급병변내소혈관양강화재연지기명현,구유감별진단개치；수방관찰대부분병변무변화。
Objective To analyze the MR manifestations of the focal nodular hyperplasia (FNH)in liver and observe the MRI changes after 30-36 months.Methods 12 (14 lesions)of the 13 patients (1 5 lesions)were firstly diagnosed as FNH by MRI with plain scan and dynamic Gd-DTPA enhancement,and then were confirmed by the follow-up survey with similar MRI after 30 - 36 months.The last one patient was also scanned with Gd-EOB-DTPA enhancement but with similar plain scans.The size,signal,en-hancement patterns of the lesions were analyzed and compared with those in the follow-up survey.Results Typical MR manifesta-tions were found in 93.33%(14/1 5)of the lesions with hypo-or iso-intensity on T1 WI,hyper-or iso-intensity on T2 WI,marked en-hancement in arterial phase and attenuation but still equal to or higher than normal liver parenchyma in portal and delayed phases af-ter Gd-DTPA administration.In addition,the central scar showed hypointensity on T1 WI,hyperintensity on T2 WI,and enhance-ment in delayed phase.The enhanced small vessels inside lesions and the pesudocapsule enhancement could be seen in delayed phase. The only one lesion with Gd-EOB-DTPA enhancement showed marked enhancement in arterial and portal phases,and slight hyperin-tensity in hepatocellular phase with hypo-intense central scar in any phases.As for the only one lesion with atypical manifestation,it showed isointensity on T1 WI,slightly hyperintensity on T2 WI,nonenhancement in arterial phase,slightly enhancement in portal phase,and small vascular enhancement inside the lesion in delayed phase.After the follow-up survey of 30-36 months 92.86%(13/14)lesions did not change,however one lesion (10mm)disappeared.Conclusion Typical FNH shows similar MRI characteristics, iso-intense or slightly hypo-intense signal on T1 WI,iso-intense or slightly hyper-intense signal on T2 WI,marked enhancement in ar-terial phase,the central scar enhancement and the inside small vascular enhancement of lesions in delayed phase.It is valuable in dif-ferential diagnosis.