原发性肝透明细胞癌的MRI表现
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摘要
目的探讨原发性肝透明细胞癌(PCCCL)的MRI表现特点。方法收集经病理证实的病例共13例,并完整行MRI平扫及增强扫描,回顾性整理分析病灶的数目、大小、边界、形态、信号、强化方式等特征。结果 13例共14个病灶,单发病灶12例,2个病灶1例,病灶位于肝右叶10个,肝左叶4个,边界清楚呈圆形或类圆形13个,信号混杂10个,信号均一4个,T1WI高信号7个,双回波扫描反相位病灶信号明显减低4个,DWI高信号7个,稍高信号7个,增强扫描均呈经典型肝细胞癌(HCC)的快进快出型强化特征,动脉期轻到中度不均匀强化10个,出现延迟性环形强化的假包膜9个。结论 PCCCL信号混杂,部分病灶双回波扫描反相位信号明显减低,部分T1WI呈高信号,大部分病灶增强呈早期轻到中度不均匀强化,有助于提高对PCCCL诊断率。
Objective To study the of the features of primary clear cell carcinoma of the liver(PCCCL)in MR images. Methods A total of 13 pathologically confirmed cases were retrospectively enrolled. MRI plain scan and enhanced scan were performed. The number, size, boundary, morphology, signal and enhancement pattern of the lesions were analyzed. Results Among the 13 cases, there were 12 cases with single lesion and1 case with 2 lesions, so a total of 14 lesions were included. 10 lesions were located in the right hepatic lobe and 4 lesions were located in the left hepatic lobe. 13 lesions have clear boundaries. 10 lesions showed non-uniformsignal, while 4 lesions showeduniform signal. 7 lesions showed high signal on T1 WI, and 4 lesions showed significantly reduced signal onout phase of the double echo scanning sequence. 7 lesions showed high-signal on DWI sequence and 7 showed slightly high-signal. On dynamic enhanced images, all the lesions showed fast wash-in and fast washout enhancement pattern which was characteristic of HCC. 10 lesions showed mild to moderate enhancement on arterial phase, and 9 lesions showed pseudo-capsular on delayed enhancement phase. Conclusion MRI featuresof PCCCL is similar to that of typical HCC, but PCCCL has some unique characteristics. PCCCL often shows nonuniformsignal, and some lesions showedobviously reduced signal on out phase of the double echo scanning.Some lesions shows high signal on T1 WI, and some lesions shows early mixedenhancement. Along with the clinical record, these features in MRI arehelpful to improve the diagnosticrate of PCCCL.
Objective To study the of the features of primary clear cell carcinoma of the liver(PCCCL)in MR images. Methods A total of 13 pathologically confirmed cases were retrospectively enrolled. MRI plain scan and enhanced scan were performed. The number, size, boundary, morphology, signal and enhancement pattern of the lesions were analyzed. Results Among the 13 cases, there were 12 cases with single lesion and1 case with 2 lesions, so a total of 14 lesions were included. 10 lesions were located in the right hepatic lobe and 4 lesions were located in the left hepatic lobe. 13 lesions have clear boundaries. 10 lesions showed non-uniformsignal, while 4 lesions showeduniform signal. 7 lesions showed high signal on T1 WI, and 4 lesions showed significantly reduced signal onout phase of the double echo scanning sequence. 7 lesions showed high-signal on DWI sequence and 7 showed slightly high-signal. On dynamic enhanced images, all the lesions showed fast wash-in and fast washout enhancement pattern which was characteristic of HCC. 10 lesions showed mild to moderate enhancement on arterial phase, and 9 lesions showed pseudo-capsular on delayed enhancement phase. Conclusion MRI featuresof PCCCL is similar to that of typical HCC, but PCCCL has some unique characteristics. PCCCL often shows nonuniformsignal, and some lesions showedobviously reduced signal on out phase of the double echo scanning.Some lesions shows high signal on T1 WI, and some lesions shows early mixedenhancement. Along with the clinical record, these features in MRI arehelpful to improve the diagnosticrate of PCCCL.
引文
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[13]钟群,赵春雷,钱根年,等.原发性肝癌MSCT动态曲线与血流动力学变化特点[J].功能与分子医学影像学(电子版),2012,1(4):275-278.
[2]Takahashi A,Saito H,Kanno Y,et al.Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman[J].World J Gastroenterol,2008,14:129-131.
[3]Li T,Fan J,Qin LX,et al.Risk factors,prognosis and management of early and late intrahepatic recurrence after resection of primary clear cell carcinoma of the liver[J].Ann Surg Oncol,2011,18(7):1955-1963.
[4]Liu Z,Ma W,Li H,et al.Clinicopathological and prognostic features of primary clear cell carcinoma of the liver[J].Hepatol Res,2008,38:291-299.
[5]Ji SP,Li Q,Dong H.Therapy and prognostic features of primary clear cell carcinoma of the liver[J].World JGastroenterol,2010,16(6):764-769.
[6]Lao XM,Zhang YQ,Jin X,et al.Primary clear cell carcinoma of liver-clinicopathologic features and surgical results of 18 cases[J].Hepatogastroenterology,2006,53(67):128-132.
[7]吴道清,李华灿.肝脏透明细胞癌CT误诊一例[J].功能与分子医学影像学(电子版),2012,1(1):60-61.
[8]Murakata LA,Ishak KG,Nzeako UC,et al.Clear cell carcinoma of the liver:a comparative immunohistochemical study with renal clear cell carcinoma[J].Mod Pathol,2000,13:874-881.
[9]Murakata LA,Ishak KG,Nzeako UC.Clear cell carcinoma of the liver:a comparative immunohistochemical study with renal clear cell carcinoma[J].Mod Pathol,2000,13:874-881.
[10]Clayton EF,Furth EE,Ziober A,et al.A case of primary clear cell hepatocellular carcinoma in a non-cirrhotic liver:an immunohistochemical and ultrastructural study[J].Rare Tumors,2012,4:e29.
[11]Inoue E,Kuroda C,Fujita M,et al.MR features of various histological grades of small hepatocellular carcinoma[J].JComput Assist Tomogr,1993,17(1):75-79.
[12]周梅玲,严福华,李清海,等.原发性透明细胞型肝癌的CT和MRI诊断[J].中华放射学杂志,2010,44(9):950-953.
[13]钟群,赵春雷,钱根年,等.原发性肝癌MSCT动态曲线与血流动力学变化特点[J].功能与分子医学影像学(电子版),2012,1(4):275-278.