MRI对肝孤立性坏死结节诊断及鉴别诊断价值研究
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摘要
目的探讨使用磁共振成像(MRI)平扫和增强扫描检查肝脏孤立性坏死结节(SNNL)的影像学特征。方法 2013年3月～2017年3月我院收治的43例SNNL患者,全部接受MRI检查,分析病灶的表现特征。结果在43例SNNL病灶中,病灶直径为(2.8±0.4) cm,其中38个病灶≤3 cm,5个病灶>3 cm;39个为单发病灶,4个为融合型病灶;36个病灶位于肝右叶,7个病灶位于肝左叶;34个为浅表部位病灶,9个为深部病灶;27个病灶为不规则形,16个为圆形或类圆形;T1WI显示32个病灶呈低信号,6个病灶呈稍低信号,5个呈等信号;T2WI显示2个病灶呈高信号或稍高信号,39个呈等信号,其中4个病灶中可见片状或斑点状高信号;DWI序列显示21个病灶呈等信号,22个呈高信号或稍高信号;43例在增强扫描后病灶内部均未见强化,且均呈低信号。结论 MRI平扫和动态增强扫描能较准确地发现SNNL的特征表现,可为临床诊断提供重要的参考依据。
Objective To summarize the imaging features of solitary necrotic nodules of liver(SNNL).Methods The imaging data of 43 patients with SNNL in our hospital between March 2013 and March 2017 were retrospectively analyzed. The abdominal MRI scan and enhanced examination were performed to observe the imaging features. Results In 43 SNNL lesions,the diameter was(2.8±0.4) cm,with 38 lesions less than and 5greater than 3 cm;39 were a single focci and 4 were fusion lesions;36 lesions were located in the right,and 7 in the left lobe of the liver;34 lesions were superficial,and 9 were deep lesions;27 lesions were irregular,while 16 were round or round-like;32 lesions showed low signal intensity,6 showed slightly low signal intensity,and 5lesions showed iso-signal intensity on T2WI;there were 2 lesions with slightly high signal intensity,and 39 lesions with isointensity on T2WI;21 lesions with equal signal intensity and 22 lesions with high signal intensity or slightly hyperintense signal intensity on DWI sequences;in 43 cases,no enhancement was found in the lesions after enhanced scanning. Conclusions MRI plain scan and dynamic contrast enhancement might provide relatively special imaging feature of SNNL,by which the clinicians could make decision for proper management in this setting.
Objective To summarize the imaging features of solitary necrotic nodules of liver(SNNL).Methods The imaging data of 43 patients with SNNL in our hospital between March 2013 and March 2017 were retrospectively analyzed. The abdominal MRI scan and enhanced examination were performed to observe the imaging features. Results In 43 SNNL lesions,the diameter was(2.8±0.4) cm,with 38 lesions less than and 5greater than 3 cm;39 were a single focci and 4 were fusion lesions;36 lesions were located in the right,and 7 in the left lobe of the liver;34 lesions were superficial,and 9 were deep lesions;27 lesions were irregular,while 16 were round or round-like;32 lesions showed low signal intensity,6 showed slightly low signal intensity,and 5lesions showed iso-signal intensity on T2WI;there were 2 lesions with slightly high signal intensity,and 39 lesions with isointensity on T2WI;21 lesions with equal signal intensity and 22 lesions with high signal intensity or slightly hyperintense signal intensity on DWI sequences;in 43 cases,no enhancement was found in the lesions after enhanced scanning. Conclusions MRI plain scan and dynamic contrast enhancement might provide relatively special imaging feature of SNNL,by which the clinicians could make decision for proper management in this setting.
引文
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[15]Colagrande S,Politi LS,Messerini L,et al.Solitary necrotic nodule of the liver:imaging and-correlation with pathologic features.Abdominal Imag,2003,28(1):41-44.
[16]俞顺,方主亭,包强,等.肝脏孤立性坏死结节的MRI特征与病理对照.中国医学影像学杂志,2013,21(9):641-643.
[17]Qian H,Li S,Ming J,et al.MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules.Eur J Gastroenterol Hepatol,2016,28(7):749-756.
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[19]姜英,常晓燕.肝脏孤立性坏死结节的临床病理分析.中华肝胆外科杂志,2007,13(9):591-593.
[20]Kim TK,Lee KH,Khalili K,et al.Hepatocellular nodules in liver cirrhosis:contrast-enhanced ultrasound.Abdom Imaging,2011,36(3):244-263.
[21]Lee JM,Choi BI.Hepatocellular nodules in liver cirrhosis:MR evaluation.Abdom Imaging,2011,36(3):282-289.
[22]Au-Yeung AW,Luk WH,Lo AX.Imaging features of colorectal liver metastasis in FDG PET-CT:a retrospective correlative analysis between CT attenuation and FDG uptake.Nucl Med Communicat,2012,33(4):403-407.
[23]De LM,Luigi B,Formisano C,et al.Solitary necrotic nodule of the liver misinterpreted as malignant lesion:considerations on two cases.J Surg Oncol,2015,74(3):219-222.
[24]Fang J,Ma X,Yu D,et al.Specific imaging characteristic of solitary necrotic nodule of the liver:Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI.Eur Radiol,2017,27(9):1-11.
[25]张国柄,徐江海.联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值.实用肝脏病杂志,2017,20(6):740-743.
[26]Lim JH,Lee JH.Inflammatory pseudotumor of the liver.Ultrasound and CT features.Clin Imaging,2015,19(1):43-46.
[2]Kang MW,Tay TKY,Poh WT,et al.Solitary necrotic nodule of the liver:radiologic-pathologic correlation in a case with unusual imaging features.Jpn J Radiol,2013,31(4):277-281.
[3]Yang WM,Yu XL,Jie TM,et al.Solitary necrotic nodule of the liver:Contrast-enhanced sonography.J Clin Ultrasound,2010,35(4):177-181.
[4]李晶,唐少珊,于宏伟.超声造影在单发转移性肝癌与肝脏孤立性坏死结节鉴别诊断中的价值.临床肝胆病杂志,2016,32(7):1338-1341.
[5]Li G.Solitary necrotic nodule of the liver:MR findings in 33pathologically proved lesions.Eur J Radiol,2012,81(4):623-629.
[6]Ge M,Zhang J,Wu B,et al.Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2 correction and estimation.Eur Radiol,2016,26(6):1913-1920.
[7]胡中华,周科峰,孔晓健,等.肝内周围型胆管细胞癌MRI表现.中国CT和MRI杂志,2016,14(10):86-88.
[8]Choi CS,Cho EY,Jeong JS,et al.Spontaneous regression of a solitary necrotic nodule of the liver.Hepatol Int,2010,4(3):649-652.
[9]邵丹丹,王雪雪,赵骞,等.肝脏孤立性坏死结节的MRI和CT诊断及鉴别诊断.放射学实践,2015,30(8):845-848.
[10]Tsui WM,Yuen RW,Chow LT,et al.Solitary necrotic nodule of the liver:parasitic origin.J Clin Pathol,1992,45(11):975-978.
[11]Patti R,Cabibi D,Sparacello M,et al.Solitary necrotic nodule of the liver:different pathological findings express a different histogenesis.Case Rep Gastroenterol,2008,2(1):149-154.
[12]Berry CL.Solitary“necrotic nodule”of the liver:a probable pathogenesis.J Clin Pathol,1985,38(11):1278-1279.
[13]Chen CJ,Chou SC,Chen HJ,et al.Solitary necrotic nodule with larval infestation in the liver on 18F-FDG PET/CT.Clin Nucl Med,2010,35(9):724.
[14]Wang LX,Liu K,Lin GW,et al.Solitary necrotic nodules of the liver:Histology and diagnosis with CT and MRI.Hepat Mon,2012,12(8):e6212.
[15]Colagrande S,Politi LS,Messerini L,et al.Solitary necrotic nodule of the liver:imaging and-correlation with pathologic features.Abdominal Imag,2003,28(1):41-44.
[16]俞顺,方主亭,包强,等.肝脏孤立性坏死结节的MRI特征与病理对照.中国医学影像学杂志,2013,21(9):641-643.
[17]Qian H,Li S,Ming J,et al.MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules.Eur J Gastroenterol Hepatol,2016,28(7):749-756.
[18]林光武,欧阳汉,周纯武,等.肝脏孤立性坏死结节的MR表现.中华放射学杂志,2007,41(10):1073-1076.
[19]姜英,常晓燕.肝脏孤立性坏死结节的临床病理分析.中华肝胆外科杂志,2007,13(9):591-593.
[20]Kim TK,Lee KH,Khalili K,et al.Hepatocellular nodules in liver cirrhosis:contrast-enhanced ultrasound.Abdom Imaging,2011,36(3):244-263.
[21]Lee JM,Choi BI.Hepatocellular nodules in liver cirrhosis:MR evaluation.Abdom Imaging,2011,36(3):282-289.
[22]Au-Yeung AW,Luk WH,Lo AX.Imaging features of colorectal liver metastasis in FDG PET-CT:a retrospective correlative analysis between CT attenuation and FDG uptake.Nucl Med Communicat,2012,33(4):403-407.
[23]De LM,Luigi B,Formisano C,et al.Solitary necrotic nodule of the liver misinterpreted as malignant lesion:considerations on two cases.J Surg Oncol,2015,74(3):219-222.
[24]Fang J,Ma X,Yu D,et al.Specific imaging characteristic of solitary necrotic nodule of the liver:Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI.Eur Radiol,2017,27(9):1-11.
[25]张国柄,徐江海.联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值.实用肝脏病杂志,2017,20(6):740-743.
[26]Lim JH,Lee JH.Inflammatory pseudotumor of the liver.Ultrasound and CT features.Clin Imaging,2015,19(1):43-46.