钆塞酸二钠增强MRI假性廓清型肝血管瘤的征象分析
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摘要
目的比较假性廓清(PWS)与非PWS肝血管瘤钆塞酸二钠(Gd-EOB-DTPA)增强MRI表现特点,总结PWS型血管瘤的相关影像学特征。方法回顾性分析行肝脏Gd-EOB-DTPA增强MRI检查的62例患者共83个肝血管瘤的影像资料。对肝血管瘤的强化方式(动脉期:结节状强化,均匀强化,动静脉瘘强化;门静脉期:是否充盈强化;过渡期:是否PWS;肝胆特异期:是否低信号)及强化程度(较肝实质信号明显增高,4分;较肝实质信号轻度增高,3分;与肝实质信号相等,2分;信号低于肝实质,1分)进行评估。采用卡方检验比较PWS与非PWS组或不同大小组肝血管瘤各期强化方式,采用Mann-Whitney U检验比较PWS及非PWS组肝血管瘤的大小及各期强化程度评分。结果 83个肝血管瘤中,14个(16. 9%)表现为PWS。与非PWS组肝血管瘤相比,PWS组血管瘤的最大径较小(P <0. 05),动脉期均匀强化比例较大(P <0. 05),动脉期结节状强化及门静脉期充盈强化的比例较小(P<0. 05),门静脉期强化程度评分较低(P <0. 05)。结论 Gd-EOB-DTPA增强MRI检查时,体积较小、动脉期均匀强化或门静脉期强化程度评分较低的肝血管瘤过渡期易表现PWS。
Objective To clarify the imaging characteristics of hemangiomas with Pseudo washout sign( PWS) by comparing their features with those without PWS on Gd-EOB-DTPA-enhanced MRI. Methods From Jan,2012 to May,2017,the imaging information of sixty-two patients with 83 hemangiomas were retrospectively analysed. The enhancement pattern( nodular enhancement、diffuse homogenous enhancement and arterioportal shunt during the arterial phase,fill-in enhancement during the portal venous phase,PWS during the transition phase) and the intensity of contrast enhancement( in relation to that of the liver parenchyma using a four-point scale during each phase : grade 4,clearly higher; grade 3,moderately higher; grade 2,equal; grade 1,lower) of the lesions were investigated independently. Chi-square test was performed to compare the enhancement pattern of the hemangiomas with and without PWS or from different size groups. Mann-Whitney U test was performed to compare the size and enhancement degree of hemangiomas with and without PWS. Results Among 83 hepatic hemangiomas,16. 9%( 14) were characterized with PWS,which were significantly smaller than those without PWS( P< 0. 05); Hemangiomas with PWS were more frequently observed to have diffuse enhancement,but less nodular or fill-in enhancement( P < 0. 05); Enhancement degree was significantly lower in hemangiomas with PWS during portal venous phase( P < 0. 05). Conclusion Hepatic hemangiomas with the characterization of being small 、showing diffuse enhancement during arterial phase or lower enhancement degree during portal venous phase tend to show PWS during the transition phase on Gd-EOB-DTPA-enhanced MRI.
Objective To clarify the imaging characteristics of hemangiomas with Pseudo washout sign( PWS) by comparing their features with those without PWS on Gd-EOB-DTPA-enhanced MRI. Methods From Jan,2012 to May,2017,the imaging information of sixty-two patients with 83 hemangiomas were retrospectively analysed. The enhancement pattern( nodular enhancement、diffuse homogenous enhancement and arterioportal shunt during the arterial phase,fill-in enhancement during the portal venous phase,PWS during the transition phase) and the intensity of contrast enhancement( in relation to that of the liver parenchyma using a four-point scale during each phase : grade 4,clearly higher; grade 3,moderately higher; grade 2,equal; grade 1,lower) of the lesions were investigated independently. Chi-square test was performed to compare the enhancement pattern of the hemangiomas with and without PWS or from different size groups. Mann-Whitney U test was performed to compare the size and enhancement degree of hemangiomas with and without PWS. Results Among 83 hepatic hemangiomas,16. 9%( 14) were characterized with PWS,which were significantly smaller than those without PWS( P< 0. 05); Hemangiomas with PWS were more frequently observed to have diffuse enhancement,but less nodular or fill-in enhancement( P < 0. 05); Enhancement degree was significantly lower in hemangiomas with PWS during portal venous phase( P < 0. 05). Conclusion Hepatic hemangiomas with the characterization of being small 、showing diffuse enhancement during arterial phase or lower enhancement degree during portal venous phase tend to show PWS during the transition phase on Gd-EOB-DTPA-enhanced MRI.
引文
1程伟中,曾蒙苏.新型多功能磁共振对比剂Gd-EOB-DTPA在肝胆系统病变中的应用[J].临床放射学杂志,2005,24:1107-1110.
2王荃荣子,刘希胜,俞同福,等.Gd-EOB-DTPA在肝脏局部结节性病变诊断中的应用[J].实用放射学杂志,2013,29:776-779.
3梁波.普美显在肝局灶性结节增生与肝细胞肝癌鉴别诊断中的价值[J].医学影像学杂志,2015,25:2175-2179.
4黄海东,曾蒙苏,丁玉芹,等.Gd-EOB-DTPA磁共振成像在慢性肝炎背景下小肝癌诊断中的应用[J].临床放射学杂志,2015,34:1085-1089.
5 Doo KW,Lee CH,Choi JW,et al."Pseudo washout"sign in highflow hepatic hemangioma on gadoxetic acid contrast-enhanced MRImimicking hypervascular tumor[J].American Journal of Roentgenology,2009,193:W490-496.
6 Tateyama A,Fukukura Y,Takumi K,et al.Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography[J].World Journal of Gastroenterology,2012,18:6269-6276.
7 Tateyama A,Fukukura Y,Takumi K,et al.Hepatic Hemangiomas:Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging[J].Magnetic Resonance in Medical Sciences:MRMS:An Official Journal of Japan Society of Magnetic Resonance in Medicine,2016,15:73-82.
8柴超,夏爽,沈文,等.Gd-EOB-DTPA的特性及其在肝细胞肝癌诊断中的应用现状[J].国际医学放射学杂志,2014,37:33-36,49.
9 Baek CK,Choi JY,Kim KA,et al.Hepatocellular carcinoma in patients with chronic liver disease:a comparison of gadoxetic acid-enhanced MRI and multiphasic MDCT[J].Clinical Radiology,2012,67:148-156.
10刘福尧,刘建国,张新广,等.不典型强化肝血管瘤在MSCT多期增强扫描中的表现[J].医学影像学杂志,2015,25:173-175.
11王赢,代向党,乔继红,等.肝血管肉瘤和血管瘤的CT影像特点对比[J].中国CT和MRI杂志,2017,15:73-75.
12言伟强,王成林,刘远健,等.肝血管瘤的螺旋CT三期扫描表现分析[J].中国CT和MRI杂志,2004,2:34-37.
13殷信道,王薇,吴前芝,等.多层动态增强MRI技术对肝血管瘤诊断的评价[J].放射学实践,2006,21:577-579.
14 Kato H,Kanematsu M,Matsuo M,et al.Atypically enhancing hepatic cavernous hemangiomas:high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings[J].European Radiology,2001,11:2510-2515.
15盛若凡,姚秀忠,饶圣祥,等.动态增强扫描结合弥散成像对磁共振成像表现不典型肝小血管瘤的诊断价值[J].中华肝胆外科杂志,2013,19:88-92.
16 Vilgrain V,Boulos L,Vullierme MP,et al.Imaging of atypical hemangiomas of the liver with pathologic correlation[J].Radiographics:A Review Publication of the Radiological Society of North America,Inc,2000,20:379-397.
17 Ringe KI,Husarik DB,Sirlin CB.Gadoxetate disodium-enhanced MRI of the liver:part 1,protocol optimization and lesion appearance in the noncirrhotic liver[J].American Journal of Roentgenology,2010,195:13-28.
2王荃荣子,刘希胜,俞同福,等.Gd-EOB-DTPA在肝脏局部结节性病变诊断中的应用[J].实用放射学杂志,2013,29:776-779.
3梁波.普美显在肝局灶性结节增生与肝细胞肝癌鉴别诊断中的价值[J].医学影像学杂志,2015,25:2175-2179.
4黄海东,曾蒙苏,丁玉芹,等.Gd-EOB-DTPA磁共振成像在慢性肝炎背景下小肝癌诊断中的应用[J].临床放射学杂志,2015,34:1085-1089.
5 Doo KW,Lee CH,Choi JW,et al."Pseudo washout"sign in highflow hepatic hemangioma on gadoxetic acid contrast-enhanced MRImimicking hypervascular tumor[J].American Journal of Roentgenology,2009,193:W490-496.
6 Tateyama A,Fukukura Y,Takumi K,et al.Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography[J].World Journal of Gastroenterology,2012,18:6269-6276.
7 Tateyama A,Fukukura Y,Takumi K,et al.Hepatic Hemangiomas:Factors Associated with Pseudo Washout Sign on Gd-EOB-DTPA-enhanced MR Imaging[J].Magnetic Resonance in Medical Sciences:MRMS:An Official Journal of Japan Society of Magnetic Resonance in Medicine,2016,15:73-82.
8柴超,夏爽,沈文,等.Gd-EOB-DTPA的特性及其在肝细胞肝癌诊断中的应用现状[J].国际医学放射学杂志,2014,37:33-36,49.
9 Baek CK,Choi JY,Kim KA,et al.Hepatocellular carcinoma in patients with chronic liver disease:a comparison of gadoxetic acid-enhanced MRI and multiphasic MDCT[J].Clinical Radiology,2012,67:148-156.
10刘福尧,刘建国,张新广,等.不典型强化肝血管瘤在MSCT多期增强扫描中的表现[J].医学影像学杂志,2015,25:173-175.
11王赢,代向党,乔继红,等.肝血管肉瘤和血管瘤的CT影像特点对比[J].中国CT和MRI杂志,2017,15:73-75.
12言伟强,王成林,刘远健,等.肝血管瘤的螺旋CT三期扫描表现分析[J].中国CT和MRI杂志,2004,2:34-37.
13殷信道,王薇,吴前芝,等.多层动态增强MRI技术对肝血管瘤诊断的评价[J].放射学实践,2006,21:577-579.
14 Kato H,Kanematsu M,Matsuo M,et al.Atypically enhancing hepatic cavernous hemangiomas:high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings[J].European Radiology,2001,11:2510-2515.
15盛若凡,姚秀忠,饶圣祥,等.动态增强扫描结合弥散成像对磁共振成像表现不典型肝小血管瘤的诊断价值[J].中华肝胆外科杂志,2013,19:88-92.
16 Vilgrain V,Boulos L,Vullierme MP,et al.Imaging of atypical hemangiomas of the liver with pathologic correlation[J].Radiographics:A Review Publication of the Radiological Society of North America,Inc,2000,20:379-397.
17 Ringe KI,Husarik DB,Sirlin CB.Gadoxetate disodium-enhanced MRI of the liver:part 1,protocol optimization and lesion appearance in the noncirrhotic liver[J].American Journal of Roentgenology,2010,195:13-28.