小肝细胞肝癌和肿块型肝内小胆管细胞癌的MRI表现特征-论文.pdf

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1、288·2014年4月第48卷第4期ChinJioJ：!!：：：．腹部放射学．小肝细胞肝癌和肿块型肝内小胆管细胞癌的MRI表现特征盛若凡曾蒙苏饶圣祥纪元陈伶俐【摘要】目的探讨小肝细胞癌(sHCC)及肿块型肝内小胆管细胞癌(sIMCC)的MRI表现特征。方法回顾性分析经手术病理证实的318例sHCC患者(351个病灶)及42例sIMCC患者(47个病灶)资料，所有患者均行肝脏MR平扫及动态增强扫描检查。对2组患者病灶TwI及动态增强各期的MR信号特点、强化模式、伴随征象进行分析。采用检验或Fisher精确概率检验对2组问MR

2、I扫描特征比较，单因素分析中具有统计学意义的影像指标进行多因素逻辑回归分析；同时根据甲胎蛋白(AFP)值对sHCC进行亚组分析，采用检验比较AFP正常及升高组强化模式。结果MR扫描特征中，强化模式及伴随征象中的肿瘤(假)包膜、肝包膜回缩是鉴别sHCC和sIMCC的主要指标，对比剂廓清(276／351)伴肿瘤(假)包膜的显现(275／351)高度提示sHCC，而填充进展的强化模式(27／47)伴肝包膜回缩(8／47)有助于sIMCC的诊断(P<0．01)。相较于AFP正常组，填充进展(4例)及持续稳定(32例)强化模式多见于

3、AFP升高组sHCC中，2组问动态增强模式差异具有统计学意义(=8．241，P<0．05)。结论动态增强模式及肿瘤(假)包膜、肝包膜回缩征象是鉴别sHCC及sIMCC最重要的影像指标；同时，AFP正常sHCC患者的病灶强化方式相对典型，有利于临床正确诊断。【关键词】肝肿瘤；肝细胞癌；胆管细胞癌；磁共振成像；对比分析ComparisonofMRIfindingsofsmallhepatocellularcarcinomaandsmallintrahepaticmass-formingcholangiocarcinomaShe

4、ngRuofan，ZengMengsu，RaoShengxiang，JiYuan，ChenLingl~DepartmentofRadiology，ZhongshanHospital，FacultyofMedicalImaging，ShanghaiMedicalCollegeofFudanEity，ShanghaiMedicalImagingInstitute，Shanghai200032，ChinaCorrespondingauthor：zengMengsu，Email：zengmengsu@gmaiLcorn【Abstr

5、act】ObjectiveTocomparetheMRfeaturesofsmallhepatocellularcarcinoma(sHCC)andsmallintrahepaticmass—formingcholangiocarcinoma(sIMCC)(≤3am)andimprovetheaccuracyindiagnosis．MethodsImagingstudiesof318patientswith351sHCCsand42patientswith47sIMCCswereretrospectivelyreviewe

6、d．SignalintensityonT2WIandoneachphaseofdynamicenhancedimaging，enhancementpatterns，andaccompanyingfindingsofthetwogroupswerecomparedbyqualitativeandquantitativestudies．ThequalitativeimagingfeaturesoftumorswerecomparedbythetestandtheFisherexacttest，andthestatistical

7、lysignificantvariablesobtainedfromunivariateanalysiswereusedtoconductmultivariatestepwiselogisticregressionanalysis．EnhancementpatternbetweensHCCswithelevatedAFPandnormalAFPwereassessedbythetest．ResultsMultivariateanalysisindicatedthatsignalfeaturesofenhancementpa

8、tternandtheaccompanyingfindingsoftumorcapsuleandhepaticcapsuleretractionwerekeypredictorsindifferentiatingsHCCfromsIMCC：Wash．outpattern(276／351)withenha