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T2WI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x2检验或Fisher精确概率检验对2组间MRI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x2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AFP升高组sHCC中,2组间动态增强模式差异具有统计学意义（x2 =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.
Objective To compare the MR features of small hepatocellular carcinoma （sHCC） and small intrahepatic mass-forming cholangiocarcinoma （sIMCC） （≤ 3 cm） and improve the accuracy in diagnosis.Methods Imaging studies of 318 patients with 351 sHCCs and 42 patients with 47 sIMCCs were retrospectively reviewed.Signal intensity on T2WI and on each phase of dynamic enhanced imaging,enhancement patterns,and accompanying findings of the two groups were compared by qualitative and quantitative studies.The qualitative imaging features of tumors were compared by the x2 test and the Fisher exact test,and the statistically significant variables obtained from univariate analysis were used to conduct multivariate stepwise logistic regression analysis.Enhancement pattern between sHCCs with elevated AFP and normal AFP were assessed by thex2 test.Results Multivariate analysis indicated that signal features of enhancement pattern and the accompanying findings of tumor capsule and hepatic capsule retraction were key predictors in differentiating sHCC from sIMCC：Wash-out pattern （276/351） with enhanced tumor capsule （275/351） highly indicated sHCC,while progressive enhancement pattern （27/47） with hepatic capsule retraction （8/47） indicated the diagnosis of sIMCC （P ＜ 0.01）.Compared with sHCC with normal AFP,atypical patterns as progressive （n =4） and stable enhancement （n =32） were more commonIy seen in lesions with elevated AFP,dynamic enhancement pattern was different between the two subgroups （x2 =8.241,P ＜ 0.05）.Conclusions Enhancement patterns and the accompanying tumor capsule and hepatic capsule retraction were the most important predictors in differentiating sHCC from sIMCC.In addition,enhancement pattern was relatively more typical in sHCCs with normal AFP which provided valuable information in diagnosis for clinicians.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第4期288-293,共6页
Chinese Journal of Radiology
关键词
肝肿瘤
肝细胞癌
胆管细胞癌
磁共振成像
对比分析
Liver neoplasms
Hepatocellular carcinoma
Cholangiocarcinoma
Magnetic resonance imaging
Comparative study
