摘要
目的分析误诊为原发性肝癌的肝脏局灶性病变的钆塞酸二钠增强MRI表现,总结误诊原因及防范误诊措施。方法回顾性分析2016年1月-2021年10月收治的曾误诊为原发性肝癌的肝脏局灶性病变27例的临床资料。结果本组因上腹部疼痛就诊6例,因恶心和呕吐就诊1例;余20例因体检发现肝脏占位性病变就诊。行钆塞酸二钠增强MRI后27例29个病灶均诊断为原发性肝癌。误诊时间10 d~6个月。24例26个病灶经肝部分切除术后病理检查证实诊断,3例3个病灶经肝穿刺活组织病理检查证实诊断;确诊再生结节6例8个病灶,血管瘤6例6个病灶,血管周上皮细胞分化肿瘤5例5个病灶,局灶性结节状增生、炎性病变、神经内分泌瘤和肝转移癌(胃肠道间质瘤肝转移和乳腺癌肝转移)各2例2个病灶,肝局灶性脂肪沉积和肝肉瘤样癌各1例1个病灶。本组确诊后经相应治疗均病情好转出院。随访1~6年,27例中21例情况良好,4例失访,1例死亡,1例随访33个月后诊断为肝细胞癌,行介入治疗后现病情稳定。结论过度重视肝胆特异期低信号、肝脏局灶性病变与原发性肝癌影像学表现相似、对肝脏少见占位性病变认识不足是导致本文病例误诊的主要原因。熟悉肝脏多种占位性病变临床特征结合相关医技检查结果进行综合分析有助于提高此类疾病的诊断准确率。
Objective The findings of gadolinium disodium enhanced MRI in hepatic focal lesions misdiagnosed as primary liver cancer were analyzed,and the causes of misdiagnosis and preventive measures were summarized.Methods The clinical data of 27 cases of hepatic focal lesions misdiagnosed as primary liver cancer admitted from January 2016 to October 2021 were retrospectively analyzed.Results In this group,6 patients were treated for upper abdominal pain and 1 patient was treated for nausea and vomiting.The other 20 cases were found to be hepatic space occupying lesions.All 29 lesions in 27 cases were diagnosed as primary liver cancer after MRI enhanced with gadolinium disodium.The misdiagnosis time was 10 days to 6 months.26 lesions in 24 cases were confirmed by pathological examination after partial hepatic resection,3 lesions in 3 cases were confirmed by hepatic puncture biopsy,and there were 6 cases of regenerated nodules with 8 lesions,6 cases of hemangioma with 6 lesions,5 cases of perivascular epithelial cell differentiation tumor with 5 lesions,2 cases of focal nodular hyperplasia,inflammatory lesions,neuroendocrine tumors and liver metastases(gastrointestinal stromal tumor liver metastases and breast cancer liver metastases)with 2 lesions respectively,and 1 case of focal hepatic fatty deposition and liver sarcomatoid carcinoma with 1 lesion,respectively.After diagnosis,all patients were discharged after treatment.During the follow-up of 1 to 6 years,4 of the 27 patients were lost to follow-up,1 died,21 were in good condition,and 1 patient was diagnosed with HCC after 33 months of follow-up,and his condition was stable after interventional therapy.Conclusion Excessive attention to hepatobiliary stage low signal,similar imaging findings of liver lesions and liver cancer and insufficient understanding of rare space occupying lesions of the liver are the main reasons for misdiagnosis of this case.It is helpful to be familiar with the clinical features of various liver space occupying lesions combined with the results
作者
张芸
郁义星
赵卫峰
ZHANG Yun;YU Yi-xing;ZHAO Wei-feng(Department of Infectious Disease,the First Affiliated Hospital of Suzhou University,Suzhou,Jiangsu 215026,China;Department of Imaging,the First Affiliated Hospital of Suzhou University,Suzhou,Jiangsu 215026,China)
出处
《临床误诊误治》
CAS
2022年第10期7-12,共6页
Clinical Misdiagnosis & Mistherapy
关键词
肝脏局灶性病变
磁共振成像
误诊
肝肿瘤
Hepatic focal lesions
Magnetic resonance imaging
Misdiagnosis
Liver neoplasms
