Role of contrast-enhanced sonography in differentiation of subtypes of hepatocellular adenoma: correlation with MRI findings.
Role of contrast-enhanced sonography in differentiation of subtypes of hepatocellular adenoma: correlation with MRI findings.
复制标题
对比增强超声检查在肝细胞腺瘤亚型分化中的作用：与 MRI 结果的相关性。
DOI：
10.2214/ajr.11.7046
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
H. Trillaud
中科院分区：
文献类型：
--
作者：
H. Laumonier;H. Cailliez;C. Balabaud;L. Possenti;J. Zucman‐Rossi;P. Bioulac;H. Trillaud
目的
肝细胞腺瘤（HCA）根据基因型和表型分为三种亚型。两个主要亚组是肝细胞核因子1α（HNF 1 α）失活的HCA和炎性HCA。这些腺瘤亚组的特定影像学特征已被描述与MRI。本研究的目的是记录腺瘤亚型的超声造影（CEUS）特征，并将其与MRI结果相关联。
材料和方法
我们回顾性分析了38例经病理证实的HCA患者的资料。所有病例均行MRI分型。
结果
发现HNF 1 α灭活HCA（n = 16）在基线灰阶超声检查时具有均匀的高回声，动脉期等血管或中度血管过多伴混合充盈，门静脉期和晚期门静脉期等回声。B型超声检查中的均匀高回声是最特异的模式（敏感性，88%;特异性，91%），并与化学位移序列获得的MR图像上观察到的弥漫性脂肪再分配相关。在炎性HCA（n = 17）中，动脉血供过多与向心充盈、线性血管、持续增强的外周边缘和晚期静脉相的中央洗脱的相关性是特异性的（敏感性，64%;特异性，100%）。CEUS期间延迟洗脱和MRI期间持续增强之间的差异可能与钆和微泡在间质间隙中扩散的差异有关。在其他5例HCA病例中（4例未分类，1例β-catenin激活），CEUS显示良性肝细胞肿瘤的特征，无特异性特征。
结论
HNF 1 α失活HCA和炎性HCA具有特征性CEUS模式。延迟洗脱是良性肝脏病变中的一种罕见发现，特别令人感兴趣，并且是炎性HCA亚型的特征。
OBJECTIVE
Hepatocellular adenomas (HCAs) are divided into three subtypes according to genotype and phenotype. The two main subgroups are hepatocyte nuclear factor 1α (HNF1α)-inactivated HCA and inflammatory HCA. Specific imaging features of these subgroups of adenoma have been delineated with MRI. The aim of this study was to document the contrast-enhanced sonographic (CEUS) features specific for adenoma subtypes and to correlate them with MRI findings.
MATERIALS AND METHODS
We retrospectively analyzed data on 38 patients with HCA confirmed at pathologic examination in all cases. All cases were classified with MRI.
RESULTS
HNF1α-inactivated HCA (n = 16) was found to have a homogeneous hyperechoic aspect at baseline gray-scale sonography, isovascularity or moderate hypervascularity with mixed filling in the arterial phase, and isoechogenicity in the portal and late portal venous phases. Homogeneous hyperechogenicity during B-mode sonography was the most specific pattern (sensitivity, 88%; specificity, 91%) and correlated with diffuse fat repartition observed on MR images obtained with chemical-shift sequences. In inflammatory HCA (n = 17) the association of arterial hypervascularity with centripetal filling, linear vascularities, peripheral rim of sustained enhancement, and central washout in the late venous phase was specific (sensitivity, 64%; specificity, 100%). Discrepancy between delayed washout during CEUS and sustained enhancement during MRI could be related to differences between gadolinium and microbubbles in diffusing in the interstitial spaces. In the five other HCA cases (four unclassified, one β-catenin activated) CEUS showed characteristics of benign hepatocellular tumors with no specific features.
CONCLUSION
HNF1α-inactivated HCA and inflammatory HCA had characteristic CEUS patterns. Delayed washout, an unusual finding in benign hepatic lesions, is of particular interest and was a characteristic of inflammatory HCA subtype.