Multiarterial phase dynamic MRI of small early enhancing hepatic lesions in cirrhosis or chronic hepatitis: Differentiating between hypervascular hepatocellular carcinomas and pseudolesions
Multiarterial phase dynamic MRI of small early enhancing hepatic lesions in cirrhosis or chronic hepatitis: Differentiating between hypervascular hepatocellular carcinomas and pseudolesions
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DOI：
10.2214/ajr.183.3.1830699
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发表时间：
2004-09-01
影响因子：
5
通讯作者：
Yuhara, M
中科院分区：
文献类型：
--
作者：
Ito, K;Fujita, T;Yuhara, M
目标。本研究的目的是评价单次屏气扫描全肝多期增强动态增强扫描对肝硬变或慢性肝炎患者早期肝脏小强化病变的诊断价值，强调对血供丰富的肝细胞癌和假性肝细胞癌的鉴别。研究人群包括40名早期有小范围强化肝脏病变的肝硬变或慢性肝炎患者(共70个病变：40个肝细胞癌，30个假性病变)。结果：40例高血供肝细胞癌中，有21例(53%)在早期增强和瘤周冠状强化后，21例(53%)肿瘤中心迅速消失，但在任何多血管假性病变中均未观察到这些表现(p<；0.001)。在19例没有快速中心清除的肝细胞癌中，病变的早期强化出现在第二、第三或第四期(平均2.5期)。19例肝细胞癌中有8例在第六期病灶强化消失。相反，在30个多血管假性病变中，病变的早期强化出现在第二、第三、第四或第五期(平均3.0期)。在这30个假性病变中，有28个病变强化持续到第六期。结论：病变早期强化后的快速中心清除和病变周围的冠状强化是小的多血管肝细胞癌的高度特异性和诊断征象，如果出现在多动脉相对比增强的动态MRI上。与富血供肝细胞癌相比，富血供假性病变在动脉期的强化时间更长。
OBJECTIVE. The purpose of this study was to assess the value of multiarterial phase contrast-enhanced dynamic MRI of the whole liver obtained during a single breath-hold for small early enhancing hepatic lesions in patients with cirrhosis or chronic hepatitis, emphasizing the distinction between hypervascular hepatocellular carcinomas and pseudolesions.MATERIALS AND METHODS. The study population included 40 patients with cirrhosis or chronic hepatitis who had small early enhancing hepatic lesions (a total of 70 lesions: 40 hepatocellular carcinomas, 30 pseudolesions). All patients underwent multilateral phase contrast-enhanced dynamic MRI (six phases) of the whole liver during a single breath-hold.RESULTS. Twenty-one (53%) of 40 hypervascular hepatocellular carcinomas showed rapid central washout after early enhancement of the lesion as well as peritumoral coronal enhancement, but these findings were not observed in any hypervascular pseudolesions (p < 0.001). In 19 hepatocellular carcinomas without rapid central washout, early enhancement of the lesion appeared at the second, third, or fourth phase (mean, 2.5 phases). In eight of these 19 hepatocellular carcinomas, lesion enhancement disappeared by the sixth phase. Conversely, in 30 hypervascular pseudolesions, early enhancement of the lesion appeared at the second, third, fourth, or fifth phase (mean, 3.0 phases). In 28 of these 30 pseudolesions, lesion enhancement continued until the sixth phase.CONCLUSION. Rapid central washout after the early enhancement of the lesion and coronal enhancement surrounding the lesion are highly specific and diagnostic findings of small hypervascular hepatocellular carcinomas if present at multiarterial phase contrast-enhanced dynamic MRI. Hypervascular pseudolesions tend to show prolonged enhancement during the arterial phase compared with hypervascular hepatocellular carcinomas.