Small nodule detection in cirrhotic livers: Evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver
Small nodule detection in cirrhotic livers: Evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver
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DOI：
10.1097/00004728-200105000-00001
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发表时间：
2001-05-01
影响因子：
1.3
通讯作者：
Ducerf, C
中科院分区：
文献类型：
--
作者：
Rode, A;Bancel, B;Ducerf, C
目的：本研究的目的是评价肝硬化中大于或等于8 tnm的结节和小肝细胞癌（HCCs）的检测和特征。方法：比较43例肝硬化患者原位肝移植术后的病理检查及超声、螺旋CT、动态MRI扫描结果。结节分为巨再生结节（MRNs）、交界性结节（IBNs）和HCC。结果：病理检查69例结节：MRN 50例，BN 6例，HCC 13例，MRN、BN、HCC的US显像敏感度分别为2%（1/50）、33.3%（2/6）、46.2% (6/13)；螺旋CT为2%（1/50）、50%（3/6）和53.8% (7/13)；MRI分别为42%（21/50）、50%（3/6）和76.9%(10/13)，共检测21个MRNs。他们在T1/ t2加权图像上表现为高/低信号（n = 8）、高/等信号（n = 7）、低信号/低信号（n = 4）、低信号/等信号（n = 1）和仅在回波平面成像上表现为低信号（n = 1）。3例BNs均为高/低强度结节。IO组hcc表现为高/等强度（n = 7）、高/低强度（n = 2）、低/等强度（n = 1）。注射钆后，除8个hcc和1个BN外，其余mrn均未增强。结论：MRI增强扫描是检测肝结节最灵敏的技术。然而，小肝癌的MR信号强度模式特征无法与良性结节区分。钆增强是HCC最敏感、最特异的特征。
Purpose: The purpose of this work was to evaluate the detection and characterization of nodules greater than or equal to8 tnm and small hepatocellular carcinomas (HCCs) in liver cirrhosis.Method: Pathologic examination and results of US, helical CT, and dynamic MRI with gadolinium were compared after orthotopic liver transplantation (OLT) of 43 cirrhotic patients. Nodules were classified as macroregenerative nodules (MRNs), borderline nodules IBNs), and HCC.Results: Pathologic examination classified 69 nodules: 50 MRNs, 6 BNs, and 13 HCCs, Sensitivities of MRN, BN, and HCC detection were, respectively, for US imaging 2% (1/50), 33.3% (2/6), and 46.2% (6/13); for helical CT 2% (1/50), 50% (3/6), and 53.8% (7/13); and for MRI 42% (21/50), 50% (3/6), and 76.9% (10/13), MRI detected 21 MRNs. They presented on T1/T2-weighted images as hyperintense/hypointense (n = 8), hyperintense/isointense (n = 7), hypointense/hypointense (n = 4), hypointense/isointense (n = 1), and hypointense depicted only on echo planar imaging(n = 1). The three detected BNs were hyperintense/hypointense nodules. The IO de tee ted HCCs appeared hyperintense/isointense (n = 7), hyperintense/hypointense (n = 2), and hypointense/isointense (n = I). None of the MRNs but eight HCCs and one BN were enhanced after gadolinium injection.Conclusion: Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.