研究论文 磁共振多时相动态增强扫描对小肝细胞癌的诊断价值.docVIP

磁共振多时相动态增强扫描对小肝细胞癌的诊断价值 Multiphase dynamic gadolinium-enhanced MR imaging findings of small hepatocellular carcinomas [摘要] 目的 探讨磁共振多时相动态增强扫描对小肝细胞癌（SHCC）的诊断价值。 方法 回顾性分析了经病理证实的30例（32个癌灶）SHCC的磁共振成像（MRI）平扫、多时相动态增强扫描表现及术前或穿刺前诊断。 结果 24个癌灶为多血供SHCC，在动脉期的时间信号强度曲线形式为速升速降型，延迟期均出现轻度强化；8个癌灶为少血供SHCC，其时间信号强度曲线形式为缓慢上升型。门脉期或延迟期对假包膜的显示（43.8%或53.1%）显著高于T1WI或T2WI（9.4%或12.5%, P0.01）对假包膜的显示。磁共振多时相动态增强扫描对SHCC诊断的准确率（93.8%）明显高于MRI平扫（62.5%, P0.01）。结论 磁共振多时相动态增强扫描对SHCC的准确诊断具有重要价值。 [关键词] 小肝细胞癌 磁共振成像 造影剂 [Abstract] Purpose To valuate the usefulness of multiphase dynamic gadolinium-enhanced MR imaging in diagnosis of small hepato-cellular carcinomas (SHCCs). Methods The features of T1-and- T2 weighted image (WI), multiphase dynamic gadolinium-enhanced MR imaging and preoperative or pre-biopsy diagnosis in 30 patients pathologically proved 32 SHCCs were reviewed retrospectively. Results Twenty-four SHCCs were hypervascular, and slight delayed enhancement detected and time-intensity curve presented fast up and down during arterial and portal venous phase. Eight SHCCs were hypovascular and time-intensity curve presented slow up. Pseudocapsule detected at portal venous phase or delayed phase (43.8% or 53.1%) was significantly higher than that of T1WI or T2WI (9.4% or 12.5%, P0.01). The diagnostic accuracy of multiphase dynamic gadolinium-enhanced MR iimaging (93.8%) was significantly higher than that T1WI or T2WI (62.5%, p0.01). Conclusion Multiphase dynamic gadolinium-enhanced MR imaging improve significantly the accuracy of SHCCs. [Key words] Small hepatocellular carcinoma Magnetic resonance imaging Gd-DTPA 小肝细胞癌（small hepatocellular carcinoma, SHCC）的早期发现与早期诊断对临床上选择有效的治疗方法和提高患者的五年生存率具有重要意义。实际工作中发现，SHCC患者常无症状，甲胎蛋白（AFP）的定量检测对SHCC的诊断价值有一定限度，影像检查对SHCC的早期发现与早期诊断具有重要的意义[1-3]。SHCC的影像表现，特别是MRI特征，国外已有许多报道，国内报道较少，有关SHCC的磁共振多时相动态增强扫描国内尚处在起步阶段[1,2,4~9]。笔者回顾性分析经病理证实的30例（32个癌灶）SHCC的MRI平扫、多时相动态增强表现及术前或穿刺前诊断，探讨磁共振多时相动态增强扫描对SHCC的诊断价值。 材料与方法 1．自1997年8月至2001年10月，经MRI平扫和多时相动态增强扫描检查后由病理证实的SHCC（≤3cm）30例（手术切除11例，手术活检