摘要
目的探讨具有双相作用的新型磁共振造影剂钆贝葡胺(Gd-BOPTA)应用于肝脏局灶性结节样增生(focal nodular hyperplasia,FNH)的MR表现及其病理基础。方法对5例临床及影像检查怀疑为FNH的患者(共6个病灶),按以下顺序分别行MRI常规轴位的T2W和T1W平扫、冠状位T2加权图像、3D磁共振胆胰管成像(MRCP)、Gd-BOPTA增强的轴位LAVA三期动态扫描(扫描延时时间为15、55及90s)、2D-T1W增强扫描、LAVA延时扫描(5及10min)及肝胆期扫描(40及80min)。收集大体标本及病理切片,与磁共振各序列表现进行对比分析。结果5例6个病灶均诊断正确(5个手术证实,1个穿刺证实)。血液动力学期(动态期):5个FNH病灶实质部分动脉期强化明显,门脉期及延迟期强化减弱呈等或稍低信号,另1个病灶除动脉期轻度强化外,门脉期及延迟期均呈等信号;5个中央疤痕动脉期及门脉期无强化,而延迟期均强化。②肝胆期(排泄期):6个病灶实质部分呈稍高或等信号,其中1个肿块中可见高信号的树枝样胆管;中央疤痕均呈稍低信号。③病理:FNH实质为正常肝细胞团呈不规则排列,伴有不同程度肝细胞水肿及淤胆改变,且均存在汇管区缺失;疤痕为大量纤维组织,内有厚壁动脉血管、增生胆管及炎性细胞浸润,部分伴有少许黏液变性。结论Gd-BOPTA作为一种双相(既能反映血液动力学特性又能被肝细胞特异性摄取)作用的造影剂,Gd-BOPTA增强MR检查能准确反映FNH的病理特点。
Objective To investigate the value of a new double action MR contrast agent Gd-BOPTA in the diagnosis of focal nodular hyperplasia （FNH） of the liver with correlation of pathology. Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis （six lesions）. The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd- BOPTA enhanced LAVA dynamic tri-phasic acquisitions （scanning at 15 s, 55 s and 90 s respectively）, enhanced 2D T1W scan, enhanced LAVA in delay phase （at 5 and 10 min） and in the hepatobiliary phase （at 40 and 80 min）. The imaging features on each MR sequence were compared with surgical and pathological findings. Results Six le- sions in 5 FNH patients were all correctly diagnosed （5 conformed by surgery and 1 by needle biopsy）. ①The hemodynamic phase： The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary （excretory） phase： The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology： The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thickwalled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes. Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion,Gd BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.
出处
《中国普外基础与临床杂志》
CAS
2007年第5期598-604,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
磁共振成像
造影剂
局灶性结节样增生
肝脏
Magnetic resonance imaging Contrast agent Focal nodular hyperplasia Liver
