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钆塞酸二钠对肝脏 局灶性结节增生的 诊断价值

作者:张进跃1 王 岩2

所属单位:1.河南省漯河市第三人民医院放射 科 (河南 漯河 462000) 2.解放军总医院放射科 (北京 100853)

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摘要

目的 探讨使用钆塞酸二钠(GdEOB-DTPA)增强MRI在肝脏局灶性结节增生 (focal nodular hyperplasia,FNH)的诊 断价值。方法 进行回顾性分析14例经病 理证实的FNH的MRI检查资料,所有病例均 行MRI平扫及Gd-EOB-DTPA增强扫描。结 果 位于肝左叶6例,肝右叶4例,尾状叶 2例,跨叶生长2例。MRI特征: T1WI 8例 呈等信号,6例呈稍低信号;抑脂T2WI 5 例呈等信号,9例呈稍高信号;7例病灶 见中央瘢痕,呈T1WI低信号,T2WI高信 号。动态增强:动脉期14例病灶均明显强 化,其中4例病灶周缘见迂曲扩张动脉; 门脉期持续强化,12例呈稍高信号,2例呈 等信号;平衡期6例呈等信号,8例呈稍高 信号;肝细胞特异期,7例病灶以等信号为 主,7例呈不均匀稍高及等、低混杂信号。 7例中央瘢痕动脉期无强化,门脉期及平 衡期持续延迟强化,肝细胞特异期呈低信 号。结论 使用Gd-EOB-DTPA增强MRI诊断 FNH具有很高的敏感性及特异性,尤其肝 细胞特异期FNH对Gd-EOB-DTPA特异性摄取 而呈等、高信号, Gd-EOB-DTPA增强能全 面、准确地显示FNH的血供特点及病理特 征,大大提高与肝内其他病变的鉴别诊断 能力。

Objective To investigate the value of Gd-EOB-DTPA in the Diagnosis of Focal Nodular Hyperplasia (FNH). Methods MRI findings of 14 cases with FNH proved by pathology were analyzed retrospectively. All were performed MRI plain and enhanced with Gd-EOB-DTPA. Results There were 6 cases located at left lobe, 4 cases at right lobe, 2 cases at caudate lobe, 2 cases crossed leaves. MRI findings: 8 cases showed equal signals, 6 cases showed slightly lower signal on T1WI, 5 cases showed equal signals, 9 cases showed slightly higher signal on fat suppression T2WI. 7 cases with central scars could be seen, and showed low signal on T1WI, high signal on T2WI.14 cases all were significantly enhanced, including 4 cases were seen tortuosity strengthened arteries during dynamic contrast-enhanced arterial phase,all continued to strengthen during the portal phase, and 12 cases showed slightly higher signal, 2 cases showed equal signal; during the balance phase, 6 cases showed equal signal, 8 cases showed slightly higher signal. During liver cell specific phase, 7 cases showed equal signals, 7 cases were uneven slightly, equal and slightly lower mixed-signals. 7 cases with central scar and without enhancement during the arterial phase, delay continued to enhance during portal venous phase and balance phase, showed low signal during liver cells specific phase. Conclusion The use of Gd-EOBDTPA-enhanced to diagnose FNH had high sensitivity and specificity, especially during liver cell specific phase, FNH specifically absorbed Gd-EOB-DTPA and showed equal、 high signal. Gd-EOB-DTPA-enhanced MRI could fully and accurately show the blood supply and pathological features of FNH, and greatly improved the ability of differential diagnosis with other hepatic diseases.

【关键词】钆塞酸二钠;肝脏局灶性结节 增生;磁共振成像;对比剂

【中图分类号】R445.2;R575

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.02.002

前言

肝脏局灶性结节增生(focal nodular hyperplasia,FNH)是肝脏 较少见的良性肿瘤样病变,临床处理以随访为主,MRI平扫及Gd-DTPA 增强检查由于使用多序列成像技术、动态增强、软组织分辨力高等优 势,已成为FNH诊断的首选检查方法,但仍缺乏特异性。双功能肝胆特 异性MR对比剂钆塞酸二钠(Gd-EOB-DTPA,商品名普美显),不仅具有细 胞外间隙对比剂Gd-DTPA 功能,而且具有肝细胞靶向功能,可被具有 正常功能的肝细胞摄取,在MR增强诊断FNH具有很高特异性,本文回顾 性分析14例经病理证实的FNH的MRI平扫及Gd-EOB-DTPA增强资料,探讨 Gd-EOB-DTPA对FNH的诊断价值,提高其诊断准确率。