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肝脏局灶性结节增生:MRI表现及其病理特征
作者:徐小虎  丁玉芹  马富平  彭进  周建军 
单位:1. 海安县人民医院影像科  江苏 海安 226600 
2.
 上海复旦大学附属中山医院放射科  上海 200032 
3.
 咸阳市中心医院肝外科  陕西 咸阳 712000 
关键词:局限性结节状增生/诊断 局限性结节状增生/病理学 磁共振成像/方法 诊断 鉴别 回顾性研究 
DOI:R735.2;R730.2
出版年,卷(期):页码:2013,28(6):597-600
摘要:
目的 探讨肝脏局灶性结节增生(focal nodular hyperplasia,FNH)确诊和误诊病例的MRI征象及其病理特征,提高对FNH的诊断和鉴别诊断的准确性。方法 回顾性分析经手术病理证实的49例FNH患者(62个病灶)的MRI影像资料,总结FNH的MRI表现特点;回顾性分析12例MRI误诊为FNH(或诊断不够准确)的病例,总结FNH与其他病变MRI的鉴别诊断要点。结果 FNH多分布在肝脏包膜下或部分突出于肝脏轮廓外(57/62),>3 cm的可以有分叶或浅分叶状(48/50),多数无包膜(57/62),少数可有假包膜样强化(5/62);FNH因病灶大小不同,瘢痕显示率及其强化特征有所差异:瘢痕显示率在>3 cm的病灶中比较高(43/50),中央瘢痕强化在3~7 cm的病灶中相对较高(15/39),瘢痕收缩征在>7 cm的病灶中相对较高(8/11);大部分需要鉴别的病例,仔细阅片可以发现误诊或诊断不够准确的原因。结论 充分认识瘢痕显示及其强化特征因病灶大小不同而产生的差异可以提高FNH诊断的准确性;注意影像细节并结合临床资料,可以提高对不典型FNH与其他病变的鉴别诊断的准确性。
Objective To examine the MRI features and the pathological basis of hepatic focal nodular hyperplasia (FNH)in diagnosed and misdiagnosed cases.Methods The MRI image data of 62 pathologically confirmed hepatic FNH lesions in 49 patients were retrospectively analyzed.The characteristics of MRI findings from 12 hepatic FNH cases of misdiagnosis or uncertain diagnosis were also analyzed.Results Hepatic FNH lesions were mostly distributed in the subcapsular area of the liver or prominent beyond the liver contours (57/62).The lesions larger than 3 cm presented lobular or shallow lobular shapes (48/50).The majority of hepatic FNH lesions were non-encapsulated (57/62)and some lesions had pseudo-capsule-like enhancement (5/62).The scar sign and enhancement pattern were different according to lesion size, the lesions larger than 3 cm had relatively higher presence rate of scar sign (43/50).Central scar enhancement was higher in lesions sized 3~7 cm (15/39)and scar contraction in lesions > 7 cm (8/11)was relatively higher.The reasons of misdiagnosis and uncertain diagnosis in most of cases might be found after carefully reading MRI images.Conclusion The diagnostic accuracy of hepatic FNH can be improved if we are aware of the difference of the presence and enhancement pattern of central scar in different tumor size.Pay attention to image details combined with clinical data can improve differential diagnosis between atypical hepatic FNH and other lesions.
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