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目的探讨具有双相增强作用的磁共振造影剂钆贝葡胺(gadobenate dimeglumine,Gd-BOPTA)诊断肝细胞癌(HCC)的价值及其MR表现的病理基础。方法33例(42个病灶)CT或超声检查疑有肝脏占位的患者,按以下顺序接受MRI常规轴位的T2WI和T1WI平扫、冠状的T2WI、3D磁共振胆胰管成像(MRCP)、Gd-BOPTA增强的轴位LAVA三期动态扫描(延时时间为15、55及90s)、2D-T1W增强扫描、LAVA延时扫描(5及10min)和肝胆期扫描(20、40及80min)。收集大体标本及病理切片,与磁共振表现进行对比分析。结果手术病理证实HCC诊断21例(27个结节)。包含动态期和肝胆期在内的综合MRI诊断HCC的敏感性、特异性及准确性分别为92.9%、93.3%和92.9%。①血液动力学期(动态及延迟期):HCC以“快进快出”强化表现为主(22个),少数呈动静脉期强化(4个)及均无强化(1个)。②肝胆期(排泄期):23个HCC结节呈均匀稍低信号;另外4个结节(3个高分化及1个中分化)呈非均匀稍低信号,其中散在云絮状或斑点状稍高信号,病理上见肿瘤细胞淤胆及含有胆汁的毛细胆管存在。结论双相作用的Gd-BOPTA增强MR检查既能反映HCC的血供特点,又能反映病灶内不同程度丢失正常肝细胞功能的病理基础,具有较好的诊断价值。
Objective To investigate the value of gadobenate dimeglumine (Gd-BOPTA) in diagnosis of hepatocellular carcinoma (HCC) with biphasic enhancement and the pathological basis of its MR findings. Methods Thirty-three patients (42 lesions) undergoing CT or ultrasonography suspected liver space occupying patients underwent T2WI and T1WI plain MRI scan, coronal T2WI and MRCP in the following order, Gd-BOPTA enhanced axial LAVA three-phase dynamic scanning (delay time of 15, 55 and 90s), 2D-T1W enhanced scan, LAVA delay scan (5 and 10min) and hepatobiliary scanning (20,40 and 80min) . Gross specimens and pathological sections were collected and compared with MR findings. Results HCC diagnosed by surgery and pathology in 21 cases (27 nodules). The sensitivity, specificity and accuracy of comprehensive MRI in diagnosis of HCC including dynamic phase and hepatobiliary phase were 92.9%, 93.3% and 92.9% respectively. ① Hemodynamics (dynamic and delayed): HCC “fast forward fast” enhanced performance of the main (22), a small number of arteriovenous phase enhanced (4) and no enhancement (1). ② hepatobiliary period (excretory phase): 23 HCC nodules showed a uniform lower signal; the other 4 nodules (3 highly differentiated and 1 moderately differentiated) showed a non-uniform slightly lower signal, which scattered clouds or spot Slightly higher signal, see the tumor cells cholestasis and the presence of biliary choriocapillaries. Conclusion The biphasic Gd-BOPTA enhanced MR examination not only reflects the blood supply characteristics of HCC, but also reflects the pathological basis of the loss of normal liver cells in varying degrees, which has a good diagnostic value.