肝癌成像机制.ppt

发现早期HCC * 早期HCC的诊断 a b c d e Images in a 59-year-old man with early HCC and hepatitis B–related cirrhosis.?(a)?Gadoxetate disodium–enhanced T1-weighted 3D GRE MR image (2.5/0.9; 11° flip angle) obtained in late hepatic arterial phase shows no definite early enhancement.?(b)?Transitional phase image obtained at 3 minutes depicts hypointense nodule (arrow).?(c)?Nodule is not clearly delineated on T2-weighted fat-saturated turbo spin-echo image (3413/88).?(d)?Nodule (arrow) is hypointense on hepatobiliary phase image acquired 20 minutes after injection.?(e)?Gross pathologic evaluation of resected specimen reveals small, vaguely nodular HCC (arrow). Histologic examination confirmed well-differentiated early HCC. Early HCCs frequently are isoenhancing relative to liver in arterial phase (incomplete neoarterialization) but seen clearly as hypointense nodules in the hepatobiliary phase (underexpression of OATP transporters). Note motion artifact in the arterial phase. 肝胆期高信号HCC 如前所述，在5-12%的HCC中OATP8表达水平升高，这些HCC肝胆期表现为高信号。病理上，这些HCC多为中等分化，少数为高分化。 肝胆期高信号HCC其他支持肝癌诊断的征象有 局部区域无对比剂摄取，表现为低信号边 缺乏FNH的结构特征（中心瘢痕和放射状纤维分隔） * 肝胆期高信号HCC * a b c d MR images in a 70-year-old man with HCC show hyperintensity in the hepatobiliary phase.?(a)Gadoxetate disodium–enhanced T1-weighted 3D GRE image (2.5/0.9; 11° flip angle) in late hepatic arterial phase shows hyperenhancing mass (arrow) in right posterior liver.?(b, c)?Relative to liver, mass is slightly hyperintense in?(b)?portal venous phase and mildly hypointense in?(c)?transitional phase.?(d)?In the hepatobiliary phase, mass is hyperintense with hypointense rim, likely representing tumor capsule (arrow). Presence of hypointense rim permits confident diagnosis of HCC despite hyperintensity of lesion. Note motion artifact on arterial phase image (arrowheads). 钆赛酸二钠MRI检查 钆赛酸MR检查通常获得4期图像：动脉期、门脉期、过渡期、肝胆期 钆赛酸由于摄取率高，故注射剂量较小，动脉期、门脉期时间窗较短，增加检查难度。 同样由于注射剂