肝硬化结节癌变的早期影像诊断杨正汉_精品.ppt

* 对肝硬化再生结节及小肝癌的显示（MSCT与MRI比较） * 原发血色病，小肝癌（MRI versus MDCT） T2WI CT动脉期 动脉晚期 平衡期 门脉期 CT门脉期 CT平衡期 * T2WI T1WI 动脉期 平衡期 门脉期 DWI 乙肝肝硬化，微小肝癌。DWI对小肝癌的检出 * 四、DN癌变的早期影像学表现 * T1WI信号降低 T2WI信号升高 T2WI低信号病灶内出现略高信号小结节（结节中结节） 结节内出现脂肪变性 血供由门静脉供血为主转变为肝动脉供血为主 病灶内出现动脉期强化结节（结节中结节强化） DWI上结节呈现高信号或部分呈高信号 枯否细胞数目和功能减低，摄取SPIO能力下降 结节直径大于3厘米 出现假包膜 病灶进行性增大 DN癌变危险信息 * B超 CT-C CT+C T1WI T2WI T1WI+C 高级DN癌变（结节中结节及强化） * DN癌变（典型的结中结） 同相位T1WI 反相位T1WI T2WI+FS * DN癌变（结节内脂肪变性） 同相位T1WI 反相位T1WI T2WI+FS * T2WI Multihance 肝细胞期 碘油CT Multihance 动脉期 CT动脉期 T1WI T2WI * T2WI（1998年9月） T2WI（2001年4月） Feridex（2001年4月） 动脉期（2001年4月） DN（高级）癌变 * 小 结 肝硬化结节种类繁多 DN为癌前病变 以下表现可能提示DN癌变或小肝癌 结节较大（直径大于3cm） 进行性增大 整体或局部动脉血供增多 信号变化：T2WI信号增高 结中结，或结中结强化 脂肪变性 假包膜 摄取肝细胞对比剂减少或排泄延迟 摄取SPIO能力降低 MRI显出肝硬化相关结节及早期癌变优于MDCT * Thank you for your attention! * A nodule-in-nodule-type (NIN) hepatocellular carcinoma (HCC) in a dysplastic nodule. (a) Cut surface of lesion shows a typical nodule in nodule lesion. A dysplastic nodule (1.1cm in diameter, black arrow) surrounded a small HCC (0.8 cm in diameter, red arrow), which occupies almost the entire nodule with a remaining crescent-shaped dysplastic nodule at the periphery. (b) Light-microscopic features of NIN reveal (point a) cirrhotic lesion, (point b) dysplastic lesion and (point c) grade 1 HCC. (c) A border between a dysplastic lesion (point b) and a cirrhotic nodule (point a). This dysplastic lesion, classified as a high-grade dysplastic nodule because the lesion reveals small cell changes with nuclear crowding, increased the cell density but less than twice normal and showed anisocytosis with hyperchromatic nuclei. (d) The lesion was classified as grade 1 HCC and was composed of small acidophilic cancer cells. Note the nuclear density was more than twice that of the neighboring cirrhotic area. * Microscopic findings of type A and type B hepatocellular carcinomas (HCC). A: Type A hepatocellular carcinoma, overt welldifferentiated hepatocellular carcinoma in the right (HCC). Lesion of th