MRI对肝转移瘤的诊断价值

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摘要：目的： 探讨mri在肝转移瘤检出、诊断与鉴别诊断中的价值。方法： 回顾性分析经临床、影像及病理证实的（hepatic metastases，HMs）33例，所有病例均进行MRI平扫和动脉期、门脉期、延迟期及扩散加权成像 （diffusion weighted imaging，DW I）扫描，分析肝转移性肿瘤（hepatic metastases，HMs）MRI平扫、多期增强及扩散加权成像 （diffusion weighted imaging，DW I）的表现。结果： 33例患者共发现 212个肝转移灶，病变分布于肝左右两叶及尾状叶，肝右叶120个病灶（57%），左叶90（43%），其中肝尾状叶2例，23例转移灶为多发， 其余 10例为单发转移灶。 病灶小于11. 5 c m。在T1WI图像上大部分为低信号，1例为高信号，2例为低等混杂信号； 在 T2W I图像上， 121个病灶（57%）显示为中等高信号， 91个病灶（43%）为中等高信号伴病灶中央更高信号区，增强动脉期显示 142个病灶 （67%）呈明显的边缘强化， 2个病灶伴异常灌注， 70个病灶（33%）呈弥漫不均匀强化，其内坏死区未见强化，6例可见壁结节强化。增强门脉期， 123个病灶表现为与动脉期相仿的强化方式与程度， 其中 53个病灶表现为较动脉期稍增厚的强化环，扩散加权成像（b值为500 s/mm 2），202个病灶高信号，10个病灶为稍高信号。结论：采用MRI，结合扩散加权成像 （diffusion weighted imaging，DW I）对的HMs的诊断及鉴别诊断具有较高的价值，大多数病灶可以和肝脏其他病变（如 HCC、血管瘤、FNH等）能正确鉴别。

关键词：扩散加权成像；磁共振成像；转移性肿瘤；肝

Abstract：Objective： To investigate the sensitivity， specificity and differential diagnosis for hepatic metastases with MRI.Methods： 33 cases hepatic metbastases with the clinical、radiological and histological diagnosis were retrospectively analyzed，all cases were underwent MRI plain scan ， and arterial ， portal ， and delayed phase enhanced scan ，and diffusion weighted imaging， the MRI images were analyzed. Results： A total of 212 hepatic lesions were detected in 33 patients. Lesions were distributed in both lobes and caudate lobe， 120 hepatic lesions in right lobe（57%），90 hepatic lesions in left lobe（43%）， 2 hepatic lesions in caudate lobe . In 23 patients the metastatic lesions were multiple. The remaining 10 patientshad solitary metastases. Lesions ranged in diameter from less than 11.5cm.MR imaging showed most of the lesions on T1-weighted images as hypointense，1 lesion were hyperintense， 2 lesions weres lightly hypiontense to mixed hyperintense.On T2-weighted images 121 lesions （57%） were moderate hyperintense， 91 lesions（43%） were moderate hyperintense in which contained more hyperintense region.After contrast administration the arterial phase images revealed 142 lesions （67%） markedly ring enhancement ， 2 lesions images showed abnormal perfusion；and 70 lesions （33%）diffuse heterogeneous enhancement， the necrosis area of these lesions was not enhanced； 6 lesions images showed the wall nodule enhancement.During the portal phase 123 lesions demonstrate same parten and degree of enhancement as arterial phase. Fifty three of 131 lesions demonstrate thicker ring than arterial phase.On diffusion weighted images（ b=500s /mm2） 202 lesions were hyperintense， 10 lesions were moderate hyperintense.Conclusion： The combination of MRI and DWI played an important role in detecting and diagnosing hepatic metastases， A differential diagnosis to other hepatic lesion （such as HCC、hemangioma、FNH etc） can be made accurately.