肝脏局灶性病变的特异性造影剂普美显MR表现课件整理

GdDTPAEOBFig.1MolecularstructureofGd-EOB-DTPAGd1肝硬化相关结节Cirrhosis-relatednodules肝硬化相关结节21、肝硬化再生和退变结节1.Regenerativeanddysplasticnodules1、肝硬化再生和退变结节3UnenhancedMRlfeatures:Typically,benigncirrhosis-assocatednodulesare<2cmandisontensetohyperin良性肝硬化结节<2cm,T1W呈等或高信号tenseonTI-weightedimages,isointensetohypointenseon,T2W呈等或低信号,DW呈等信号。含脂T2weightedimagesandisointenseondiffusion-weighted结节或变性结节表现为在反相位图像上信号0DW)mags.Lipid-containingnodulesorsteatoticnox减低。含铁结节或铁质沉着结节表现为T2Wulesdisplaysignallossonout-of-phasegradientecho和T2W明显低信号(图2)(GRE)imagesincomparsonwithm-phaseimages.IroncontainingnodulesorsideroticnodulesappearmarkedlyhypointenseonT2-weightedandT2*weightedimages(Fig.2)UnenhancedMRlfeatures:Typica4Dinanicinagingwithextracelluarcontrastagent.Aftertheinjectionofthecontrast,mostbenigncihosiassociated-nodulesshowsimilarenhancementtotheadja.注射造影剂后,大部分良性硬化结节在动脉期和静脉期表现为与周围肝实质centlivermthearterialandvenousphases9.10.scme类似的强化。一些良性硬化结节在动脉benigncirrhosisassocated-nodulesenhanceinthearterial期强化,在静脉期退为等信号phaseandtypicallyfadetoisointensityinthevenousImagingwithGid-EOB-DTPA:Uptakeandexcretionofadobenatedimegummebythesenodulesisusuallypreserved.Consequently,theyareusuallyhortensenthe在肝胆期表现为等信号hepatocellularphase(HCP)[]Dinanicinagingwithextracell5appearhypointenseintheHCP,potentiallymtalesmayPotentiapitfalls:Sideroticandsteatoticnodalreadyoflowsignalintensityintheprecomtemaking铁质沉着和变性结节在肝胆期表现为低信earlyhcC.Thisisduetotheironandfontrastfatsa,号,有可能和早期HCC混淆。有些良性结节ratedsequences.Somebenignnodulesmayappearhyper-在HCP表现为高信号(图3)。机制不明kp叫3MechanisnEsS但是OATP过多表达或者MDRs负调节可能TmP起作用。这些结节可能被误认为FNH样病变ssiblyplayarole.Suchlesionsmaybemistakenforfoca或者HCP高信号的不典型HCC。小的良性硬nodularhyperplasia(FNH-likelesions(thesearealso化结节在动脉期强化,HCP低信号,可能不benign,sothedistinctionisirrelevant)oratypicalHCCs能和小HCC区别withHCPhyperintensity.ThedifferentiationbetweenbenignandmalignantHCP-hypernmtensenodulesisdiscussedinthefollowingtwosections.Smallbenigncirrhosisassociatednoduleswitharterial-phasehyperenhancementandHCPhypointensitymaybeindistinguishablefromsmallHCcsappearhypointenseintheHCP,6Fig2Abenigncirrhosis-associatednodulena38-year-olwomanarrowspointtoasmallroundedfocallesion,markedlyhypoinphase,edelayedphase,IhepatocelluLarphase.TheimageshowsaliveringnoenhancementwiththecontrastagentThecuredaronwithabbulatedcontourandanodularparenchyma(cirhosis],ThemultipkGamna-gamdybodies(hemosiderindeposition)图2,肝硬化含铁结节。F肝胆期Fig2Abenigncirrhosis-assoc7Fig3Abenigncirrhosis.associatednodulema39-year-oldmanwithchronicliverdis.enseGd-EOB-DTPAenhancedMRiaarterialphase,bPvphase,cdelayedphase,dlatingGid-EOB-DIPA-benign图3,良性肝硬化结节。A动脉期B门脉期C延迟期D延迟5分钟E延迟10分钟F肝胆期Fig3Abenigncirrhosis.82、获得性FNH样病变2.AcquiredFNH-likelesions2、获得性FNH样病变9OverviewTheselesionsaredescribedincirrhoticliv-ers,andaremacroscopically,microscopicallyandimmu-nohistochemicallyidenticaltoclassicFNHseeninnon-cirrhoticlivers.Theyarebelievedtooriginatefromac-quredhyperplasticresponsestovascularalterationsasso-ciatedwithcirrhosis,asopposedtoconventionalFNHs,whicharebelievedtooriginatefromdevelopmentalresponsestocongenitalarterio-vascularmalfomations这些病变发生在肝硬化基础上,肉眼镜下、免疫组化和非肝硬化基础上典型的FNH都一样。它们起源于和肝硬化有关的血管变化的增生反应,而传统的FNH起源于对先天性血管畸形的进一步反应。OverviewTheselesionsaredes10肝脏局灶性病变的特异性造影剂普美显MR表现课件整理11肝脏局灶性病变的特异性造影剂普美显MR表现课件整理12肝脏局灶性病变的特异性造影剂普美显MR表现课件整理13肝脏局灶性病变的特异性造影剂普美显MR表现课件整理14肝脏局灶性病变的特异性造影剂普美显MR表现课件整理15肝脏局灶性病变的特异性造影剂普美显MR表现课件整理16肝脏局灶性病变的特异性造影剂普美显MR表现课件整理17肝脏局灶性病变的特异性造影剂普美显MR表现课件整理18肝脏局灶性病变的特异性造影剂普美显MR表现课件整理19肝脏局灶性病变的特异性造影剂普美显MR表现课件整理20肝脏局灶性病变的特异性造影剂普美显MR表现课件整理21肝脏局灶性病变的特异性造影剂普美显MR表现课件整理22肝脏局灶性病变的特异性造影剂普美显MR表现课件整理23肝脏局灶性病变的特异性造影剂普美显MR表现课件整理24肝脏局灶性病变的特异性造影剂普美显MR表现课件整理25肝脏局灶性病变的特异性造影剂普美显MR表现课件整理26肝脏局灶性病变的特异性造影剂普美显MR表现课件整理27肝脏局灶性病变的特异性造影剂普美显MR表现课件整理28肝脏局灶性病变的特异性造影剂普美显MR表现课件整理29肝脏局灶性病变的特异性造影剂普美显MR表现课件整理30肝脏局灶性病变的特异性造影剂普美显MR表现课件整理31肝脏局灶性病变的特异性造影剂普美显MR表现课件整理32肝脏局灶性病变的特异性造影剂普美显MR表现课件整理33肝脏局灶性病变的特异性造影剂普美显MR表现课件整理34肝脏局灶性病变的特异性造影剂普美显MR表现课件整理35肝脏局灶性病变的特异性造影剂普美显MR表现课件整理36肝脏局灶性病变的特异性造影剂普美显MR表现课件整理37肝脏局灶性病变的特异性造影剂普美显MR表现课件整理38肝脏局灶性病变的特异性造影剂普美显MR表现课件整理39肝脏局灶性病变的特异性造影剂普美显MR表现课件整理40肝脏局灶性病变的特异性造影剂普美显MR表现课件整理41肝脏局灶性病变的特异性造影剂普美显MR表现课件整理42肝脏局灶性病变的特异性造影剂普美显MR表现课件整理43肝脏局灶性病变的特异性造影剂普美显MR表现课件整理44肝脏局灶性病变的特异性造影剂普美显MR表现课件整理45肝脏局灶性病变的特异性造影剂普美显MR表现课件整理46肝脏局灶性病变的特异性造影剂普美显MR表现课件整理47肝脏局灶性病变的特异性造影剂普美显MR表现课件整理48肝脏局灶性病变的特异性造影剂普美显MR表现课件整理49肝脏局灶性病变的特异性造影剂普美显MR表现课件整理50肝脏局灶性病变的特异性造影剂普美显MR表现课件整理51肝脏局灶性病变的特异性造影剂普美显MR表现课件整理52肝脏局灶性病变的特异性造影剂普美显MR表现课件整理53肝脏局灶性病变的特异性造影剂普美显MR表现课件整理54肝脏局灶性病变的特异性造影剂普美显MR表现课件整理55肝脏局灶性病变的特异性造影剂普美显MR表现课件整理56肝脏局灶性病变的特异性造影剂普美显MR表现课件整理57肝脏局灶性病变的特异性造影剂普美显MR表现课件整理58肝脏局灶性病变的特异性造影剂普美显MR表现课件整理59肝脏局灶性病变的特异性造影剂普美显MR表现课件整理60肝脏局灶性病变的特异性造影剂普美显MR表现课件整理61肝脏局灶性病变的特异性造影剂普美显MR表现课件整理62肝脏局灶性病变的特异性造影剂普美显MR表现课件整理63肝脏局灶性病变的特异性造影剂普美显MR表现课件整理64肝脏局灶性病变的特异性造影剂普美显MR表现课件整理65肝脏局灶性病变的特异性造影剂普美显MR表现课件整理66肝脏局灶性病变的特异性造影剂普美显MR表现课件整理67肝脏局灶性病变的特异性造影剂普美显MR表现课件整理68肝脏局灶性病变的特异性造影剂普美显MR表现课件整理69肝脏局灶性病变的特异性造影剂普美显MR表现课件整理70肝脏局灶性病变的特异性造影剂普美显MR表现课件整理71肝脏局灶性病变的特异性造影剂普美显MR表现课件整理72肝脏局灶性病变的特异性造影剂普美显MR表现课件整理73肝脏局灶性病变的特异性造影剂普美显MR表现课件整理74肝脏局灶性病变的特异性造影剂普美显MR表现课件整理75肝脏局灶性病变的特异性造影剂普美显MR表现课件整理76肝脏局灶性病变的特异性造影剂普美显MR表现课件整理77肝脏局灶性病变的特异性造影剂普美显MR表现课件整理78肝脏局灶性病变的特异性造影剂普美显MR表现课件整理79肝脏局灶性病变的特异性造影剂普美显MR表现课件整理80肝脏局灶性病变的特异性造影剂普美显MR表现课件整理81肝脏局灶性病变的特异性造影剂普美显MR表现课件整理82肝脏局灶性病变的特异性造影剂普美显MR表现课件整理83肝脏局灶性病变的特异性造影剂普美显MR表现课件整理84肝脏局灶性病变的特异性造影剂普美显MR表现课件整理85肝脏局灶性病变的特异性造影剂普美显MR表现课件整理86肝脏局灶性病变的特异性造影剂普美显MR表现课件整理87肝脏局灶性病变的特异性造影剂普美显MR表现课件整理88肝脏局灶性病变的特异性造影剂普美显MR表现课件整理89肝脏局灶性病变的特异性造影剂普美显MR表现课件整理90肝脏局灶性病变的特异性造影剂普美显MR表现课件整理91肝脏局灶性病变的特异性造影剂普美显MR表现课件整理92肝脏局灶性病变的特异性造影剂普美显MR表现课件整理93肝脏局灶性病变的特异性造影剂普美显MR表现课件整理94肝脏局灶性病变的特异性造影剂普美显MR表现课件整理95肝脏局灶性病变的特异性造影剂普美显MR表现课件整理96肝脏局灶性病变的特异性造影剂普美显MR表现课件整理97肝脏局灶性病变的特异性造影剂普美显MR表现课件整理98肝脏局灶性病变的特异性造影剂普美显MR表现课件整理99肝脏局灶性病变的特异性造影剂普美显MR表现课件整理100肝脏局灶性病变的特异性造影剂普美显MR表现课件整理101肝脏局灶性病变的特异性造影剂普美显MR表现课件整理102肝脏局灶性病变的特异性造影剂普美显MR表现课件整理103肝脏局灶性病变的特异性造影剂普美显MR表现课件整理104肝脏局灶性病变的特异性造影剂普美显MR表现课件整理105肝脏局灶性病变的特异性造影剂普美显MR表现课件整理106肝脏局灶性病变的特异性造影剂普美显MR表现课件整理107肝脏局灶性病变的特异性造影剂普美显MR表现课件整理108肝脏局灶性病变的特异性造影剂普美显MR表现课件整理109肝脏局灶性病变的特异性造影剂普美显MR表现课件整理110肝脏局灶性病变的特异性造影剂普美显MR表现课件整理111肝脏局灶性病变的特异性造影剂普美显MR表现课件整理112肝脏局灶性病变的特异性造影剂普美显MR表现课件整理113肝脏局灶性病变的特异性造影剂普美显MR表现课件整理114肝脏局灶性病变的特异性造影剂普美显MR表现课件整理115肝脏局灶性病变的特异性造影剂普美显MR表现课件整理116肝脏局灶性病变的特异性造影剂普美显MR表现课件整理117肝脏局灶性病变的特异性造影剂普美显MR表现课件整理118肝脏局灶性病变的特异性造影剂普美显MR表现课件整理119肝脏局灶性病变的特异性造影剂普美显MR表现课件整理120肝脏局灶性病变的特异性造影剂普美显MR表现课件整理121肝脏局灶性病变的特异性造影剂普美显MR表现课件整理122肝脏局灶性病变的特异性造影剂普美显MR表现课件整理123肝脏局灶性病变的特异性造影剂普美显MR表现课件整理124肝脏局灶性病变的特异性造影剂普美显MR表现课件整理125肝脏局灶性病变的特异性造影剂普美显MR表现课件整理126GdDTPAEOBFig.1MolecularstructureofGd-EOB-DTPAGd127肝硬化相关结节Cirrhosis-relatednodules肝硬化相关结节1281、肝硬化再生和退变结节1.Regenerativeanddysplasticnodules1、肝硬化再生和退变结节129UnenhancedMRlfeatures:Typically,benigncirrhosis-assocatednodulesare<2cmandisontensetohyperin良性肝硬化结节<2cm,T1W呈等或高信号tenseonTI-weightedimages,isointensetohypointenseon,T2W呈等或低信号,DW呈等信号。含脂T2weightedimagesandisointenseondiffusion-weighted结节或变性结节表现为在反相位图像上信号0DW)mags.Lipid-containingnodulesorsteatoticnox减低。含铁结节或铁质沉着结节表现为T2Wulesdisplaysignallossonout-of-phasegradientecho和T2W明显低信号(图2)(GRE)imagesincomparsonwithm-phaseimages.IroncontainingnodulesorsideroticnodulesappearmarkedlyhypointenseonT2-weightedandT2*weightedimages(Fig.2)UnenhancedMRlfeatures:Typica130Dinanicinagingwithextracelluarcontrastagent.Aftertheinjectionofthecontrast,mostbenigncihosiassociated-nodulesshowsimilarenhancementtotheadja.注射造影剂后,大部分良性硬化结节在动脉期和静脉期表现为与周围肝实质centlivermthearterialandvenousphases9.10.scme类似的强化。一些良性硬化结节在动脉benigncirrhosisassocated-nodulesenhanceinthearterial期强化,在静脉期退为等信号phaseandtypicallyfadetoisointensityinthevenousImagingwithGid-EOB-DTPA:Uptakeandexcretionofadobenatedimegummebythesenodulesisusuallypreserved.Consequently,theyareusuallyhortensenthe在肝胆期表现为等信号hepatocellularphase(HCP)[]Dinanicinagingwithextracell131appearhypointenseintheHCP,potentiallymtalesmayPotentiapitfalls:Sideroticandsteatoticnodalreadyoflowsignalintensityintheprecomtemaking铁质沉着和变性结节在肝胆期表现为低信earlyhcC.Thisisduetotheironandfontrastfatsa,号,有可能和早期HCC混淆。有些良性结节ratedsequences.Somebenignnodulesmayappearhyper-在HCP表现为高信号(图3)。机制不明kp叫3MechanisnEsS但是OATP过多表达或者MDRs负调节可能TmP起作用。这些结节可能被误认为FNH样病变ssiblyplayarole.Suchlesionsmaybemistakenforfoca或者HCP高信号的不典型HCC。小的良性硬nodularhyperplasia(FNH-likelesions(thesearealso化结节在动脉期强化,HCP低信号,可能不benign,sothedistinctionisirrelevant)oratypicalHCCs能和小HCC区别withHCPhyperintensity.ThedifferentiationbetweenbenignandmalignantHCP-hypernmtensenodulesisdiscussedinthefollowingtwosections.Smallbenigncirrhosisassociatednoduleswitharterial-phasehyperenhancementandHCPhypointensitymaybeindistinguishablefromsmallHCcsappearhypointenseintheHCP,132Fig2Abenigncirrhosis-associatednodulena38-year-olwomanarrowspointtoasmallroundedfocallesion,markedlyhypoinphase,edelayedphase,IhepatocelluLarphase.TheimageshowsaliveringnoenhancementwiththecontrastagentThecuredaronwithabbulatedcontourandanodularparenchyma(cirhosis],ThemultipkGamna-gamdybodies(hemosiderindeposition)图2,肝硬化含铁结节。F肝胆期Fig2Abenigncirrhosis-assoc133Fig3Abenigncirrhosis.associatednodulema39-year-oldmanwithchronicliverdis.enseGd-EOB-DTPAenhancedMRiaarterialphase,bPvphase,cdelayedphase,dlatingGid-EOB-DIPA-benign图3,良性肝硬化结节。A动脉期B门脉期C延迟期D延迟5分钟E延迟10分钟F肝胆期Fig3Abenigncirrhosis.1342、获得性FNH样病变2.AcquiredFNH-likelesions2、获得性FNH样病变135OverviewTheselesionsaredescribedincirrhoticliv-ers,andaremacroscopically,microscopicallyandimmu-nohistochemicallyidenticaltoclassicFNHseeninnon-cirrhoticlivers.Theyarebelievedtooriginatefromac-quredhyperplasticresponsestovascularalterationsasso-ciatedwithcirrhosis,asopposedtoconventionalFNHs,whicharebelievedtooriginatefromdevelopmentalresponsestocongenitalarterio-vascularmalfomations这些病变发生在肝硬化基础上,肉眼镜下、免疫组化和非肝硬化基础上典型的FNH都一样。它们起源于和肝硬化有关的血管变化的增生反应,而传统的FNH起源于对先天性血管畸形的进一步反应。OverviewTheselesionsaredes136肝脏局灶性病变的特异性造影剂普美显MR表现课件整理137肝脏局灶性病变的特异性造影剂普美显MR表现课件整理138肝脏局灶性病变的特异性造影剂普美显MR表现课件整理139肝脏局灶性病变的特异性造影剂普美显MR表现课件整理140肝脏局灶性病变的特异性造影剂普美显MR表现课件整理141肝脏局灶性病变的特异性造影剂普美显MR表现课件整理142肝脏局灶性病变的特异性造影剂普美显MR表现课件整理143肝脏局灶性病变的特异性造影剂普美显MR表现课件整理144肝脏局灶性病变的特异性造影剂普美显MR表现课件整理145肝脏局灶性病变的特异性造影剂普美显MR表现课件整理146肝脏局灶性病变的特异性造影剂普美显MR表现课件整理147肝脏局灶性病变的特异性造影剂普美显MR表现课件整理148肝脏局灶性病变的特异性造影剂普美显MR表现课件整理149肝脏局灶性病变的特异性造影剂普美显MR表现课件整理150肝脏局灶性病变的特异性造影剂普美显MR表现课件整理151肝脏局灶性病变的特异性造影剂普美显MR表现课件整理152肝脏局灶性病变的特异性造影剂普美显MR表现课件整理153肝脏局灶性病变的特异性造影剂普美显MR表现课件整理154肝脏局灶性病变的特异性造影剂普美显MR表现课件整理155肝脏局灶性病变的特异性造影剂普美显MR表现课件整理156肝脏局灶性病变的特异性造影剂普美显MR表现课件整理157肝脏局灶性病变的特异性造影剂普美显MR表现课件整理158肝脏局灶性病变的特异性造影剂普美显MR表现课件整理159肝脏局灶性病变的特异性造影剂普美显MR表现课件整理160肝脏局灶性病变的特异性造影剂普美显MR表现课件整理161肝脏局灶性病变的特异性造影剂普美显MR表现课件整理162肝脏局灶性病变的特异性造影剂普美显MR表现课件整理163肝脏局灶性病变的特异性造影剂普美显MR表现课件整理164肝脏局灶性病变的特异性造影剂普美显MR表现课件整理165肝脏局灶性病变的特异性造影剂普美显MR表现课件整理166肝脏局灶性病变的特异性造影剂普美显MR表现课件整理167肝脏局灶性病变的特异性造影剂普美显MR表现课件整理168肝脏局灶性病变的特异性造影剂普美显MR表现课件整理169肝脏局灶性病变的特异性造影剂普美显MR表现课件整理170肝脏局灶性病变的特异性造影剂普美显MR表现课件整理171肝脏局灶性病变的特异性造影剂普美显MR表现课件整理172肝脏局灶性病变的特异性造影剂普美显MR表现课件整理173肝脏局灶性病变的特异性造影剂普美显MR表现课件整理174肝脏局灶性病变的特异性造影剂普美显MR表现课件整理175肝脏局灶性病变的特异性造影剂普美显MR表现课件整理176肝脏局灶性病变的特异性造影剂普美显MR表现课件整理177肝脏局灶性病变的特异性造影剂普美显MR表现课件整理178肝脏局灶性病变的特异性造影剂普美显MR表现课件整理179肝脏局灶性病变的特异性造影剂普美显MR表现课件整理180肝脏局灶性病变的特异性造影剂普美显MR表现课件整理181肝脏局灶性病变的特异性造影剂普美显MR表现课件整理182肝脏局灶性病变的特异性造影剂普美显MR表现课件整理183肝脏局灶性病变的特异性造影剂普美显MR表现课件整理184肝脏局灶性病变的特异性造影剂普美显MR表现课件整理185肝脏局灶性病变的特异性造影剂普美显MR表现课件整理186肝脏局灶性病变的特异性造影剂普美显MR表现课件整理187肝脏局灶性病变的特异性造影剂普美显MR表现课件整理188肝脏局灶性病变的特异性造影剂普美显MR表现课件整理189肝脏局灶性病变的特异性造影剂普美显MR表现课件整理190肝脏局灶性病变的特异性造影剂普美显MR表现课件整理191肝脏局灶性病变的特异性造影剂普美显MR表现课件整理192肝脏局灶性病变的特异性造影剂普美显MR表现课件整理193肝脏局灶性病变的特异性造影剂普美显MR表现课件整理194肝脏局灶性病变的特异性造影剂普美显MR表现课件整理195肝脏局灶性病变的特异性造影剂普美显MR表现课件整理196肝脏局灶性病变的特异性造影剂普美显MR表现课件整理197肝脏局灶性病变的特异性造影剂普美显MR表现课件整理198肝脏局灶性病变的特异性造影剂普美显MR表现课件整理199肝脏局灶性病变的特异性造影剂普美显MR表现课件整理200肝脏局灶性病变的特异性造影剂普美显MR表现课件整理201肝脏局灶性病变的特异性造影剂普美显MR表现课件整理202肝脏局灶性病变的特异性造影剂普美显MR表现课件整理203肝脏局灶性病变的特异性造影剂普美显MR表现课件整理204肝脏局灶性病变的特异性造影剂普美显MR