肝脏特异性对比剂对肝脏占位性病变诊断价值(羽林论坛)教程.ppt

TACE术：肝癌 由于 HCC 中多不具备有正常功能的肝细胞，因此，在肝胆特 异期，病灶较周围肝实质而言，呈明显低信号,但是经研究报 道，少部分 HCC会吸收一定量的普美显，在肝胆特异期呈等、 稍高信号，其证实与HCC 的病理分级有关。文献报道，对于一 些分化较好的HCC，在肝胆特异期病灶可呈相对等“稍高信号， 其分子机制可能为病灶中肝细胞膜表面 OATP1B3 的表达。 53岁男性 动脉期 门脉期 3 min 病例 1 普美显MR 3 min 20 s 平扫 1 min 20 min Grade II HCC 普美显-MRI比MDCT更经常地表现出HCC的典型强化方式 病例 1 病例2：II级 HCC T1WI portal 3 min arterial portal 20min 3 min 普美显 马根维显 动脉期 20 min 平扫-T1WI 平扫-T2WI LGDN HGDN 病例 3 病例15：男，79。B超发现肝占位一周，无其它不适 T2WI DWI ADC 0分钟 3分钟 15分钟 25分钟 32分钟 DN? HCC(高分化)？ * * * Figure 2 Typical haemangioma. A 52-year-old woman with a liver lesion, discovered incidentally but not fully characterized using CT. (a) T2-weighted imaging. (b) Contrast-enhanced (GD-EOB-DTPA) T1-weighted arterial phase imaging. (c) Contrast-enhanced (GD-DTPA) T1-weighted delayed phase imaging. (d) Contrast-enhanced (GD-EOB-DTPA) T1-weighted hepatocyte phase imaging. The T2-weighted hyperintense lesion in the right hepatic lobe (arrow) demonstrates the typical discontinuous peripheral nodular enhancement with GD-EOB-DTPA. However, in the delayed or hepatocyte phase (d) it becomes hypointense, unlike what is seen on delayed images with extracellular agents (c). Arrowhead in (d): excreted contrast agent within the left hepatic bile duct. * Figure 3 Atypical (“flash-filling”) haemangioma. An asymptomatic 35-year-old woman with history of ovarian cancer. (a) T2-weighted imaging. (b) Contrast-enhanced (GD-EOB-DTPA) T1-weighted arterial phase imaging. (c) Contrast-enhanced (GD-EOB-DTPA) T1-weighted hepatocyte phase imaging. Round T2 hyperintense lesion in the right hepatic lobe (arrow) demonstrates intense diffuse arterial enhancement with GD-EOBDTPA, and washes out the contrast medium in the hepatocyte phase. This case illustrates the importance of correlating the hepatocyte phase with the other sequences to avoid misinterpretation. Differentiation from hypervascular metastases (e.g., neuroendocrine tumours) can be challenging due to a similar appearance in both unenhanced and contra