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目的探讨MRI在原发性肝细胞癌(HCC)患者门静脉癌栓和血栓鉴别诊断中的价值。方法回顾性分析2009年4月~2015年5月间80例肝细胞癌伴门静脉癌栓(PVTT,57例)及门静脉血栓(PVT,23例)患者的临床资料及MRI特征并比较异同。所有患者均行MRI平扫、动态增强及弥散加权(DWI)成像。结果 57例PVTT表现为T1WI高信号4例,病灶强化52例,DWI高信号41例,与肝内癌灶毗邻46例,局部血管膨胀性改变31例;23例PVT表现为T1WI高信号14例,病灶强化0例,周围管壁轨道状强化7例,DWI高信号2例,与肝内癌灶毗邻3例,局部血管膨胀性改变3例,差异具有统计学意义(P<0.05)。结论 MRI平扫、增强联合DWI在HCC患者PVTT和PVT鉴别中具有重要参考价值。
Objective To investigate the value of MRI in the differential diagnosis of portal vein tumor thrombus and thrombus in patients with primary hepatocellular carcinoma (HCC). Methods The clinical data and MRI features of 80 patients with hepatocellular carcinoma with portal vein tumor thrombus (PVTT, 57 cases) and portal vein thrombosis (PVT, 23 cases) from April 2009 to May 2015 were retrospectively analyzed. All patients underwent MRI scan, dynamic enhancement and diffusion weighted (DWI) imaging. Results PVTT in 57 cases showed high T1WI signal in 4 cases, focal enhancement in 52 cases, DWI high signal in 41 cases, adjacent to intrahepatic carcinoma in 46 cases, local vascular expansion in 31 cases, 23 cases of PVT showed T1WI high signal in 14 cases , 0 cases of focal enhancement, 7 cases of orbital wall-like enhancement, 2 cases of DWI high signal, 3 cases adjacent to intrahepatic cancer and 3 cases of local vascular expansion. The difference was statistically significant (P <0.05). Conclusion MRI scan and enhanced combined DWI have important reference value in the differential diagnosis of PVTT and PVT in patients with HCC.