磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用

曾蒙苏; 李若坤

磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用

1. 复旦大学附属中山医院放射诊断科上海市影像医学研究所
2. 复旦大学上海医学院影像学系
3. 复旦大学附属金山医院放射科

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中图分类号: R735.7
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出版历程
- 出版日期: 2013-01-20

Clinical value of susceptibility-weighted imaging for studying the multi-step hepatocarcinogenic process of cirrhotic liver nodules

摘要

摘要:
肝癌早期发现,早期治疗,明显提高5年生存率。肝硬化患者,绝大部分均经历肝硬化结节多步癌变的过程,即由再生结节发展为异型增生结节,其中高分化异型增生结节发展为癌变结节后(早期肝癌),再发展为小肝癌,小肝癌最后发展成进展期或晚期肝癌。上述结节的一系列变化过程中,其结节内内源性铁逐步廓清,本文重点介绍利用磁共振磁敏感加权成像(SWI)技术观察结节中内源性铁变化情况,同时结合常规MR T2WI、弥散加权成像(DWI)和动态增强等技术,提高识别肝硬化背景下的癌变/早期肝癌结节能力,从而对进一步提高早期小肝癌的诊疗,具有更重要的临床意义。
- 肝硬化 /
- 癌,肝细胞 /
- 铁化合物 /
- 磁共振成像
Abstract:
Early detection, diagnosis, and effective treatment markedly improves the 5-year survival rate of patients with hepatocellular carcinoma (HCC) .Initiation of the multi-step hepatocarcinogenesis process often involves a cirrhotic nodule.After the regenerative nodule develops into a dysplastic nodule (DN) , it continues to advance from a low degree DN to a high degree DN.The high degree DN may then further develop to early HCC/small HCC or even progressed/advanced HCC.Previous studies have shown that endogenous iron within the nodule can inhibit or resolve the hepatocarcinogenic process.This review discusses the clinical utility of magnetic resonance (MR) susceptibility-weighted imaging for detecting and monitoring changes in nodular iron and the implications of this technology when combined with T2WI, diffusion weighted imaging, and dynamic contrast enhancement for improving clinical decision-making, thereby enhancing diagnostic efficacy for early HCC/small HCC in the cirrhotic background.
- liver cirrhosis /
- carcinoma /
- hepatocellular /
- iron compounds

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参考文献(25)

[1] Sherman M. Epidemiology of hepatocellular carcinoma[J]. Oncology, 2010, 78 (Suppl 1) : 7-10.

[2]Benvegnu L, Gios M, Boccato S, et al.Natural history ofcompensated viral cirrhosis:a prospective study on inci-dence and hierarchy of major complications[J].Gut, 2004, 53 (5) :744-749.

[3]Kim YS, Um SH, Ryu HS, et al.The prognosis of liver cir-rhosis in recent years in Korea[J].J Korean Med Sci, 2003, 18 (6) :833-841.

[4] Planas R, Balleste B, Alvarez MA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. Study of 200 patients[J]. J Hepatol, 2004, 40 (5) : 823-830.

[5]Hytiroglou P, Park YN, Krinsky G, et al.Hepatic precancer-ous lesions and small hepatocellular carcinoma[J].Gastro-enterol Clin North Am, 2007, 36 (4) :867-887.

[6] Hanna RF, Aguirre DA, Kased N, et al. Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features[J]. Radiographics, 2008, 28 (3) : 747-769.

[7]Shinmura R, Matsui O, Kobayashi S, et al.Cirrhotic nodules:association between MR imaging signal intensity and intranodu-lar blood supply[J].Radiology, 2005, 237 (2) :512-519.

[8]Park YN.Update on precursor and early lesions of hepatocel-lular carcinomas[J].Arch Pathol Lab Med, 2011, 135 (6) :704-715.

[9]Kim MJ.Current limitations and potential breakthroughs forthe early diagnosis of hepatocellular carcinoma[J].Gut Liv-er, 2011, 5 (1) :15-21.

[10]Ludwig J, Hashimoto E, Porayko MK, et al.Hemosiderosisin cirrrhosis, a study of 447 native livers[J].Gastroenterolo-gy, 1997, 112 (3) :882-888.

[11] Zhang JB, Krinsky GA. Iron-containing nodules of cirrhosis[J]. NMR Biomed, 2004, 17 (7) : 459-464.

[12]Terada T, Kadoya M, Nakanuma Y, et al.Iron-accumulatingadenomatous hyperplastic nodule with malignant foci in thecirrhotic liver.Histopathologic, quantitative iron, and mag-netic resonance imaging in vitro studies[J].Cancer, 1990, 65 (9) :1994-2000.

[13]Terada T, Nakanuma Y.Iron-negative foci in siderotic mac-roregenerative nodules in human cirrhotic liver.A marker ofincipient neoplastic lesions[J].Arch Pathol Lab Med, 1989, 113 (8) :916-920.

[14]Honda H, Kaneko K, Kanazawa Y, et al.Imaging of hepato-cellular carcinomas:effect of Cu and Fe contents on signalintensity[J].Abdom Imaging, 1997, 22 (1) :60-66.

[15] Pascale RM, De Miglio MR, Muroni MR, et al. Transferrin and transferrin receptor gene expression and iron uptake in hepatocellular carcinoma in the rat[J]. Hepatology, 1998, 27 (2) : 452-461.

[16] Lee AW, Oates PS, Trinder D. Effects of cell proliferation on the uptake of transferrin-bound iron by human hepatoma cells[J]. Hepatology, 2003, 38 (4) : 967- 977.

[17]Tan MG, Kumarasinghe MP, Wang SM, et al.Modulation ofiron-regulatory genes in human hepatocellular carcinomaand its physiological consequences[J].Exp Biol Med (May-wood) , 2009, 234 (6) :693-702.

[18]Holmstr m P, Gafvels M, Eriksson LC, et al.Expression ofiron regulatory genes in a rat model of hepatocellular carcino-ma[J].Liver International, 2006, 26 (8) :976-985.

[19]Haacke EM, Xu YB, Cheng YC, et al.Susceptibility weigh-ted imaging (SWI) [J].MRM, 2004, 52 (3) :612-618.

[20]Thomas B, Somasundaram S, Thamburaj, et al.Clinical applica-tions of susceptibility-weighted imaging of the brain-a pictori-al review[J].Neuroradiology, 2008, 50 (2) :105-116.

[21] Haacke EM, Mittal S, Wu Z, et al. Susceptibility weighted imaging: technical ascepts and clinical applications, part 1[J]. AJNR Am J Neuradiol, 2009, 30 (1) : 19-30.

[22] Haacke EM, Mittal S, Wu Z, et al. Susceptibility weighted imaging: technical ascepts and clinical applications, part 2[J]. AJNR Am J Neuradiol, 2009, 30 (2) : 232- 252.

[23]Yu JS, Chung JJ, Kim JH, et al.Small hypervascular hepa-tocellular carcinomas:value of“washout”on gadolinium-enhanced dynamic MR imaging compared to superparamag-netic iron oxide-enhanced imaging[J].Eur Radiol, 2009, 19 (11) :2614-2622.

[24]Yoo HJ, Lee JM, Lee MW, et al.Hepatocellular carcinomain cirrhotic liver:double-contrast-enhanced, high-resolu-tion 3.0T-MR imaging with pathologic correlation[J].In-vest Radiol, 2008, 43 (7) :538-546.

[25]Chung YE, Park MS, Kim MS, et al.Quantification of super-paramagnetic iron oxide-mediated signal intensity change inpatients with liver cirrhosis using T2 and T2*mapping:apreliminary report[J].Magn Reson Imaging, 2010, 31 (6) :1379-1386.

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