杨伟斌　卢陈英　杨宏远　徐　民　陈春妙　涂建飞　高　杨　程　雪　纪建松浙江大学丽水医院放射科，浙江丽水　323000

MRI在原发性肝细胞癌门静脉癌栓与血栓鉴别中的应用价值

杨伟斌卢陈英杨宏远徐民陈春妙涂建飞高杨程雪纪建松▲
浙江大学丽水医院放射科，浙江丽水323000

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。

原发性肝细胞癌；门静脉；癌栓；血栓；磁共振成像

［Abstract］Objective To exp1ore c1inic va1ue of MRI in identifying porta1 vein tumor thrombus（PVTT）and porta1 venous thrombosis（PVT）in hepatoce11u1ar carcinoma patients.Methods C1inica1 data of 80 HCC patients with PVTT（n= 57）and PVT（n=23）between Apri1 2009 and May 2015 in our hospita1 were retrospective1y ana1yzed.T1WI，T2WI，DWI and contrast-enhanced MRI（CE-MRI）were performed in a11 patients.The typica1 features were observed.Results In PVTT patients，hyper-intense on T1-weighted MR images（T1WI）in 4 cases，enhanced in 52 cases，hyper-intense on DWI in 41 cases，adjacent hepatic tumor were appeared in 46 cases，expansib1e change of affected porta1 vein in 31 cases.In 23 cases of PVT，hyper-intense on T1WI in 14 cases，unenhanced in a11 cases，vesse1 wa11 enhanced in 7 cases，hyper-intense on DWI in 2 cases，adjacent hepatic tumor appeared in 3cases，expansib1e change of affected porta1 vein in 3 cases.The difference was statistica11y significant.Conclusion T1WI，T2WI，DWI and CE-MRI show important va1ue for identifying PVTT and PVT.

［Key words］Hepatoce11u1ar carcinoma；Porta1 vein；Tumor thrombus；Thrombosis；Magnetic resonance imaging

原发性肝细胞癌（hepatoce11u1ar carcinoma，HCC）是肝脏最常见的原发性恶性肿瘤［1］，80%的HCC病例来自东亚、撒哈拉以南的非洲［2］。HCC伴发门静脉癌栓预后差，在临床工作中肝细胞癌并发门静脉血栓易误诊为癌栓。准确鉴别肝细胞癌门静脉癌栓与血栓，对治疗方案的选择及预后有重要影响［3］。目前大部分文献报道对这两者的鉴别诊断以超声和CT增强检查为主，但是其影像学诊断依据相对单一［4］，肝细胞癌门静脉癌栓、血栓的MRI鉴别报道较少。本文探讨MRI在原发性肝细胞癌门静脉癌栓与血栓鉴别诊断中的价值，现报道如下。……