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鉴别诊断丨肝脏T2高信号中心瘢痕病变

2021-11-01 花人青 熊猫放射

肝脏T2高信号中心瘢痕
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到底怎么鉴别？一文读懂！

鉴别诊断：T2高信号中心瘢痕

Differential Diagnosis：T2 Bright Central Scar

① T2高信号并更高信号中心瘢痕，外周结节样强化，持续渐进性强化

  • T2 bright lesion

  • T2 brighter scar

  • Peripheral nodular enhancement

  • Persistent enhancement

 

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巨大及中等大小的血管瘤 

Giant and a mid-size hemangioma

②T2等信号并轻度更高信号瘢痕，明显均匀强化，廓清至等信号

  • T2 isointense

  • T2 slightly brighter scar

  • Homogeneous enhancement

  • fades to isointensity

 

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局灶性结节性增生（FNH）

Focal nodular hyperplasia

③ T2轻度高信号并更高信号瘢痕，不均质强化，廓清并包膜强化

  • T2 slightly bright lesion

  • T2 brighter scar

  • Heterogeneous enhancement

  • Washout with capsular enhancement

 

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肝细胞癌（巨块型）

Hepatocellular carcinoma

小结

  • 评估T2WI：第一例，高信号病变+更高信号瘢痕。第二例，等信号病灶+高信号瘢痕。第三例，较高信号病灶+更高信号瘢痕。

  • 评估增强动脉期：第一例，外周结节样强化。第二例，除瘢痕之外明显均匀强化。第三例，较明显不均质强化。

  • 评估增强门脉期：第一例，向心性渐进性强化。第二例，廓清至等信号。第三例，廓清、假包膜强化。

  • 评估增强延迟期：第一例，持续强化并中心瘢痕不强化。第二例，等信号并中心瘢痕及分隔强化。第三例，廓清、假包膜强化。

 

☆ 内容来源：英文图书《Liver MRI》

补充病例及讲解 

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肝细胞癌，主要特点：增强扫描“快进快出”、中心裂隙状坏死、明显弥散受限、假包膜。

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FNH，主要特点：T2WI等或略高信号，中心更高信号瘢痕，动脉期明显全瘤性强化，延迟期等或稍高信号，肝胆期呈等信号。

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肝转移瘤（肝穿：小细胞癌；另发现左下肺占位），主要特点：小类圆形、边界清楚，弥散受限，乏血供，延迟期中心强化。

伴有中心瘢痕的肝脏病变

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部分资料来源：影像专家鉴别诊断-腹部分册

评论区 (5)
#插入话题
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    2022-08-09 meichuangyi

    #高信号#

    0

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    2021-11-03 12498a1cm67暂无昵称

    #瘢痕#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1950841, encodeId=f89f195084158, content=<a href='/topic/show?id=20101021e97e' target=_blank style='color:#2F92EE;'>#高信号#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102179, encryptionId=20101021e97e, topicName=高信号)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e4137, createdName=meichuangyi, createdTime=Tue Aug 09 08:26:16 CST 2022, time=2022-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336995, encodeId=5a06133699516, content=<a href='/topic/show?id=48f8e12220f' target=_blank style='color:#2F92EE;'>#瘢痕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71222, encryptionId=48f8e12220f, topicName=瘢痕)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fa82500120, createdName=12498a1cm67暂无昵称, createdTime=Wed Nov 03 13:26:16 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506974, encodeId=741515069e448, content=<a href='/topic/show?id=a66b9624e0c' target=_blank style='color:#2F92EE;'>#鉴别诊断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96247, encryptionId=a66b9624e0c, topicName=鉴别诊断)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77179846395, createdName=Homburg, createdTime=Wed Nov 03 13:26:16 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066453, encodeId=f0a3106645350, content=谢谢，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 01:00:01 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066101, encodeId=04be1066101e5, content=动脉活检被认为是诊断巨细胞动脉炎的, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Tue Nov 02 07:15:18 CST 2021, time=2021-11-02, status=1, ipAttribution=)]
    2021-11-03 Homburg

    #鉴别诊断#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1950841, encodeId=f89f195084158, content=<a href='/topic/show?id=20101021e97e' target=_blank style='color:#2F92EE;'>#高信号#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102179, encryptionId=20101021e97e, topicName=高信号)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e4137, createdName=meichuangyi, createdTime=Tue Aug 09 08:26:16 CST 2022, time=2022-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1336995, encodeId=5a06133699516, content=<a href='/topic/show?id=48f8e12220f' target=_blank style='color:#2F92EE;'>#瘢痕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71222, encryptionId=48f8e12220f, topicName=瘢痕)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fa82500120, createdName=12498a1cm67暂无昵称, createdTime=Wed Nov 03 13:26:16 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506974, encodeId=741515069e448, content=<a href='/topic/show?id=a66b9624e0c' target=_blank style='color:#2F92EE;'>#鉴别诊断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96247, encryptionId=a66b9624e0c, topicName=鉴别诊断)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77179846395, createdName=Homburg, createdTime=Wed Nov 03 13:26:16 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066453, encodeId=f0a3106645350, content=谢谢，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 01:00:01 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066101, encodeId=04be1066101e5, content=动脉活检被认为是诊断巨细胞动脉炎的, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Tue Nov 02 07:15:18 CST 2021, time=2021-11-02, status=1, ipAttribution=)]
    2021-11-03 1482963am12暂无昵称

    谢谢，学习了

    0

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    2021-11-02 查查佳佳

    动脉活检被认为是诊断巨细胞动脉炎的

    0