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从肝硬化结节到早期肝癌需要经过几个阶段,首先是在肝硬化基础上形成再生结节(regenerative nodule,RN),再发展为不典型增生结节(dysplastic nodule,DN),最终发展成肝细胞性肝癌(hepatic cell carcinoma,HCC)[1]。从RN向HCC的进展过程中,肿瘤血管逐渐增多[2],并逐渐动脉化,使结节内的门静脉血供逐渐减少,动脉血供则逐渐增加。从RN、DN到HCC,结节内肿瘤新生血管生成的数量不同,其中RN血供与正常的肝细胞非常相似,主要为门静脉供血。DN的门静脉血供基本正常或仅有轻度减少,在直径2 cm以下的小HCC中,约有94%的病灶动脉血供多于正常肝组织,门静脉血供显著少于正常肝组织[3]。弥散加权成像(diffusion-weighted imaging,DWI)、灌注加权成像(perfusion-weighted imaging,PWI)、肝细胞特异性造影剂增强成像等多种MRI技术能基于以上病理改变为临床提供丰富的诊断信息,进一步提高了肝硬化、肝癌的诊断准确率。
肝硬化和肝癌MRI诊断研究进展
Advances in MRI diagnosis of cirrhosis and hepatocellular
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摘要: 大多数肝硬化、肝癌患者发现时就已经进入晚期,预后不佳,其早期诊断和治疗对患者的预后至关重要。随着医学影像学诊断技术的进步,越来越多的MRI技术被用于肝硬化、肝癌的诊断,弥散加权成像、灌注加权成像、肝细胞特异性造影剂增强成像等多种新的成像技术可以从分子水平、细胞功能等多个方面提供更为丰富的诊断信息,进一步提高了肝硬化、肝癌的诊断准确率。对提高肝硬化、肝癌诊断的准确率及改善患者预后具有重大意义。Abstract: Most of the cirrhosis and hepatic carcinoma patients have reached an advanced stage as they are diagnosed, the prognosis is poor, and its early diagnosis and treatment are essential for the patient's prognosis. With medical diagnostic imaging technology advanced, more and more MRI technology is used to the diagnosis, such as diffusion-weighted imaging, perfusion-weighted imaging, new hepatocellular specific contrast agent enhanced MRI can provide more extensive diagnostic information from a plurality of the molecular level, cellular functions, and improve the accuracy of diagnosis of cirrhosis and hepatic carcinoma. This is of great significance to improve cirrhosis and hepatic carcinoma's diagnostic accuracy and improve patient's prognosis.
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