Imaging characteristics of hereditary hepatic carcinoma combined with cirrhosis in patients with hepatic cysts
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摘要:
目的 总结肝硬化并发原发性肝癌合并肝囊肿(HHC)患者的影像学特征。 方法 分析106例HHC患者的上腹部增强CT,观察其临床特征、囊肿的直径、所在肝段、CT值等,并以109例无合并原发性肝癌的肝硬化肝囊肿患者作为对照。 结果 与无合并肝癌的对照组比较,HHC组的年龄偏大(P=0.039)、肝炎合并比例高(P=0.036)且肝硬化病程长(P=0.043);HHC组的囊肿为2~9个,而对照组为1~5个,两组的囊肿总数差异具有统计学意义(P<0.05);HHC组患者囊肿直径3~11 cm,而对照组为2~6 cm,两组的囊肿直径差异具有统计学意义(P<0.05);对照组的CT值多在15 Hu以内,而HHC组约半数超过15 Hu,两组差异具有统计学意义(P<0.05);HHC组的囊肿病灶总体以右半肝为主,尤其是S6段及S8段偏多,左半肝则以S3段偏多;对照组患者囊肿病灶以左半肝为主,尤其S3及S4偏多,两组的囊肿肝段分布差异具有统计学意义(χ2=2.572,P=0.011)。 结论 年龄、肝炎、肝硬化可能是原发性肝癌患者合并肝囊肿的危险因素;多发、右叶多见、直径大、易发生坏死,是HHC患者的囊肿形态学特征。 Abstract:Objective To summarize the imaging features of hereditary hepatic carcinoma (HHC) combined with cirrhosis in patients with hepatic cysts. Methods 106 HHC cases were included as the HCC group and undertook upper abdominal enhanced CT examination, while 109 cirrhosis patients with hepatic cysts were included as the control group. CT findings, including HHC’s clinical features, diameter of the cyst, hepatic segment where cysts locate, CT value, were observed and compared with that of the control group. Results Compared with the control group, patients in HHC group were significantly older (P=0.039) and had a higher proportion of hepatitis (P=0.036)and longer course of cirrhosis (P=0.043); he total number of cyst differed significantly between HHC group and the control group (2-9 in HHC group, 1-5 in control group)(P=0.036);the cyst diameter differed significantly between two groups, with it being 3~11cm in HHC group and 2~6cm in the control group(P=0.041); the difference of CT value between two groups was significant, with it being within 15hu in the control group and over 15hu in about half of the HHC group (P=0.023); the segment of cyst distribution differed significantly between the two groups, as the majority of cysts in HCC group located in the right liver, especially in the S6 and S8 section, while that of the control group located in the left half liver, especially in the S3 segment (χ2=2.572, P=2.572). Conclusion Age, hepatitis, cirrhosis of the liver may be risk factors for hepatic cysts in HCC patients. The morphological features of hepatic cysts in HCC patients include multiple lesions, frequent occurrence in the right lobe see, large diameter, and high susceptibility to necrosis. -
表 1 两组患者一般情况比较(n, Mean±SD)
分组 n 性别 年龄(岁) 肝炎病史 肝硬化病程(年) 男 女 有 无 HHC组 106 75 31 55.48±16.39 103 3 19.26±5.38 对照组 109 71 38 51.28±11.67 94 15 13.63±3.71 χ2/t χ2=1.022 t=6.294 χ2=3.124 t=3.175 P 0.086 0.039 0.036 0.043 表 2 两组患者囊肿特征比较(Mean±SD)
分组 n 囊肿总数 直径(cm) CT值(Hu) HHC组 106 5.39±3.28 6.19±3.27 18.38±4.29 对照组 109 3.16±1.67 4.16±2.28 11.36±3.01 t 1.761 1.922 4.206 P 0.036 0.041 0.023 -
[1] Kawada M, Hayami N, Suwabe T, et al. Hepatocellular carcinoma in a patient with polycystic liver disease[J]. Jpn J Med, 2015, 54(15): 1891-6. https://www.researchgate.net/profile/Satoshi_Hamanoue/publication/280630492_Hepatocellular_Carcinoma_in_a_Patient_with_Polycystic_Liver_Disease/links/57e1447508ae79eb80731257.pdf?origin=publication_detail [2] Bae KT, Zhu F, Chapman AB, et al. Magnetic resonance imaging evaluation of hepatic cysts in early Autosomal-Dominant polycystic kidney disease: the consortium for radiologic imaging studies of polycystic kidney disease cohort[J]. Clin J Am Soc Nephrol, 2006, 1(1): 64-7. [3] Recinos A, Zahouani T, Guillen J, et al. Congenital hepatic cyst[J]. Clin Med Insights Pediatr, 2017, 41(5): 699-703. http://insights.sagepub.com/congenital-hepatic-cyst-article-a6278 [4] 张雪峰, 易大勇, 李孝舜. 肝脏巨大黏液型恶性纤维组织细胞瘤CT表现一例[J]. 中华放射学杂志, 2014, 48(12): 1056-7. doi: 10.3760/cma.j.issn.1005-1201.2014.12.023 [5] Vannucchi A, Masi A, Vestrini G, et al. Extraperitoneal hemorrhagic rupture of a simple hepatic cyst. A case report and literature review[J]. Ann Ital Chir, 2016, 27(11): 87-93. [6] 张卫兵, 陈建, 颜朝晖, 等. 超声引导下聚桂醇与无水乙醇硬化治疗单纯性肝囊肿的比较[J]. 实用医学杂志, 2014, 30(8): 1312-4. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_syyxzz201408043 [7] 刘吉平, 张国胜, 高志伟. 腹腔镜带蒂大网膜填塞术治疗直径>10 cm肝囊肿36例[J]. 中国微创外科杂志, 2015, 23(07): 632-4. doi: 10.3969/j.issn.1009-6604.2015.07.016 [8] Qian LJ, Zhu J, Zhuang ZG, et al. Spectrum of multilocular cystic hepatic lesions: CT and Mr imaging findings with pathologic correlation[J]. Radiographics, 2013, 33(5): 1419-33. doi: 10.1148/rg.335125063 [9] Lantinga MA, Geudens A, Gevers T, et al. Systematic review: the management of hepatic cyst infection[J]. Aliment Pharmacol Ther, 2015, 41(3): 253-61. doi: 10.1111/apt.13047 [10] Scherer K, Gupta N, Caine WP, et al. Differential diagnosis and management of a recurrent hepatic cyst: a case report and review of literature[J]. J Gen Intern Med, 2009, 24(10): 1161-5. doi: 10.1007/s11606-009-1062-1 [11] Aditya, Ambade, Abhishek, et al. Adult mouse model of early hepatocellular carcinoma promoted by alcoholic liver disease[J]. World J Gastroenterol, 2016, 22(16): 4091-108. doi: 10.3748/wjg.v22.i16.4091 [12] Nakamura Y, Higaki T, Akiyama Y, et al. Diffusion-weighted Mr imaging of non-complicated hepatic cysts: Value of 3T computed diffusion-weighted imaging[J]. European J Radiol Open, 2016, 3(9): 138-44. [13] 房泽辉. 肝囊肿和血管瘤的磁共振扩散加权成像诊断及鉴别诊断价值[J]. 实用医学影像杂志, 2016, 17(05): 409-13. [14] Farraher SW, Jara H, Chang KJ, et al. Differentiation of hepatocellular carcinoma and hepatic metastasis from cysts and hemangiomas with calculated T2 relaxation times and the T1/T2 relaxation times ratio[J]. J Magn Reson Imaging, 2006, 24(6): 1333-41. doi: 10.1002/(ISSN)1522-2586 [15] 包作伟, 张伟民, 邵珍, 等. 超声引导下聚桂醇硬化治疗单纯性肝囊肿疗效及安全性分析[J]. 介入放射学杂志, 2014, 23(6): 520-2. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_jrfsxzz201406015 [16] Arslanoglu A, Chalian H, Sodagari F, et al. Threshold for enhancement in treated hepatocellular carcinoma on MDCT: effect on necrosis quantification[J]. AJR Am J Roentgenol, 2016, 206(3): 536-43. doi: 10.2214/AJR.15.15339 [17] Bouras J, Truant S, Zerrweck CA, et al. Image of the month cystic hepatocellular carcinoma[J]. Arch Surg, 2011, 146(6): 755-6. doi: 10.1001/archsurg.2011.124-a [18] Sawada N, Endo T, Mikami K, et al. Kidney injury due to ureteral obstruction caused by compression from infected simple hepatic cyst[J]. Case Rep Gastroenterol, 2017, 11(2): 312-9. doi: 10.1159/000475919 [19] Morii K, Yamamoto T, Nakamura S, et al. Infectious hepatic cyst: an underestimated complication[J]. Intern Med, 2018, 35(7): 139-43. [20] Kübeck M, Stöckl V, Stainer W, et al. Cystic echinococcosis and hepatocellular carcinoma--a coincidence? A case report [J]. Zeitschrift Für Gastroenterologie, 2014, 52(7): 657-62. doi: 10.1055/s-00000094 [21] Taguchi E, Nakanishi N, Nakao K, et al. Inferior Vena Cava thrombi caused by enlarged, solitary hepatic cyst[J]. Circ J, 2018, 82(2): 604-5. doi: 10.1253/circj.CJ-17-0160 [22] Panchal M, Alansari A, Wallack M, et al. Hepatic cyst compressing the right atrial and ventricular inflow tract: an uncommon cardiac complication[J]. Ann Hepatol, 2018, 17(1): 165-8. https://www.researchgate.net/publication/322099736_Hepatic_Cyst_Compressing_The_Right_Atrial_and_Ventricular_Inflow_Tract_An_Uncommon_Cardiac_Complication [23] Terada T. Hepatic nodular hamartoma containing liver cysts, ductal plate malformations and peribiliary glands[J]. Hepatology Research, 2011, 41(1): 93-8. doi: 10.1111/hep.2011.41.issue-1 [24] Parapar AL, Anton GS, Arguelles MV, et al. Hypersplenism secondary to splenoportal axis compression by a giant hepatic cyst[J]. Rev Esp Enferm Dig, 2018, 110(1): 51-8. https://www.researchgate.net/publication/251534321_Intolerancia_digestiva_en_un_anciano_por_compresion_de_quiste_hepatico_gigante