[CT and MRI findings of primary hepatic neuroendocrine neoplasm]
- PMID: 28835083
- DOI: 10.3760/cma.j.issn.0253-3766.2017.08.008
[CT and MRI findings of primary hepatic neuroendocrine neoplasm]
Abstract
Objective: To study imaging features of primary hepatic neuroendocrine neoplasm (PHNEN) with CT and MRI. Methods: CT/MRI findings of ten patients with pathologically confirmed PHNEN were retrospectively analyzed. The result was compared with pathologic features classified by the 2010 WHO classification of gastro-entero-pancreatic neuroendocrine tumor which was also compared with the conventional method. Results: Six cases of neuroendocrine tumor (NET), all of which were classified as grade 2 (G2), consisted of 5 cases of carcinoid and 1 case of atypical carcinoid. Four cases of neuroendocrine carcinoma (NEC) classified as grade 3 (G3) were composed of 1 case of atypical carcinoid and 3 cases of small cell carcinoma. On the basis of conventional classification method, CT/MRI features were as follows: (1) Carcinoid: For 5 carcinoid cases, two with solitary mass, two with dominant masses and satellite nodules, and one with diffused nodules. Four cases were cystic-solid and one was solid. Four showed low density on plain CT and moderate to obvious enhancement in arterial phase. Three showed consistent enhancement in portal and delayed phase while one showed rapid washout in portal phase. Four showed low density in delayed phase. One case with cystic degeneration showed hypo-intensity on T1W, hyper-intensity on T2W and halo like hyper-intensity on DWI. In dynamic MRI, the solid part of tumor showed obvious enhancement in arterial phase, consistent enhancement in portal phase with slight washout and homogeneous or slight hypo-geneous signal density in delayed phase. (2) Atypical carcinoid: Two cases presented with cystic-solid mass. They were all dominant masses with satellite nodules. They showed low density on plain CT and mild to moderate enhancement in arterial phase. One case showed rapid washout in portal and delayed phase with embolus in portal vein. The other case showed consistent enhancement in portal phase and hypo-density in delayed phase without enhancement of satellite nodules. (3) Small cell neuroendocrine carcinoma: Three cases of small cell carcinoma were composed of one cystic-solid tumor, one solid tumor and one dominant mass with satellite nodules. Two cases showed low density in CT plain scan while one with cystic degeneration presented hypo-intensity on T1W, hype-rintensity on T2W and halo like hyper-intensity on DWI. Dynamic CT and MRI showed mild to moderate enhancement in arterial phase, consistent enhancement in portal phase and low density or hypo-intensity in delayed phase. Conclusion: PHNEN has specific features on CT and MRI which are valuable in diagnosis and differential diagnosis.
目的： 分析肝脏原发性神经内分泌肿瘤(PHNEN)的CT和磁共振成像(MRI)表现特征。 方法： 回顾性分析经病理证实的10例PHNEN患者的CT及MRI资料，并与病理结果进行对照分析，按照2010年WHO胃肠胰神经内分泌肿瘤的分类分级方法进行分类，并与传统分类方法进行比较。 结果： 10例PHNEN患者中，神经内分泌瘤6例，均为G2级，其中类癌5例，不典型类癌1例；神经内分泌癌4例，均为G3级，其中不典型类癌1例，小细胞癌3例。按照传统分类方法，5例类癌患者中，单发2例，主结节伴卫星灶2例，弥漫性病变1例；囊实性4例，实性1例。有4例类癌患者的CT平扫均呈低密度，实性部分动脉期中度到明显强化，其中3例门脉期及延迟期持续强化；1例门脉期廓清，延迟期呈低密度。有1例类癌患者的MRI T1WI呈低信号，T2WI呈高信号，其内可见囊性变，DWI呈晕环样高信号。增强扫描显示，实性部分动脉期明显强化，门脉期持续强化，但有廓清，延迟期呈等或稍低信号。2例不典型类癌均为囊实性，表现为主结节伴卫星灶。2例不典型类癌患者的CT平扫均呈低密度，增强扫描显示动脉期轻至中度强化，其中1例门脉期及延迟期廓清，门脉瘤栓形成；1例门脉期持续增强，延迟期呈低密度，卫星灶未见明显强化。3例小细胞癌患者中，单发囊实性1例，实性1例，主结节伴卫星灶1例(呈囊实性)。2例小细胞癌患者的CT平扫均呈低密度。1例小细胞癌患者的MRI T1WI呈低信号，T2WI呈高信号，内见囊性变，DWI呈晕环样高信号。增强扫描显示，实性部分动脉期轻度或中度强化，门脉期持续强化，延迟期呈低密度或低信号。 结论： PHNEN的CT和MRI影像表现具有一定的特征，在诊断和鉴别诊断中有一定价值。.
Keywords: Liver neoplasms; Magnetic resonance imaging; Primary hepatic neuroendocrine neoplasm; Tomography, X-ray computed.
