• 四川大學(xué)華西醫(yī)院放射科（成都610041）;

目的介紹1995年國際肝病工作組關(guān)于肝硬變結(jié)節(jié)的分類標(biāo)準(zhǔn)，總結(jié)與病理學(xué)特征相關(guān)的各種肝結(jié)節(jié)的影像學(xué)表現(xiàn)，并探討各種影像學(xué)檢查方法的診斷價(jià)值。方法用超聲、CT、MRI、血管造影性CT等各種影像學(xué)檢查方法。結(jié)果在肝硬變背景基礎(chǔ)上肝癌的發(fā)生、發(fā)展，沿循從再生結(jié)節(jié)、低度非典型性結(jié)節(jié)、高度非典型性結(jié)節(jié)到小肝癌（SHCC）、大肝癌的逐步演進(jìn)過程，在此過程中同時(shí)伴有結(jié)節(jié)內(nèi)血流供應(yīng)和灌注的相應(yīng)變化。結(jié)論現(xiàn)代影像學(xué)檢查技術(shù)的發(fā)展為肝內(nèi)各種結(jié)節(jié)的檢出、定性和鑒別診斷提供了多種十分有效的方法，為各類肝結(jié)節(jié)，特別是早期小肝癌結(jié)節(jié)的診斷、治療創(chuàng)造了有利條件。

引用本文： 吳苾,宋彬. 肝硬變結(jié)節(jié)性病變的影像學(xué)和相關(guān)病理學(xué)表現(xiàn). 中國普外基礎(chǔ)與臨床雜志, 2003, 10(3): 288-294. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. International Working Party. Terminology of nodular hepatocellular lesions [J]. Hepatology, 1995; 22（3）∶ 983.
2. 周曉軍. 肝臟交界性病變的病理組織學(xué)特點(diǎn) [J]. 中華病理學(xué)雜志,2001； 30（3）∶ 222.
3. Krinsky G. Terminology of hepatocellular nodules in cirrhosis: plea for consistency [J]. Radiology, 2002; 224(3)∶ 638.
4. Hussain SM, Zondervan PE, IJzermans JN, et al. Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation [J]. Radiographics, 2002; 22(5)∶ 1023.
5. Choi BI. Hepatocarcinogenesis in liver cirrhosis: imaging diagnosis [J]. J Korean Med Sci, 1998; 13(2)∶ 103.
6. Lim JH,Choi BI. Dysplastic nodules in liver cirrhosis： imaging [J]. Abdom Imaging, 2002; 27(2)∶ 117.
7. Matsui O, Kadoya M, Kameyama T, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply [J]. Radiology, 1991; 178(2)∶ 493.
8. Matsui O, Ueda K, Kobayashi S, et al. Intra and perinodular hemodynamics of hepatocellular carcinoma: CT observation during intraarterial contrast injection [J]. Abdom Imaging, 2002; 27(2)∶ 147.
9. Hayashi M, Matsui O, Ueda K, et al. Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material [J]. Radiology, 2002; 225(1)∶ 143.
10. Roncalli M, Roz E，Coggi G, et al. The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: implications for diagnosis and classification [J]. Hepatology, 1999; 30(5)∶ 1174.
11. Horton KM, Bluemke DA, Hruban RH, et al. CT and MR imaging of benign hepatic and biliary tumors [J]. Radiographics, 1999; 19(2)∶ 431.
12. 李肅，徐堅(jiān)民，單軍. 肝局灶結(jié)節(jié)樣增生MR、CT表現(xiàn)（附6例報(bào)告） [J]. 實(shí)用放射學(xué)雜志,2001； 17（4）∶ 281.
13. Mathieu D, Bruneton JN, Drouilard J, et al. Hepatic adenomas and focal nodular hyperplasia: dynamic CT study [J]. Radiology, 1986; 160(1)∶ 53.
14. Takayasu K, Furukawa H, Wakao F, et al. CT diagnosis of early hepatocellular carcinoma: sensitivity, findings, and CTpathologic correlation [J]. AJR Am J Roentgenol, 1995; 164(4)∶ 885.
15. Itoh Y, Akamatsu K. Relationships between echo lever and histological characteristics in small hepatocellular carcinomas [J]. J Clin Ultrasound, 1998; 26(6)∶ 295.
16. 李傳福，劉松濤，馬祥興.螺旋CT多期增強(qiáng)掃描對(duì)小肝癌的診斷 [J]. 山東醫(yī)科大學(xué)學(xué)報(bào),2000； 38（4）∶ 403.
17. Zhou K,Yan F,Tu B. Evaluation of the arterial phase of biphasic enhanced SCT in the diagnosis of small HCC [J]. Zhonghua Ganzangbing Zazhi, 1999; 7(3)∶ 135.
18. 王薇.三種檢查方法聯(lián)合早期發(fā)現(xiàn)肝細(xì)胞癌的臨床意義 [J]. 實(shí)用放射學(xué)雜志, 2000； 16（8）∶ 496.
19. Rode A,Bancel B,Douek P, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver [J]. J Comput Assist Tomogr, 2001; 25(3)∶ 327.
20. 楊海山，張宇，張惠茅.US、CT、MRI和DSA診斷原發(fā)性肝癌的比較研究 [J]. 中國醫(yī)學(xué)影像學(xué)雜志, 2001； 9（1）∶ 70.
21. Murakami T, Kim T, Takahashi S, et al. Hepatocellular carcinoma: multidetector row helical CT [J]. Abdom Imaging, 2002; 27(2)∶ 139.
22. Yu JS,Kim MJ.Hepatocellular carcinoma: contrastenhanced MRI [J].Abdom Imaging, 2002; 27(2)∶ 157.
  1. 1. International Working Party. Terminology of nodular hepatocellular lesions [J]. Hepatology, 1995; 22（3）∶ 983.
  2. 2. 周曉軍. 肝臟交界性病變的病理組織學(xué)特點(diǎn) [J]. 中華病理學(xué)雜志,2001； 30（3）∶ 222.
  3. 3. Krinsky G. Terminology of hepatocellular nodules in cirrhosis: plea for consistency [J]. Radiology, 2002; 224(3)∶ 638.
  4. 4. Hussain SM, Zondervan PE, IJzermans JN, et al. Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation [J]. Radiographics, 2002; 22(5)∶ 1023.
  5. 5. Choi BI. Hepatocarcinogenesis in liver cirrhosis: imaging diagnosis [J]. J Korean Med Sci, 1998; 13(2)∶ 103.
  6. 6. Lim JH,Choi BI. Dysplastic nodules in liver cirrhosis： imaging [J]. Abdom Imaging, 2002; 27(2)∶ 117.
  7. 7. Matsui O, Kadoya M, Kameyama T, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply [J]. Radiology, 1991; 178(2)∶ 493.
  8. 8. Matsui O, Ueda K, Kobayashi S, et al. Intra and perinodular hemodynamics of hepatocellular carcinoma: CT observation during intraarterial contrast injection [J]. Abdom Imaging, 2002; 27(2)∶ 147.
  9. 9. Hayashi M, Matsui O, Ueda K, et al. Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material [J]. Radiology, 2002; 225(1)∶ 143.
  10. 10. Roncalli M, Roz E，Coggi G, et al. The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: implications for diagnosis and classification [J]. Hepatology, 1999; 30(5)∶ 1174.
  11. 11. Horton KM, Bluemke DA, Hruban RH, et al. CT and MR imaging of benign hepatic and biliary tumors [J]. Radiographics, 1999; 19(2)∶ 431.
  12. 12. 李肅，徐堅(jiān)民，單軍. 肝局灶結(jié)節(jié)樣增生MR、CT表現(xiàn)（附6例報(bào)告） [J]. 實(shí)用放射學(xué)雜志,2001； 17（4）∶ 281.
  13. 13. Mathieu D, Bruneton JN, Drouilard J, et al. Hepatic adenomas and focal nodular hyperplasia: dynamic CT study [J]. Radiology, 1986; 160(1)∶ 53.
  14. 14. Takayasu K, Furukawa H, Wakao F, et al. CT diagnosis of early hepatocellular carcinoma: sensitivity, findings, and CTpathologic correlation [J]. AJR Am J Roentgenol, 1995; 164(4)∶ 885.
  15. 15. Itoh Y, Akamatsu K. Relationships between echo lever and histological characteristics in small hepatocellular carcinomas [J]. J Clin Ultrasound, 1998; 26(6)∶ 295.
  16. 16. 李傳福，劉松濤，馬祥興.螺旋CT多期增強(qiáng)掃描對(duì)小肝癌的診斷 [J]. 山東醫(yī)科大學(xué)學(xué)報(bào),2000； 38（4）∶ 403.
  17. 17. Zhou K,Yan F,Tu B. Evaluation of the arterial phase of biphasic enhanced SCT in the diagnosis of small HCC [J]. Zhonghua Ganzangbing Zazhi, 1999; 7(3)∶ 135.
  18. 18. 王薇.三種檢查方法聯(lián)合早期發(fā)現(xiàn)肝細(xì)胞癌的臨床意義 [J]. 實(shí)用放射學(xué)雜志, 2000； 16（8）∶ 496.
  19. 19. Rode A,Bancel B,Douek P, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver [J]. J Comput Assist Tomogr, 2001; 25(3)∶ 327.
  20. 20. 楊海山，張宇，張惠茅.US、CT、MRI和DSA診斷原發(fā)性肝癌的比較研究 [J]. 中國醫(yī)學(xué)影像學(xué)雜志, 2001； 9（1）∶ 70.
  21. 21. Murakami T, Kim T, Takahashi S, et al. Hepatocellular carcinoma: multidetector row helical CT [J]. Abdom Imaging, 2002; 27(2)∶ 139.
  22. 22. Yu JS,Kim MJ.Hepatocellular carcinoma: contrastenhanced MRI [J].Abdom Imaging, 2002; 27(2)∶ 157.