CT and MR Image Analysis of Fifteen Cases' Nodules Which Were Scarce of Blood Supply in the Liver

Objectives:Many space ocuupying pathological changes of liver are scarce of blood supply during enhanced CT scan .To distinguish these changes is difficult because their image is similar during enhanced CT scan .When these changes are small ,it is more difficult to distinguish them because their shape is similar.This thesis discuss distinguishing diagnosis of livers, nodules which are scarce of blood supply by analyzing their CT and MR image.Materials and Methods:Collected CT and MR image of fifteen cases from dec,2006-nov,2007.Ten cases are male and five cases are female among them.Their age were from 23 to 72 and the average age was 50.9.Thirteen cases had single nodule and two cases had several nodules in the liver. The most nodules, diameter were less than 2cm.One nodule was cut out by operation and made pathological checking .The other nodules were made follow-up observation for five months to twelve months. All the cases had got plain CT scan and enhanced CT scan.Some cases also had got MRI. All the image were retrospectively analyzed by two radiological specialists.Results:1 Untypical hemangioma of the liver was two cases. The two nodules were all in right lobe of the liver. Their diameters were 3cm and 2cm . The 3cm nodule was enhanced slightly during the three phases. The 2cm nodule was enhanced slightly during the arterial phase and portal phase and it was isodense during delayed phase. The MR image of the nodule were both like the typical hemangioma but their brightness were less than the typical hemangioma on T2WI. The 3cm nodule was made sure diagosis of hemangioma by blood pool imaging of liver . The 2cm nodule was no change during follow-up observation.2 Focal nodular hyperplasia (FNH) was one case. The nodule was in right lobe of the liver and beneath the surface . Its diameter was 4cm. The nodule was slightly enhanced during the three phase of the enhanced CT scan. The enhanced peak appeared in arterial phase. The nodule showed eaqual single on MRI and it was no change during the follow-up observation of six months.3 Focal nodular hepatic fatty infiltration was two cases. These two nodules, diameter were both less than 2cm and they were both in the left lobe near the falciform lightment beneath the liver surface. The two nodules showed slight enhancement on enhanced CT scan. One case was carried out MRI and the nodule showed indistinct on T1WI and T2WI . The two case both had diffuse fatty liver and the nodule were no change during the follow-up observation.4 Hepatic inflammatory hyperplastic nodule was three cases . All the cases had got HBV heptitis for a long time . Two cases were found single nodule in their right lobe of the liver and the nodule diameter were both less than 2cm . The third case had six nodules in his liver and their diameter were all less than 1cm .All the nodules were slightly enhanced during the contrast CT scan and several nodules were enhanced along their fringe in the portal phase. The case with several nodules had been operated and one nodule near the surface was cut out , made pathological checking . The conclusion showed it was a inflammatory hyperplastic nodule. All the nodule were no change during the follow-up observation.5 Hepatic inflammatoty pseudotumor was four cases. All the nodules were all single in the liver and their diameter were all less than 3cm . They were all slightly enhanced during the contrast CT scan . Their enhanced peak all appear in portal phase. All the nodules were no change during the follow-up observation.6 Hepatocellular carcinoma scarce of blood supply was one case .The case had liver cirrhosis and the diameter of the nodule was 45mm .It was slightly enhanced during the enhanced CT scan. The nodule showed slightly long T1 and slightly long T2 signal on MRI . The nodule was not found its artery which supplied blood during the aortography of the liver . The nodule became smaller than before after eight months. But it was not cured. The carcinoma became small maybe because its artery which supplied blood was blocked .7 Hepatic isolated necrotic nodule was one case . The nodule was in the right lobe of the liver. It was isodense and had hypodense ring. Its diameter was 1 cm. The nodule was not enhanced during the contrast CT scan. It showed low signal on T1WI and low-equal signal on T2WI. It was no change during the follow-up observation of ten months.8 Cholangio cellular carcinoma was one case . The case was operated two years ago for cholangio cellular carcinoma. One 3cm nodule was found in the lobe which was operated. It was round and hypeodense. Another nodule was found in left lobe and its diameter was 1cm. The two nodules were both slightly enhanced and their enhanced peak were in delayed phase.We thought these case had a relapse of cholangio cellular carcinoma.Conclusion: How to diagnose these nodules scarce of blood supply ? It has great significance for diagnosing the untipical hemangioma when the nodule,s image on T2WI show enen long T2 signal . It has great significance for diagnosing FNH when the nodule,s image on T1WI and T2WI show even equal signal .It has great value for diagnosing focal nodular hepatic fatty infiltration when the nodule is in the left lobe near the falciform ligment and its image on T1WI and T2WI show indistinct. If the nodule show no enhancement on contrast CT scan and its MRI image show equal-low signal , we usually think it is hepatic isolated necrotic nodule. Showing slightly long T1 and slightly long T2 signal is still the characteristic of hepatocellular carcinoma and cholangio carcinoma. The small nodule which was slightly enhanced and the case is no other ill history we usually think it is the inflammatory nodule.