fnh肝局灶性结节性增生ppt课件.ppt

《fnh肝局灶性结节性增生ppt课件.ppt》由会员分享，可在线阅读，更多相关《fnh肝局灶性结节性增生ppt课件.ppt（26页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。肝局灶性结节性增生肝局灶性结节性增生Focal nodular hyperplasia (FNH) “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。Outline FNH FNH accounts for approximately 8% of all accounts for approximately 8% o

2、f all primary hepatic tumor and is the second primary hepatic tumor and is the second most common benign liver tumor after most common benign liver tumor after hemangiomahemangioma. . This benign tumour occurs most commonly in women aged 2050 years, but may occur in both men and women at any age, wi

3、th multiple lesions being found in 20 per cent of cases.FNH FNH “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 Oral contraceptiveOral contraceptive口服避孕药口服避孕药 use is use is associated with FNH but the responsibility of associated with FNH but the responsibility of

4、 oral contraceptives in the occurrence of the oral contraceptives in the occurrence of the lesion has not been demonstrated. lesion has not been demonstrated. “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。Clinical symptomsClinical symptomsFNH is usually an incide

5、ntal finding at imaging and only one-third are discovered because of clinical symptoms such as mild epigastric pain or discomfort and or palpable abdominal mass .Blood liver tests are normal in half of the cases and show only increased in serum gamma-glutamyl-transpeptidase血清r-谷氨酰转肽酶 activity in mos

6、t of the remnants .“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 well-circumscribed lobulated mass with central scar (arrow) and radiating septations. P Pathological appearanceathological appearance“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联

7、网应用为重点的“群众性治安防控工程”。FNH is defined as a nodule composed of benign-FNH is defined as a nodule composed of benign-appearing hepatocytes occurring in a liver that is appearing hepatocytes occurring in a liver that is otherwise histologically normal. otherwise histologically normal. FNH is a hyperplastic

8、 liver parenchyma FNH is a hyperplastic liver parenchyma （增生性肝实（增生性肝实质）质）subdivided into nodules by fibrous septa that subdivided into nodules by fibrous septa that may form stellate scarsmay form stellate scars（星状瘢痕）（星状瘢痕）. .The lesion is usually solitary (80%) and measures The lesion is usually so

9、litary (80%) and measures less than 5 cm in diameter . Occasionally, FNH is less than 5 cm in diameter . Occasionally, FNH is pedunculatedpedunculated( (蒂蒂) ). . “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。Photomicrograph of histopathologic specimen shows regio

10、ns of nodular hepatocellular proliferation separated by radiating bands and surrounding myxomatous scar (arrows).“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。The margin is sharp, often lobulated and no capsule is present . Hemorrhage and necrosis are rare. At mi

11、croscopy, the central fibrotic zone is dense connective tissue（致密结缔组织） which contains numerous abnormally thickwalled arteries. Marked proliferation of biliary structures surrounded by inflammatory cells is observed within and at the periphery（边缘） of the fibrous septae. Kupffer cells are also seen w

12、ithin the lesion. “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。FNH FNH classic(80%)non-classic(20%) (a) telangiectatic FNH, (b) with atypia, (c) mixed hyperplastic and adenomatous FNH “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防

13、控工程”。Diagnosis（CT）Nonenhanced Nonenhanced CT scans CT scans FNH is demonstrated as a focal hypodense FNH is demonstrated as a focal hypodense or isodense mass compared with normal liver. or isodense mass compared with normal liver. A central hypodense scar is depicted in only A central hypodense sca

14、r is depicted in only one-third of the cases . Calcifications within one-third of the cases . Calcifications within the central scar are very rare and observed in the central scar are very rare and observed in only about 1% of the cases .only about 1% of the cases .“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、

15、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。contrast-enhanced CT scanarterialarterial phase phaseThe lesion enhances rapidly in most cases The lesion enhances rapidly in most cases and the lesion to liver contrast is high and the lesion to liver contrast is high . . Lesion contour is well demar

16、cated and may Lesion contour is well demarcated and may be lobulated. At that time, the central scar is be lobulated. At that time, the central scar is hypodense and appears more evident than hypodense and appears more evident than on unenhanced CT scans on unenhanced CT scans . .“雪亮工程是以区（县）、乡（镇）、村（

17、社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 portal venous phaseportal venous phaselesion enhancement decreases and the lesion may lesion enhancement decreases and the lesion may be either iso or slightly hyperdense relative to be either iso or slightly hyperdense relative to nor

18、mal liver. Small-sized FNH may be barely visible, normal liver. Small-sized FNH may be barely visible, whereas large-sized FNH are visualized due to whereas large-sized FNH are visualized due to deformity in the liver contour or displacement of deformity in the liver contour or displacement of adjac

19、ent vessels or depiction of a relatively adjacent vessels or depiction of a relatively hypoattenuating central scar. hypoattenuating central scar. “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 delayeddelayed phasephase FNH are isodense relative to normal FNH are

20、 isodense relative to normal liver and in most cases, central scars liver and in most cases, central scars appear iso or hyperattenuating . A central appear iso or hyperattenuating . A central scar is observed more often in large scar is observed more often in large lesions than in small lesions .le

21、sions than in small lesions .“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。CT“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。T1 WI T2WI D Diagnosis（MRI）Nonenhanced Nonenhanced MRIMRI scans scans Typical FNHs are iso or hypointen

22、se on T1Typical FNHs are iso or hypointense on T1WIWI and iso or slightly hyperintense on T2and iso or slightly hyperintense on T2WI.WI. The central scar is hypointense on T1The central scar is hypointense on T1WIWI and and strongly hyperintense on T2strongly hyperintense on T2WI.WI.“雪亮工程是以区（县）、乡（镇）

23、、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。contrast-enhanced MRI scan dramatic enhancement in the arterial phase, dramatic enhancement in the arterial phase, followed by isointensity of the lesion during the followed by isointensity of the lesion during the portal venous phas

24、e. On delayed phase imaging, portal venous phase. On delayed phase imaging, the central scar shows high signal intensity. the central scar shows high signal intensity. “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。Atypical forms“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以

25、综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。scars are seen in more than 80% of cases . However, radio-pathologic papers have demonstrated that some FNH may have no scar even at pathology especially FNH measuring less than 3 cm in diameter。 “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公

26、共安全视频监控联网应用为重点的“群众性治安防控工程”。 Rarely, scars remain hypodense or isodense on delayed scans or are hypointense on T2-weighted images. These findings may be observed up to 20% of cases . Nearly all FNHs are hypervascular at the arterial phase of the enhancement, but lesion enhancement may vary at the por

27、tal phase or on delayed images. Both hypodensity or intensity of the mass on delayed phase, or on both portal vein and delayed phase images as well as hyperdensity-intensity of the mass on the portal vein phase or on both portal vein and delayed phases may be seen . “雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台

28、、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 Although FNH is a non-encapsulated lesion, capsule like enhancement may be observed on portal vein and on delayed phase scans in about 2536% of the cases . The pseudocapsule(假包膜) is hypointense on T1 and slightly hyperintense on T2.“雪亮工程是以区（县）、乡（镇）、

29、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。 Differential diagnosisv肝囊肿肝囊肿Hepatic cystv 原发性肝癌原发性肝癌primary hepatic carcinoma“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。v肝囊肿肝囊肿Hepatic cystnoncontrast-enhancedcontrast-enhancedCTnonenhancement

30、nonenhancement“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。v肝囊肿肝囊肿Hepatic cystT1WIT2WIMRIcontrast-enhancednonenhancementnonenhancement“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。v 原发性肝癌原发性肝癌primary hepatic carcinoma快进快出快进快出noncontrast-enhancedcontrast-enhancedCT“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。v 原发性肝癌原发性肝癌primary hepaticcarcinoma快进快出快进快出T1WIT2WIcontrast-enhanced“雪亮工程是以区（县）、乡（镇）、村（社区）三级综治中心为指挥平台、以综治信息化为支撑、以网格化管理为基础、以公共安全视频监控联网应用为重点的“群众性治安防控工程”。Thank you.