Медицинская литература. Новинки

 

 

 

 

 

 

Современные возможности лучевой диагностики гепатоцеллюлярных аденом (обзор литературы и собственные наблюдения)

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Цель сообщения – осветить новую генотип фенотип классификацию гепатоцеллюлярных аденом (ГЦА), подразделяемых на 3 подгруппы: 1) воспалительные ГЦА, 2) ГЦА с мутированным ядерным фактором 1 альфа (HNF 1a), 3) b катенин-мутированные ГЦА. Обсуждаются их наиболее характерные особенности, в том числе клинические проявления, макро и микроскопические признаки, особенности отображения при УЗИ, рентгеновской КТ и МРТ, а также тактика лечения. Описаны и проиллюстрированы типичные диагностические признаки ГЦА, способствующие выбору корректной тактики лечения соответствующих пациентов. Показано, что МРТ с внутривенным контрастированием является методом выбора в распознавании выделенных типов ГЦА. Использование гепатоспецифичных контрастных препаратов может улучшить возможность распознавания этих опухолей. Собственный материал представлен 8 клиническими наблюдениями: 7 женщин и 1 мужчина (возраст 22–50 лет). Одиночный узел выявлен у 5 больных, множественные узлы – у 3. Всего обнаружено 18 ГЦА

Ключевые слова:
опухоли печени, гепатоцеллюлярная аденома, МРТ

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The Current Approaches to the Diagnosis of Hepatocellular Adenomas (Literature Review аnd Clinical Cases)

The purpose of this paper is to discuss the new genotype phenotype classification of hepatocellular adenomas categorized into three distinct subtypes: (a) inlammatory hepatocellular adenomas, (b) hepatocyte – nuclear factor 1 a–mutated hepatocellular adenomas, and (c) b catenin – mutated hepatocellular adenomas. We discuss the most characteristic features of them, including clinical presentation, gross pathology and histology, imaging findings at ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging, management strategies. We describe and illustrate the key imaging features of hepatic adenomas in the hope of facilitating more confident treatment of affected patients. It has been shown that contrast enhanced MR imaging is the imaging modality of choice for the differentiation of the subtypes of hepatocellular adenoma. MRI with intracellular, liver specific contrast agents may improve the correct detection of the tumor. The personal data are based on the recent experience with 8 patients (f/m = 7/1, age: 22–50), including those with single (n = 5), or multiple hepatocellular adenomas (n = 3). The total number of adenomas is 18.

Keywords:
liver lesions, hepatocellular adenoma, MRI.