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磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用

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曾蒙苏。等.磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用

磁共振磁敏感加权成像在肝硬化结节 多步癌变中的临床应用
曾蒙苏1,李若坤2 (1复旦大学附属中山医院放射诊断科,上海市影像医学研究所,复旦大学上海医学院影像学系,上海200032; 2复旦大学附属金山医院放射科,上海201508)

摘要:肝癌早期发现,早期治疗,明显提高5年生存率。肝硬化患者,绝大部分均经历肝硬化结节多步癌变的过程,即由再生结 节发展为异型增生结节,其中高分化异型增生结节发展为癌变结节后(早期肝癌),再发展为小肝癌,小肝癌最后发展成进展期或晚 期肝癌。上述结节的一系列变化过程中,其结节内内源性铁逐步廓清,本文重点介绍利用磁共振磁敏感加权成像(SWI)技术观察结 节中内源性铁变化情况,同时结合常规MR T2WI、弥散加权成像(DWI)和动态增强等技术,提高识别肝硬化背景下的癌变/早期肝 癌结节能力,从而对进一步提高早期小肝癌的诊疗,具有更重要的临床意义。 关键词:肝硬化;癌,肝细胞;铁化合物;磁共振成像 中图分类号:R735.7 文献标志码:A 文章编号:1001—5256(2013)01—0038—04

Clinical value of susceptibility—-weighted imaging for studying the multi—-step hepatocarcinogenic process of cirrhotic
liver nodules ZENG Mengsu,LI Ruokun.(Department

ofDiagnostic Radiology,Zhongshang of
Medical

Hospital,Fudan

University;Department ofMedical

Imaging,

Shanghai Medical School,Fudan University;Shanghai Institute

Imaging,Shanghai
often involves
to a


200032,China)

Abstract:Early detection,diagnosis,and effective treatment markedly improves the 5一year survival rate of patients with hepatocellular

carcinoma(HCC).Initiation of the multi—step hepatocarcinogenesis
develops
into


process


cirrhotic nodule.After the regenerative nodule

dysplastic nodule(DN),it
to

continues
even

to

advance from

low degree DN

high degree DN.The high degree DN may then

further develop nodule
can

early HCC/small HCC
or

or

progressed/advanced HCC.Previous studies have shown that endogenous iron within the

inhibit

resolve the hepatocarcinogenic process.This review discusses the clinical utility of magnetic resonance(MR)suscepti— and the implications of this technology when combined with decision—making,thereby enhancing diagnos—

bility—weighted imaging for detecting and monitoring changes in nodular iron

T2WI,diffusion weighted imaging,and dynamic
tic

contrast

enhancement for improving clinical

efficacy for early HCC/small HCC in the cirrhotic background.
resonance

Key words:liver cirrhosis:carcinoma,hepatocellular;iron compounds;magnetic

imaging

肝细胞癌(hepatocellular carcinoma,HCC)是最常见的肝 脏原发性恶性肿瘤,位居全球恶性肿瘤发病率第6位、死亡原 因第3位…。在东方人群中,80%~90%的HCC伴有肝硬化 背景,而12%~20%的肝硬化也将进一步发展为HCC¨。。。 肝硬化背景下的HCC生成大都经历了肝硬化结节的多步癌变 过程:即由再生结节(regenerative nodule,RN)、异型增生结节
(dysplastic nodule,DN)、DN癌变或早期肝癌(early hepatocel—
lular

率则更高。因此,及早识别肝硬化背景下的癌变/早期肝癌结 节并积极干预治疗对改善预后具有重要意义。


常规磁共振成像(MRI)在肝硬化结节多步癌变中的诊断限度 MRI是肝硬化背景下sHCC与癌前结节鉴别的重要方法。

RN在T1聊及T2WI呈等信号,也可以呈T1WI高信号、r12聊低
信号;DN在T1WI常呈高信号,T2WI为等或低信号;sHCC*扫 T1WI及T2WI信号多变,与RN及DN均有重叠,HCC内细胞密 度、分化程度、结构模式、脂肪变性、金属粒子沉积、新生孤行小动 脉数量及血窦毛细血管化的程度均会对sHCC信号造成影响怕J。 肝硬化结节多步癌变过程中,门静脉供血逐渐下降,同时 由于肿瘤新生血管的形成,其动脉血供呈先下降后增加的趋 势。采用Gd“一DTPA的MRI动态增强扫描中,RN及大部分 DN因由门静脉供血常与周边肝组织*行强化,sHCC则以肝 动脉供血为主,在精确捕捉的肝动脉期图像上,其强化明显高

carcinoma,eHCC)到小肝癌(small

hepatoeellular

carcino—

ma,sHCC)。41。HCC预后差,进展期HCC 5年生存率在12% 以下,而小肝癌5年生存率可达50%~60%∞1,早期肝癌生存

收稿日期:2012—1l一05 修回日期:2012—11—28 作者简介:曾蒙苏(1963一),男,教授,博士,主要研究腹部疾病的影 像学诊断,尤其肝胆胰腺肿瘤的诊断与鉴别。

万方数据

临床肝胆病杂志2013年1,EJ第29卷第1期J

cI.n Hepatol。January 2013。V01.29。NO.1

39

于背景肝组织,在门静脉期或*衡期可见造影剂的流出,这种 “快进快出”(wash—in
and

采用高分辨、长回波时间、三维梯度回波序列进行扫描,在选 层、相位和读出三个梯度方向上均有流动补偿,可同时得到幅 度图和相位图两组原始图像,二者成对出现,对应的解剖位置 完全一致。常规MRI序列仅利用单一的幅度信息,相位信息 则被忽略。但相位信息反映了质子弛豫过程中相位位移的改

wash—out)的动态增强特征是目前

肝硬化背景下sHCC与癌前结节鉴别的重要依据。但约17% ~32%的DN会出现不同数量的新生血管进而表现为动脉期 强化,在高级别DN(high—grade
dysplastic

nodule,HGDN)中更

为多见,部分sHCC(尤其是eHCC)可接受双重供血、新生血管 化不足,表现为动脉期乏血供和/或保持门脉血供M。o。 目前所强调的是以钆剂动态增强为主体的多模式的MRI 诊断策略。弥散加权成像(DWI)、灌注加权成像(PWI)、波谱 分析(MRS)、肝细胞性特异性造影剂等新的成像技术及手段 层出不穷,可以从分子水*、代谢特征、细胞功能等多个方面提 供更为丰富的诊断信息,进一步提高了肝硬化背景下eHCC和 sHCC的诊断准确性。 2肝硬化结节多步癌变过程中的内源性铁廓清 肝硬化常有内源性铁沉积,在非胆汁性肝硬化中达22% 一67%o101。铁常选择性的沉积于肝硬化结节内,统称为铁沉 积结节(siderotie nodule,SN),RN和DN均可出现铁沉积’1“。 伴铁沉积的结节几乎均为良性,而癌变结节内组织铁以及可染 色铁的数量常明显减少。早期研究即发现,DN内部可出现局

变,与组织中磁敏感物质含量有关,蕴含了丰富的诊断信息。
SWI能够利用一直被忽略的相位信息,并经过一系列复杂的图 像后处理将相位图与幅度图融合,进而形成独特的图像对比。 SWI还可以通过最小信号强度投影使分散在各层面的信号连 续化,有利于显示扭曲结构及静脉血管的连续性¨”2“。 SWI的成像优势在于对磁敏感物质的显示,包括非血红素 铁、出血、静脉结构等。肝细胞内的铁沉积多为铁蛋白,网状内 皮系统内的铁沉积多为含铁血黄素,二者均为强顺磁性物质, 在磁场内导致质子失相位,这种相位信息为SWI所利用,从而 有助于铁沉积的检出。笔者研究发现,SWI检出肝硬化铁沉积 的能力优于T2 t(目前最敏感的肝脏铁沉积无创性检测技 术),其优势在于对轻中度铁沉积的检出能力上,敏感性可提 高37.6%~46.6%(图1)。在SWI图像上,铁沉积结节呈低信号, 癌变结节则因铁廓清表现为铁沉积背景上的局灶性乏铁区。

灶性的增生活跃的亚结节一“结中结”,这些亚结节几乎都是
恶性的,发生于铁沉积结节者,新生的亚结节常呈乏铁改 变¨2。1 3I。Honda等¨41通过定量分析发现HCC内铁含量 [(87.7±49.1)¨s/gww]明显低于癌周组织[(106.2±86.8) 斗g/gww]。 肝硬化结节癌变时的铁廓清机制尚未完全明确。病理学 研究显示,尽管sHCC组织学上无铁沉积,但具有很高的铁摄 取率,这是因为铁是细胞增殖代谢中的必须物质,参与新陈代 谢的众多环节(如DNA合成的核糖核苷酸还原酶需要铁作为 辅助因子,能量通路中电子链的传递也需要铁才能发挥作用) [15-16]。Tan等¨71对24例感染HBV的HCC患者术后标本行 铁染色分析,HCC均未见铁染色,而70.8%的癌周组织中可见 铁沉积。他们随后对HCC、癌周组织及10例正常肝脏的42个 铁调节相关基因表达谱进行分析。结果显示,HCC内铁调素 (hepcidin)、转铁蛋白受体2(TfR2)、转铁蛋白(Tf)、血浆铜蓝 蛋白(cp)和铁调节蛋白(IRPl)表达明显下调;癌周有铁沉积 的非硬化肝组织中铁调素、TfR2、膜铁转运蛋白l(ferroportinl, FPl)和二价金属离子转运体1(DMT 1)表达明显上调。HCC 的高代谢铁需求可能是肝细胞内铁廓清的主要原因¨””1。网 状内皮系统内的铁沉积主要源于肝细胞降解后由Kupffer细胞 吞噬的含铁颗粒。肝硬化结节多步癌变时,高分化HCC内 Kupffer细胞数目减少、吞噬能力下降,中低分化HCC内常无 Kupffer细胞,因此网状内皮系统内也无铁沉积旧’。…。 3磁敏感加权成像敏感显示肝硬化结节多步癌变内源性铁 廓清 磁敏感加权成像(susceptibility—weighted imaging,SWI)

腮F飞
.,l,..




胯F■


鲑k=-厶.L出遵]

L过二=.▲‘J
图1

组\

。,1



a:T2WI仅见数个铁沉积结节,右后叶见一囊肿;b:T2¥ 检出散在铁沉积结节,显示程度为1级;c:SWI示弥漫分布铁 沉积结节,同时检出更多的微小铁沉积结节,显示程度为3分;

d:普鲁士蓝染色示3级铁沉积(X400r


SWI有助于肝硬化背景下小肝癌的诊断 通过引入外源性铁可以造成不同性质肝硬化结节内的铁

含量差别,从而为sHCC及癌前结节的鉴别提供诊断信息,临 床最常用的是超顺磁性氧化铁(superparamagnetic
iron oxide

particles,SPIO)。SPIO是一种网状内皮系统特异性造影剂,约 80%会被肝脏Kupffer细胞摄取。肝硬化良性结节仍保存着相 当数量的有功能的Kupffer细胞,可以摄取SPIO,呈低信号;结 节癌变时Kupffer细胞数量减少或消失,无法摄取SPIO或摄取 能力下降,呈相对高信号。联合SPIO及钆剂的双对比增强能 够提高诊断效能,但会大大增加患者医疗费用及副反应发生

万方数据

曾蒙苏。等.磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用

率‘孙…。
SWI不需注入对比剂,直接利用不同性质肝硬化结节中的 内源性铁含量差别来达到鉴别诊断的需求。如前所述,良性结

SWI技术的改进及临床经验的积累,其在sHCC早期诊断,尤 其eHCC诊断中将会发挥更大的作用。

节常伴铁沉积呈低信号,癌变结节因铁廓清呈高信号,SWI所
提供得内源性铁沉积信息独立于结节血供特征,与钆剂动态增 强具有很好的协同作用。笔者研究发现,常规MRI联合SWI 对结节进行评价可以明显提高肝硬化背景下sHCC的诊断敏 感性和阳性预测值,在不同年资的阅片者之间也存在很好的一 致性,对于2.0 ca以下小病灶可极大的提升诊断信心(图2)。 对于TIWI高信号的病灶,其强化程度肉眼通常难以判断,误 诊率达50%一60%,SWI能够敏感显示结节内有无铁沉积,可 以纠正常规MRI误判的结节。总之,SWI能够从铁沉积角度 为常规MRI不能明确的结节提供诊断信息,有助于提高诊断 准确性,使患者获益。

参考文献:
[1] [2】
Sherman

M.Epidemiology of hepatocellular carcinoma[J].

Oncology。2010,78{Suppl 1):7—10.
Benvegnu L,Gios

M。Boccato S,et a1.Natural history of cirrhosis:a
prospective study
on

compensated viraf

inci—

dence and hierarchy of

major complications[J].Gut,2004,

53(5):744—749. [3]Kim YS,Um SH。Ryu HS,et
rhosis in recent years in a1.The prognosis of liver cir- Korean

Korea[J].J

Med Sci,2003,

18(6):833-841. [4]Planas
R,Balleste

B,Alvarez MA,et a1.Natural history of C virus—related cirrhosis.Study of

decompensated hepatitis 200

patients[J].J Hepatol,2004,40(5):823-830.
P,Park YN,Krinsky G,et a1.Hepatic precancer- lesions and small hepatocellu!ar

【5]

Hytiroglou
OUS

carcinoma[J]

Gastro-

enteroI

Clin North Am,2007,36(4):867-887.
DA。Kased N,et al of

[6]Hanna RF,Aguirre
hepatocellular imaging

Cirrhosis—associated MR

nodules:correlation

histopathotogic and

features[J].Radiographics,2008,28(3):747-769.
R。Matsui 0,Kobayashi S,et a1.Cirrhotic nodules: between MR

一 1葛
a:T1WI呈高信号;b:T2WI呈等信号;c:动脉期明显强 化,门脉期(d)呈低信号;e:SWI显示背景肝脏中散在分布的 低信号铁沉积结节,sHCC呈乏铁改变,为均匀高信号(箭); f:HE染色(X50)示背景肝脏内l级铁沉积,sHCC内无铁沉积
图2

[7]

Shinmura

association lar blood

imaging

signal intensity and intranodU-

supply[J].Radiology,2005,237(2):512-519.
on

[8]Park
lular

YN.Update

precursor and early lesions of hepatocel— Pathol Lab

carcinomas[J].Arch

Med,2011,135(6):

704—715.

[9]

Kim

MJ.Current limitations and potential breakthroughs for

the early diagnosis of hepatocellular

carcinoma[J].Gut Lm

er。2011,5(1):15-21. [10]Ludwig
J。Hashimoto E,Porayko MK。et a1.Hemosiderosis

in cirrrhosis。a study of 447 native gy,1997,1

livers[J].Gastroenterolo-

12f3】:882—888.
GA.Iron—containing nodules of cirrhosis

[1 1]Zhang [12]Terada

JB.Krinsky

[J].NMR Biomed,2004.17(7):459-464.
T,Kadoya

M.Nakanuma Y。et a1.Iron—accumulating

adenomatous hyperplastic nodule with malignant foci in the
cirrhotic liver. netic HistOpat卜IOIOgic。quantitative iron.and mag-

resonance

imaging in vitro studies[J].Cancer。1 990,

65(9 J:1994-2000. [1 3]Terada
T,Nakanuma Y.Iron—negative

foci in siderotic mac—

roregenerative nodules in human cirrhotic liver.A marker of incipient neoplastic

lesions[J].Arch

Pathol Lab Med.1 989。

113(8):916—920

5趋势与展望 SWI诊断sHCC的病理基础是基于结节的内源性铁沉积 信息,对于无铁沉积背景的肝硬化患者其能力可能有限;另外, 囊肿和血管瘤等常见肝脏病变也呈乏铁改变,诊断应与常规序 列相结合以避免假阳性;肝硬化结节多步癌变时的铁含量改变 较为轻微,SWI定量技术可能会有助于结节内铁廓清的精确评 价,为各类结节的进一步鉴别提供新的影像依据。相信随着

[14]Honda

H,Kaneko

K。Kanazawa Y,et a1.Imaging of hepato-
and Fe contents
on

cellular carcinomas:effect of Cu

signal

intensity[J]Abdom Imaging,1997,22(1):60—66. [15]Pascale
RM,De

Miglio MR.Muroni MR,et al
and iron

Transferrin uptake in 998。

and transferrin receptor gene expression hepatocellular carcinoma in the

rat[J]Hepatology,1
Effects of cell

27(2):452—461 [1 6]Lee AW,Oates
PS,Trinder D proliferation
on

万方数据

临床肝胆病杂志2013年1月第29卷第1期J

Clin HepatoI,January 2013,VOI.29,N。.1

41

the uptake of transferrin—bound

iron

by

human hepatoma

[J]AJNR Am [23]
Yu



Neuradiol,2009,30(2):232—252

cells[J]Hepatology,2003,38(4):967—977. [17]
Tan MG,Kumarasinghe MP。Wang SM,et a1.Modulation of iron—regulatory genes in human hepatocellula r Biol carcinoma

JS,Chung JJ,Kim JH,et a1.Small hypervascular hepa— gadolinium—

tocellular carcinomas:value of“washout”on enhanced dynamic MR imaging compared to netic iron oxide—enhanced

superparamag—

and its physiological

consequences[J].Exp

Med(May- [24]

imaging[J]

Eur Radiol,2009,

wood),2009,234(6):693—702 [18]
Holmstr6m P.Gafvels M。Eriksson LC,et a1.Expression of
iron regulatory genes in


19(11):2614—2622.
Yoo HJ。Lee in

JM,Lee MW,et a1.Hepatocellular carcinoma

rat modeI of hepatocellular carcino-

cirrhotic liver:double—contrast—enhanced,high—resolu—

ma[J]Liver International,2006,26(8):976—985. [19] [20]
Haacke ted

tion 3 vest

OT—MR imaging with pathologic correlation[J]¨

E M,×u YB,Cheng YC,et al

Susceptibility weigh—

Radiol,2008,43(7):538—546.
MS,Kim MS,et a1.Quantification of super-
intensity change in

imaging(SWll[J】.MRM,2004,52(3):612—6侣

[25]

Chung YE,Park paramagnetic patients

Thomas tions of al

B,Somasundaram S,Thamburaj,et

a1.Clinical applica—

iron oxide—mediated signal

susceptibitity-weighted imaging of the brain—a pictori—

with liver cirrhosis using T2 and T2}mapping:a

review[J]Neuroradiology,2008.50(2):105-116.
EM,MittaI S,Wu Z,et a1.Susceptibility weighted
ascepts and clinical applications,pa rt 1

preliminary

report[J].Magn

Reson

Imaging。2010,31(6):

[21]

Haacke

1379—1386

imaging:technical

[J].AJNR [22]
Haacke

Am J

Neuradiol。2009,30(1):19—30. S,Wu
Z,et al

(本文编辑:刘晓红)


E M,Mittal

Susceptibility weighted
applications,pa rt

imaging:technical

ascepts and clinical

[12]

Carr BI.Kondraqunta V,Buch lence in survival vtt rium 90

SC,et a1.Therapeutic equiva— chemoembolization and
in unresectable hepato-

diofrequency ablation Eur J

VS

radiofrequency

ablation

alone[J].
in ad—

for hepatic arterial

Radiol,2011,81(3):189—193.
JM.Ricci

microspheres treatments

[18]Llovet
vanced

S,Mazzaferro V,et al

Sorafenib

cellular carcinoma:a

two—cohort study[J]Cancer,2010,

hepatocellular

carcinoma[J]N

Engl J Med,2008,

116(5):1305—1314

359(4):378-390 [1 9]
Strebel

[13] [14]

刘允怡,赖俊雄。刘晓欣,等.钇90微球治疗原发性肝癌 [J]临床肝胆病杂志,2011,4(27):348-350.
Monsky

BM,Dufour JF.Combined approach to hepatocellular

carcinoma:a new treatment concept for nonresectable dis—

WL。Kruskal
an

JB,Lukyanov AN,et al

Radiofrequen-
accu—

ease【J]Expert
—1749

Rev

Anticancer]-her,2008,8(”):1743
Phase II study of

cy ablation

increases intratumoral liposomal doxorubicin animal breast tumor

mulation in

model[J]

Radiology,

[20]Park JW,Koh YH,Kjm
with unresectable

HY,et al

concu r-

2002,224(3):823-829 [15】 [16] 陈敏山,刘芙蓉.射频消融在肝癌多学科综合治疗中的应用 [J].临床肝胆病杂志,2011,27(4):368—371
Pompili ablation

rent transa rterial chemoembolization and sorafenib in patients hepatocellula r

carcinoma[J]J

Hepatol,

2012。56(6):1336—1342
Percutaneous

M.Mirante VG,Rondinara G,et al
procedures in cirrhotic patients

[21]Pawlik TM,Reyes DK,Cosgrove D,et
sorafenib combined bolization

a1.Phase

II

trial of

with hepatocellular

with concurrent transarterial chemoem—
ca rcino--

carcinoma submitted to liver transplantation:assessment of efficacy at explant analysis of safety for

with drug——eluting beads for hepatocellular

tumor

recurrence

ma[J].J Clin Oncol,201 1,29(30):3960-3967.

[J]Liver Transpl,2005,11(9):1117—1126. [17]
Kim

JW,Kim JH。Won

HJ,et a1.HepatoceI|uIar carcinomas

(本文编辑:王

莹)

2—3cm

indiameter:transarterial

chemoembolization plus

ra—

万方数据

磁共振磁敏感加权成像在肝硬化结节多步癌变中的临床应用
作者: 作者单位: 刊名: 英文刊名: 年,卷(期): 曾蒙苏, 李若坤, ZENG Mengsu, LI Ruokun 曾蒙苏,ZENG Mengsu(复旦大学附属中山医院放射诊断科,上海市影像医学研究所,复旦大学上海医学院影像 学系,上海200032), 李若坤,LI Ruokun(复旦大学附属金山医院放射科,上海,201508) 临床肝胆病杂志 Journal of Clinical Hepatology 2013,29(1)

参考文献(25条) 1.Sherman M Epidemiology of hepatocellular carcinoma 2010(Suppl 1) 2.Benvegnu L;Gios M;Boccato S Natural history of compensated viral cirrhosis:a prospective study on incidence and hierarchy of major complications[外文期刊] 2004(05) 3.Kim YS;Um SH;Ryu HS The prognosis of liver cirrhosis in recent years in Korea 2003(06) 4.Planas R;Balleste B;Alvarez MA Natural history of decompensated hepatitis C virus-related cirrhosis.Study of 200 patients[外文期刊] 2004(05) 5.Hytiroglou P;Park YN;Krinsky G Hepatic precancerous lesions and small hepatocellular carcinoma 2007(04) 6.Hanna RF;Aguirre DA;Kased N Cirrhosis-associated hepatocellular nodules:correlation of histopathologic and MR imaging features 2008(03) 7.Shinmura R;Matsui O;Kobayashi S Cirrhotic nodules:association between MR imaging signal intensity and intranodular blood supply[外文期刊] 2005(02) 8.Park YN Update on precursor and early lesions of hepatocellular carcinomas 2011(06) 9.Kim MJ Current limitations and potential breakthroughs for the early diagnosis of hepatocellular carcinoma 2011(01) 10.Ludwig J;Hashimoto E;Porayko MK;at al Hemosiderosis in cirrrhosis,a study of 447 native livers 1997(03) 11.Zhang JB;Krinsky GA Iron-containing nodules of cirrhosis 2004(07) 12.Terada T;Kadoya M;Nakanuma Y;at al Histopathologic,quantitative iron,and magnetic resonance imaging in vitro studies 1990(09) 13.Terada T;Nakanuma Y Iron-negative foci in siderotic macroregenerative nodules in human cirrhotic liver.A marker of incipient neoplastic lesions 1989(08) 14.Honda H;Kaneko K;Kanazawa Y Imaging of hepatocellular carcinomas:effect of Cu and Fe contents on signal intensity 1997(01) 15.Pascale RM;De Miglio MR;Muroni MR Transferrin and transferrin receptor gene expression and iron uptake in hepatocellular carcinoma in the rat[外文期刊] 1998(02) 16.Lee AW;Oates PS;Trinder D Effects of cell proliferation on the uptake of transferrin-bound iron by human hepatoma cells[外文期刊] 2003(04) 17.Tan MG;Kumarasinghe MP;Wang SM Modulation of iron-regulatory genes in human hepatocellular carcinoma and its physiological consequences 2009(06) 18.Holmstr(o)m P;Gafvels M;Eriksson LC Expression of iron regulatory genes in a rat model of hepatocellular carcinoma [外文期刊] 2006(08) 19.Haacke EM;Xu YB;Cheng YC Susceptibility weighted imaging(SWI)[外文期刊] 2004(03) 20.Thomas B;Somasundaram S;Thamburaj Clinical applications of susceptibility-weighted imaging of the brain-a pictorial review[外文期刊] 2008(02) 21.Haacke EM;Mittal S;Wu Z Susceptibility weighted imaging:technical ascepts and clinical applications,part 1 2009(01) 22.Haacke EM;Mittal S;Wu Z Susceptibility weighted imaging:technical ascepts and clinical applications,part 2 2009(02)

23.Yu JS;Chung JJ;Kim JH Small hypervascular hepatocellular carcinomas:value of "washout" on gadoliniumenhanced dynamic MR imaging compared to superparamagnetic iron oxide-enhanced imaging 2009(11) 24.Yoo H J;Lee JM;Lee MW Hepatocellular carcinoma in cirrhotic liver:double-contrast-enhanced,high-resolution 3.0T-MR imaging with pathologic correlation[外文期刊] 2008(07) 25.Chung YE;Park MS;Kim MS Quantification of superparamagnetic iron oxide-mediated signal intensity change in patients with liver cirrhosis using T2 and T2 * mapping:a preliminary report 2010(06)

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