Discrimination Of Benign From Malignant Hepatic Lesions With Fast Mr Imaging Sequences:

Yasser Hassan Ali. 

English SummaryThis study was done on thirty (30) patients who had hepatic focallesions. Theses patients were examined by MRI (T1 , Fast Tz, and Fastheavy Tz sequences), CT ( with and without contrast) , us , and colorDoppler US . Complementary histopathological and laboratory datawere also obtained.The aim of this study is to discriminate between the benign andmalignant hepatic focal lesions by using fast MRI sequences.Among the thirty ( 30 ) patients examined, eighteen ( 18) patientshad malignant lesions and twelve ( 12 ) patients had benign lesions .”’’’’ Th e incidence of different pathological types were:Begin lesions :Hemangioma 10 % .Degenerative nodule 10%Abscesses 7.2 %FNH3.2%Focal segmental hypertrophy 3.2%Adenoma 3.2%Caroli syndrome 3.2%Ma6gnant lesions :H.C.C47%Metastasis 10 %Cholangiocarcinoma 3 %”’’’’The general signs that favor presence of malignant lesion were:1- Presence of capsule in TI.2- Presence of portal vein thrombosis.3- lli-defined margin of the lesions.4- Presence of contour bulge.5- Presence of different types of degeneration.6- Hyperintensity in Fast Tz with decreased the signal in Fastheavy Ts.7- Multiplicity of the lesions.** Comparing the different modalities as regard the sensitivity,specificity, positive and negative predictive values:-All the modalities had 100% sensitivity.-The MRI was the most specific technique 100% , then CT 75% , thenUS 58%.-Also all the modalities had 100%negative predictive values.-The MRI had 100 % positive predictive value, then the CT 86 % , thenthe US 78%.1o* Comparing the different modalities in detection of portal veinthrombosis :-Color Doppler was considered the gold standard with 100% sensitivity, specificity, negative and positive predictive values.-MRI had very high score, ( 100% sensitivity, 100% specificity, 100%negative and positive predictive values) .-Then come the US ( 80% sensitivity , 100 specificity ,100% positivepredictive value, and 90.9”10 negative predictive value) .Then, the CT (50% sensitivity, 100 specificity ,100%positive predictive value, and 80% negative predictive value ) .** Although the high specificity of the MRI, there are somelimitation encountered with its use:-The non-existence of constant techniques makes it difficult tostandardize parameters for each technique.-There is practical and economical difficulty concerning the time ,patient cooperativity and cost.-Certain skills are needed to interpret MR images particularly for nonradiologist.-The rather limited capability of assessment the rest of the abdomen onthe same sequence.