肝血管平滑肌脂肪瘤超声及CT影像学对比分析  

Angiomyolipoma of the liver:Ultrasound and CT imagings

作　　者：刘文英[1] 严昆[1] 刘毅强[2] 张秀梅[1] 付颖[1] 陈敏华[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所超声科,100036 [2]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所病理科,100036

出　　处：《中华医学超声杂志（电子版）》2008年第5期28-31,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：北京市科委重大项目培育专项(Z0005190040432)

摘　　要：目的探讨肝血管平滑肌脂肪瘤(HAML)的影像学表现及其与病理组织学相关性。方法回顾性分析我院近3年经病理诊断的6例11灶HAML患者的常规超声、超声造影及CT表现,并对照病理组织学进行分析。结果6例HAML中脂瘤型2例,肌瘤型1例,混合型3例。脂瘤型、肌瘤型、混合型3种类型超声表现分别为高回声、低回声及混合回声,相应CT平扫表现为含脂肪成分的极低密度影、软组织密度影及混杂密度影。3例行超声造影检查动脉期均有不均匀或均匀强化,2例脂瘤型延迟期仍稍高于周围肝实质,1例混合型有轻度退出。增强CT(CECT)所有病灶动脉期均有不均匀或均匀强化,门脉期4例(脂瘤型2例,混合型2例)高于周围肝实质,2例(肌瘤型1例,混合型1例)低于周围肝实质。超声诊断良性2例,恶性1例,性质不确定3例;CT诊断良性3例,性质不确定3例。结论因脂肪组织、平滑肌及血管3种成分比例及分布不同,HAML影像学表现呈多样性,超声造影及增强CT有助于良恶性诊断,但部分病例仍难以除外恶性,确诊须依据肝穿刺活检或术后病理检查。Objective To analyze the imaging characteristics of hepatic angiomyolipoma （HAML） and pathological mechanism. Methods The ultrasound, contrast-enhanced ultrasound （CEUS） and CT imagings of 11 lesions in the 6 patients with HAML were retrospectively analyzed and pathological histology was assessed. Results The six cases were classified into lipomatous （2 hyperecho cases） , myomatous （ 1 hypoecho case） and a mixed subtypes （3 heterogeneous cases）. The relative CT detected adipose, soft tissue and mixed density respectively. The CEUS in 3 cases were enhanced in early arterial phase. In delayed phase, 2 lipomatous cases remained higher than the normal parenchyma and 1 mixed case was slightly washed out. The CECT in 6 cases showed higher than normal parenchyma in 4 cases （2 lipomatous cases and 2 mixed cases included） and lower in 2 cases （ l myomatous case and 1 mixed case included） in portal phases. Two benign cases, I malignant case and 3 uncertain cases were diagnosed by ultrasound. Three benign cases and 3 uncertain cases were diagnosed by CT. Conclusions The HAML imaging was diverse based on distribution and a ratio of fat tissue, smooth muscle, and blood. The CEUS and CECT may be helpful for benign diagnosis, but the pathologic diagnosis could be necessary for differentiating malignancy and pathologic diaguosis.

关 键 词：肝肿瘤 血管平滑肌 脂肪瘤 超声检查 病理学 

分 类 号：R735.7[医药卫生—肿瘤] R734.2[医药卫生—临床医学]