肝脏血管平滑肌脂肪瘤的多样性CT表现  

The varied features of hepatic angiomyolipoma in computed tomography

作　　者：林江[1] 陈祖望[1] 周康荣[1] 

机构地区：[1]上海医科大学附属中山医院放射科,200032

出　　处：《上海医学》2000年第6期328-330,共3页Shanghai Medical Journal

摘　　要：目的　分析肝脏血管平滑肌脂肪瘤 (AML)的CT表现及其组织病理学特点。方法　对 7例 8枚经手术和病理证实的AML行CT平扫及增强扫描 ,其中 5例 6枚行动脉期和门脉期双期扫描。回顾性分析CT表现 ,研究多样性CT表现同组织病理学的关系。结果　 8枚病灶中 3枚CT显示肿块同时含有软组织成分和脂肪成分 ,软组织成分有中度强化 ,门静脉期与肝脏等密度。 1枚虽然密度不均匀 ,但CT无法确定病灶内有无脂肪。 1枚病灶因太小使CT无法确定有无脂肪。另 3枚病灶密度均匀 ,未见脂肪 ,其中 1枚强化方式与肝细胞癌相同 ,表现为动脉期显著强化而门脉期消褪快成为低密度。 1例同时含 2枚病灶 ,其CT表现相似。后 4例 5枚病灶CT诊断困难或误诊 ,其中有 1枚经细针抽吸活检诊断为AML ,5年后CT随访肿块明显增大。 8枚病灶组织病理学均显示由脂肪、平滑肌和血管成分构成 ,其构成比例有差异 ,其中 3枚病灶脂肪含量很少。结论　AML的CT表现多种多样。同时含有软组织成分和脂肪成分 ,且软组织成分有中度强化是其较为典型的CT表现。对不典型病灶必须结合临床病史和其它影像检查方法。Objective To analyze the computed tomographic features and histopathology of hepatic angiomyolipoma(AML). Methods 7 patients with 8 pathologically proved hepatic AMLs underwent CT examination with or without contrast and contrast enhancement, 6 lesions had both arterial and portal venous phase scans. The varied CT appearances were studied and correlated with histopathology. Results CT showed masses containing both soft tissue and adipose tissue components in 3 lesions. The soft tissue component was moderately enhanced, which was isodense with the liver in portal phase. In one lesion, the fat contained could not be determined by CT, although the density was inhomogenous. One lesion was too small to allow the depiction of fat. While another 3 lesions were homogenous without showing pressence of fat, and one of them showed marked enhancement in the arterial phase and rapid washout in the portal venous phase, of which, the enhancement was similar to that of hepatocellular carcinoma. One case had 2 foci and CT features were similar. The latter 4 patients with 5 lesions were diagnosed with difficulty, in one of them, the diagnosis of AML was established by fine needle aspiration biopsy (FNAB), followed up for 5 years, the tumor was found to be significantly enlarged. Histopathologically, all 8 lesions were composed of adipose tissue, smooth muscle and blood vessels in different proportions, and in three, the amount of fat was little. Conclusion Hepatic AML has varied appearances in computed tomography, these containing both soft tissue and fatty tissue with moderate enhancement of soft tissue component are typical features, when untypical, other imaging modalities should be added and aspiration biopsy is helpful.(Shanghai Med J, 2000,23∶328 330)

关 键 词：肝脏血管平滑肌脂肪瘤 诊断 CT 病理学 

分 类 号：R735.7[医药卫生—肿瘤]