肝细胞腺瘤的影像学表现与组织病理学的相关性  

Hepatocellular Adenoma:Imaging Characteristics and Correlation with Pathologic Findings

作　　者：杨秋霞[1] 张嵘[1] 吴静[1] 谢传淼[1] 何明燕[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心影像与微创介入中心,广东广州510060

出　　处：《中国CT和MRI杂志》2013年第1期48-52,71,共6页Chinese Journal of CT and MRI

摘　　要：目的分析肝细胞腺瘤多种影像学(CT、MRI、超声)与组织病理学特征及联系。方法共收集7例肝细胞腺瘤患者,1例同时行MR、CT及超声检查,1例同时行CT及超声检查,4例同时行MR及超声检查,余1例仅行CT检查。7例均由手术切除病理证实。评价所有患者的影像及病理结果,分析其相关性。结果多发病灶(数目>10个)1例,2个病灶者1例,余5例均为单发。多发病灶患者MRI示部分病灶呈全瘤脂肪信号,内见少量长T1长T2信号。余患者病灶CT示(3个病灶)等或稍低密度,中心区见不规则更低密度区,增强扫描动脉期较明显强化,门脉期1例强化较明显减退,另2例持续性强化。MRI示(5个病灶)信号混杂,1个病灶内见脂质区,2个病灶内见出血坏死区,增强扫描动脉期不均匀强化明显,门脉期及延迟期4例持续强化,另1例强化减退。4个瘤周及内部见较多血管影,3个病灶周缘见包膜,延迟强化。超声示(6个病灶)较均匀低回声(2个)或混杂回声(4个),CDFI示5个病灶周围及内部见丰富血流信号,探及动脉频谱。结论 MRI的信号变化比CT、超声更能在一定程度上反映肝细胞腺瘤的组织学变化;多种影像检查手段综合运用可辅助诊断肝细胞腺瘤。Objective The purpose of this study was to describe the comprehensive imaging appearance of hepatocellular adenoma（HA） and correlate the findings of imaging and pathology. Methods Clinical fentures, imaging characteristics, patho- logical findings of 7 patients with HA proved pathologically were analyzed retrospectively. Cross-sectional imaging, including computed tomography（CT） （n= 1 ）, or both CT and ultrasound（US） （n= 1）, or both magnetic resonance imaging （MRI） and US（n=4）, or CT, MR as well as US（n=I） was available in all cases. Results 1 case of HA was lnt, ltile-sion, 5 cases were single lesion and another case had 2 lesions. Part of the lesions in the case with multile-sion showed fat singal heterogeneously in whole-tumor. Among other cases, 3 lesions were detected with CT showing isodense or lightly hypodense lesions with patchy necrosis. All the 3 lesions showed heterogeneously enhancement in the hepatic arterial phase, 1 lesion faded away and other 2 lesions showed persistent enhancement with slight washing out in the portal venous phase. 5 lesions were lbund with MRI with heterogeneous mixed signal. Moderate and heterogeneous enhancement visualized in the arterial phase with regions of fat content in I lesion and necrosis in 2 lesions. At contrast washout, 4 lesions showed persistent hyperintense and I lesion showed retrogres- sion in the delayed phase. Hepatic or portal vein branches displaced along edge of 4 tumors. Pseudocapsule detected in 3 lesions showed moderate enhancement in the delayed phase. 6 lesions were found with US, showing that the tumors were hypoechoic or mixed-echoic. Peritumour vessels and fast hyperechoic enhance- ment visualized in the arterial phase, 4 lesions remained hyperechoic and 1 lesion faded in the delayed phase. Conclusion The feathers of the signal intense on MRI have more advantages in representing the pathologic changes compared to CT and US. Multiple modalities are helpful for analyzing the leathers of HA.

关 键 词：腺瘤 肝细胞 影像诊断 病理学 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]