肝脏上皮样血管内皮瘤的CT和MRI表现  

CT and MRI Features of Hepatic Epithelioid Hemangioendotheliomas

作　　者：周丽莎[1] 翟凤仪[1] 董帜[1] 罗宴吉[1] 黄坤[1] 郑可国[1] 李子平[1] 冯仕庭[1] 

机构地区：[1]中山大学附属第一医院医学影像科,广州510080

出　　处：《临床放射学杂志》2015年第3期402-405,共4页Journal of Clinical Radiology

基　　金：国家自然科学青年基金项目(编号:81000626);广东省自然科学基金(编号:S2013010016004);珠江科技新星专项(编号:2012J2200084);中央高校基本科研业务费专项资金(编号:10ykpy11)

摘　　要：目的总结肝脏上皮样血管内皮瘤（HEHE）的CT和MRI表现。方法搜集经手术或穿刺活检后病理证实的HEHE 11例,所有的病例均行CT检查,其中5例行CT平扫及双期增强扫描（动脉期＋门静脉期）,其他6例行CT平扫及三期增强扫描（动脉期＋门静脉期＋延迟期）。11例中有5例加做MRI平扫及动态增强扫描。回顾性分析病变的生长方式、分布特点、密度（信号）特点、强化方式及邻近组织情况。结果 11例均表现为肝内多发病灶,大部分病灶位于肝包膜下,根据生长方式分为三型：结节型（5例）,匍匐生长型（1例）和混合型（5例）。CT平扫,病灶均呈低密度,直径〉2 cm的病灶内见类圆形更低密度。MRI平扫：病灶呈T1WI低信号、T2WI高信号,直径〉2 cm的病灶信号不均匀（T1WI内见更低信号,T2WI内见更高信号）。其他影像学征象包括＂棒棒糖征＂（6例）、包膜退缩征（6例）。增强扫描：病灶直径〈1 cm的表现为轻度较均匀强化;病灶直径为1~2 cm主要表现为轻度较均匀强化;病灶直径〉2 cm的多为不均匀渐进性强化。结论 HEHE的CT和MRI表现具有一定的特征性,其强化方式与病灶的大小相关。Objective To analyze CT and MRI features of hepatic epithelioid hemangioendotheliomas（ HEHE） in order to improve its diagnostic level.Methods A total of 11 patients with pathologically-confirmed HEHE were collected.CT examination was employed in all patients,including plain CT scan and dual phase enhanced scan（ arterial phase and portal vein phase） in 5 cases,and plain CT scan and triple phase enhanced scan（ arterial phase ＋ portal vein phase ＋ delayed phase） in 6 cases.Additional plain and dynamic enhanced MRI was performed in 5 cases.The imaging features,including growth pattern,distribution characteristics,density（ signal） features,enhancement pattern and the changes of adjacent structure,were evaluated.Results In all the 11 cases,the HEHEs were characterized by multiple lesions in the liver.Most of the lesions（ about 75%） were located at subcapsular region.According to the growth pattern HEHEs could be divided into three types： nodular type（ n = 5）,creeping type（ n = 1） and mixed type（ n = 5）.On plain CT scan,all lesions were hypodense,and round lower density could be observed within 〉 2 cm lesions.On plain MRI,all lesions presented as hypo-intensity signal on T1 WI and hyper-intensity signal on T2 WI,heterogeneous signal intensity could be seen in 〉2 cm lesions（ lower signal on T1 WI and higher signal on T2WI）.Other imaging signs included ＂ lollipop＂ sign（ n = 6） and capsular retraction sign（ n = 6）.On contrast-enhanced CT and MRI scan,most 〈 1cm lesions showed mild homogeneous enhancement; 1.0- 2.0 cm lesions mainly showed mild homogeneous enhancement; and 〉 2 cm lesions had heterogeneous and progressive enhancement.Conclusion Hepatic epithelioid hemangioendotheliomas have certain CT and MRI characteristics,its enhancement pattern is related to the lesion’s size.

关 键 词：肝脏 上皮样血管内皮瘤 计算机断层扫描 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2