肝脏上皮样血管内皮瘤的影像表现  

Imaging manifestations of hepatic epithelioid hemangioendothelioma

作　　者：常瑞萍[1] 甘露[1] 王湛博[2] 于国[2] 杨立[1] 

机构地区：[1]解放军总医院放射诊断科,北京100853 [2]解放军总医院病理科,北京100853

出　　处：《中华放射学杂志》2015年第6期449-453,共5页Chinese Journal of Radiology

摘　　要：目的：探讨肝脏上皮样血管内皮瘤（HEH）的影像表现特征。方法回顾性分析经病理证实的14例HEH患者资料。5例行腹部CT平扫和双期增强扫描，7例行腹部MRI平扫和多期多时相增强扫描，2例同时行CT和MRI检查。观察肝脏病变CT平扫、MR T2WI影像表现及强化特征，并将病变分为单发型、多发型和弥漫型。结果（1）多发型HEH：共11例228个病灶，其中MRI显示病灶178个，CT显示病灶50个。MR T2WI平扫，79.2%（141/178）病灶表现为三环征或双环征，三环征由内向外依次呈高信号、薄低信号环和晕环样稍高信号，双环征由内向外呈高信号和晕环样稍高信号。多发型HEH的强化特征包括：66.3%（118/178）病灶动脉期中心无强化，边缘轻度环形强化，门静脉期和延迟期环形持续强化，呈双层或多层黑靶征；27.0%（48/178）病灶为门静脉期和延迟期中心和外层明显高信号而中层低信号的白靶征，随时间延长高信号的强化部分逐渐向低信号区蔓延；2.2%（4/178）病灶动脉期呈周边结节样强化，门静脉期向内填充；4.5%（8/178）病灶增强后呈轻度渐进性强化。CT平扫病灶呈低密度实性结节。增强扫描42个病灶呈双层黑靶征，3个病灶呈白靶征，5个病灶呈类血管瘤样强化。（2）弥漫型HEH：共2例，1例病变与正常肝实质分界不清，增强后病变内见沿脉管走行渐进性异常强化；1例呈弥漫结节，结节均匀强化并逐渐呈等密度或信号。（3）单发型HEH：1例，病灶呈团块样，平扫密度不均匀，增强后呈不均匀轻度渐进性强化。结论 HEH影像表现具有一定的特征，当T2WI出现三环征或双环征，增强扫描随时间延长出现黑靶征或白靶征时对其诊断具有一定提示作用。Objective To explore imaging manifestations of hepatic epithelioid hemangioendothelioma （HEH）. Methods CT and MR images in 14 patients with HEH proven by histopathology were retrospectively analyzed. Plain and two-phase contrast-enhanced CT scan were performed in 5 cases, non-contrast and multiphase contrast-enhanced MR scan were performed in 7 cases, CT and MRI were both performed in 2 cases. Characteristics of CT and MR T2WI images were classified and analyzed. All lesions were classified into three types：multiple, diffuse and solitary form. Results （1） Multiple form of HEH：228 lesions were found in 11 patients, including 178 lesions on MRI and 50 lesions on CT. On T2WI, three or two layered-target-signs with hyperintensity core were found in 79.2% （141/178） of the lesions. Three layer-target-sign included hyperintensity core, hypointensity rim and slightly high signal halo from the inside out. Two layer-target-sign included hyperintensity core and slightly high signal halo from the inside out. Characteristics of dynamic contrast-enhanced scan included peripheral two or three layered-rim-like enhancement in 66.3%（ 118/178） of the lesions;peripheral, gradual rim-like enhancement with enhanced core in 27.0%（ 48/178） of the lesions;heterogeneously mild enhancement in 2.2%（ 4/178） of the lesions;centripetal enhancement in 4.5%（ 8/178） of the lesions. Fifty lesions were found in CT, which showed low density nodules or masses with clear margins. Two-layered-black-target sign were found in 42 lesions in contrast-enhanced images, white-target sign were found in 3 cases, and centripetal enhancement was found in 5 cases. （2） Diffuse form of HEH：in one of the two cases of this type, the lesions could not be separated from normal liver parenchyma, gradual enhancements were found along with the＆amp;nbsp;vessels in the center of the lesions. （3） Solitary form of HEH： one case, the lesion showed heterogeneous density in non-contrast CT images and gradual enhancement in contrast-en

关 键 词：肝肿瘤 磁共振成像 体层摄影术 X线计算机 

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