肉瘤样肝细胞癌的磁共振征象分析  

Analysis of magnetic resonance imaging features of sarcomatoid hepatocellular carcinoma

作　　者：曾从俊[1,2] 汤敏[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]上海交通大学医学院附属苏州九龙医院放射科,苏州215021

出　　处：《放射学实践》2017年第8期856-860,共5页Radiologic Practice

摘　　要：目的:探讨肉瘤样肝细胞癌(SHC)的磁共振成像表现。方法:回顾性分析经手术病理证实的12例SHC的MRI及临床资料。全部患者行MRI平扫及增强检查,由2位放射科医师主要从病灶的数目、大小、形态、分布、信号特点(出血、坏死、囊变等)、边界(有无包膜等)、强化特征及邻近改变(侵犯、转移、肝实质有无肝硬化等)这8个方面分析其MRI特征。结果:12例中10例患有慢性肝炎,8例AFP阴性。9例单发,3例多发,共16个病灶,病灶最大径为1.3~12.1cm,平均(4.9±3.3)cm。MRI显示肝内病灶信号不均匀,中心可见坏死囊变,实性成分呈环形或不规则分隔样强化,尤以周边部分动脉期明显强化,门脉期及延迟期呈廓清表现,伴或不伴有包膜延迟强化,病灶侵犯邻近器官伴肝门淋巴结肿大。免疫组化染色结果显示Hepa阳性12例,EMA阳性8例、间叶组织标志物Vimentin阳性12例。结论:肉瘤样肝细胞癌的临床和MRI表现有一定特征性,但确诊需依赖组织病理学检查。Objective：To discuss the MRI features of sarcomatoid hepatocellular carcinoma （SHC）. Methods：12 patients with sarcomatoid hepatocellular carcinoma proved by surgery and pathology were included in this study, and their clinical and MRI data were analyzed retrospectively. All the patients underwent plain and contrast-enhanced MRI examina- tion. MRI findings especially eight main features including number, size, shape,margin （including with or without pseud- ocapsule）, signal characteristics （necrosis, calcification, hemorrhage, etc）, enhancement pattern, and adjacent changes （ inva- sion to other organs or lymph nodes,metastasis or etc） were analyzed by two radiologists. Results：10 of the 12 patients had chronic hepatitis and 8 had a negative alpha-fetoprotein. There were totally 16 lesions,including solitary lesion in 9 cases and multiple lesions in 3 cases,with maximum diameter range of 1.3-12. 1cm,an average of （4.9±3.3）cm. MRI showed that the lesions were inhomogeneous,with center necrosis or cystic degeneration,circular or irregular septal-like enhancement. Especially in the peripheral part,marked enhancement could be seen in the arterial phase,and then rapid clearance was seen in portal venous phase and delayed phase,with or without delayed enhancement of pseudocapsule. Invasion to the adjacent organs with lymphatic metastasis around hepatic hilum was found in all patients. Immunohistoehemical staining examination showed Hepa was positive in 12 cases,EMA was positive in 8 cases,mesenchymal tissue marker vimentin was positive in 12 cases. Conclusion：MRI can show the characteristic features of sarcomatoid hepatocellular carcinoma （SHC）, but the final di- agnosis is provided only by histopathological examination.

关 键 词：肝肿瘤 肝细胞癌 肉瘤样 磁共振成像 病理学 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]