肝脏上皮样血管平滑肌脂肪瘤的CT和MRI表现及误诊分析  

CT and MRI Manifestations and Misdiagnosis of Hepatic Epithelioid Angiomyolipomas

作　　者：李健[1] 徐志刚 徐珍珍 曾献军[1] 龚洪翰[1] LI Jian;XU Zhi-gang;XU Zhen-zhen;ZENG Xian-jun;GONG Hong-han(Department of Radiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Radiology,Fuzhou Jianqiang Fifth Hospital,Fuzhou 344100,China)

机构地区：[1]南昌大学第一附属医院影像科,南昌330006 [2]抚州健强第五医院影像科,江西抚州344100

出　　处：《实用临床医学（江西）》2021年第5期42-46,共5页Practical Clinical Medicine

基　　金：江西省教育厅科学技术研究项目(GJJ190134);江西省卫生健康委科技计划(20203130)。

摘　　要：目的探讨肝脏上皮样血管平滑肌脂肪瘤(hepatic epithelioid angiomyolipoma,HEAML)的CT与MRI表现,以提高对其的认识及诊断准确率。方法回顾性分析10例经手术病理确诊的HEAML患者的CT和MRI表现,并分析其误诊原因。结果术前被误诊为肝细胞肝癌5例,误诊为胆管细胞癌1例,误诊为局灶性结节增生2例,误诊为囊腺癌1例,诊断为血管平滑肌脂肪瘤1例。10例HEAML中男2例,女8例,年龄37~61岁,中位年龄49岁,病灶均单发,其中位于肝右叶4例、肝左叶6例,肿瘤长径为2.3~12.7 cm。4例行CT平扫,呈不均匀稍低密度,2例含脂肪密度,1例有出血灶。8例行MRI平扫表现为T 1WI呈稍低信号,T 2WI呈稍高信号,6例信号不均匀;7例行CT增强及10例行MRI增强,动脉期大多为不均匀明显强化,仅1例均匀明显强化。增强模式为“快进慢出”型5例、“快进快出”型4例、延迟强化1例。动脉期6例病灶可见“早期引流静脉”,8例可见“迂曲血管征”,4例可见肝动脉供血,4例见假包膜征。结论HEAML的影像学表现具有一定特征性,可提高术前诊断率,但其确诊仍有赖于组织病理学及免疫组织化学检查。Objective To evaluate the CT and MRI features of hepatic epithelioid angiomyolipomas(HEAML),and to improve the knowledge and diagnostic accuracy of this disease.Methods The CT and MRI data of 10 patients with HEAML proved by pathology were analyzed retrospectively,and the causes of misdiagnosis were investigated.Results Among the 10 HEAML patients,5 were misdiagnosed as hepatocellular carcinoma,1 as cholangiocarcinoma,2 as focal nodular hyperplasia,1 as cystadenocarcinoma,and 1 as angiomyolipomas.These patients included 2 males and 8 females,with a median age of 49 years(range,37 to 61 years).All the lesions were solitary.Among them,4 were located in the right liver lobe and 6 in the left liver lobe.The tumor size was 2.3-12.7 cm in length.Four cases underwent non-contrast CT and showed slightly heterogeneous low-density lesions(2 case had fat density and 1 cases had hemorrhage).Eight cases underwent non-contrast MRI and showed slightly low signal intensity on T 1WI and slightly high signal intensity on T 2WI(the signal was uneven in 6 cases).Seven cases underwent contrast-enhanced CT and all cases underwent contrast-enhanced MRI.The results manifested obvious nonhomogeneous enhancement in the arterial phase(1 case showed uniform enhancement).The enhancement was"fast in and slow out"mode in 5 cases,"fast in and fast out"mode in 4 cases,and delayed mode in 1 case.In the arterial phase,6 cases showed"early venous drainage",8 cases showed"tortuous blood vessel sign",4 cases showed hepatic arterial supply,and 4 cases showed pseudocapsule sign.Conclusion HEAML has characteristic imaging findings,and therefore can improve the preoperative diagnosis rate.However,the definite diagnosis of HEAML still mainly relies on histopathologic and immunohistochemical examinations.

关 键 词：肝脏上皮样血管平滑肌脂肪瘤 体层摄影术 X线计算机 磁共振成像 误诊 

分 类 号：R735.7[医药卫生—肿瘤]