肝上皮样血管内皮瘤的影像学表现及误诊分析  

Imaging findings of hepatic epithelioid hemangioendothelioma and analysis of misdiagnosis

作　　者：刘一萍 陈栋 霍雷 吴钰娴 张思斯 贾宁阳 LIU Yi-ping;CHEN Dong;HUO Lei;WU Yu-xian;ZHANG Si-si;JIA Ning-yang(Department of Medical Imaging,The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200438,China)

机构地区：[1]海军军医大学(第二军医大学)第三附属医院医学影像科,上海200438

出　　处：《海军军医大学学报》2023年第6期759-762,共4页Academic Journal of Naval Medical University

摘　　要：目的总结肝上皮样血管内皮瘤(EHE)的影像学特征,并对误诊病例进行分析。方法回顾性分析我院2015年2月至2021年12月经手术或穿刺病理证实为肝EHE的11例患者的临床及影像学资料。结果11例患者均行MRI检查,2例行CT检查。10例表现为肝脏多发占位,1例表现为肝内单发实性占位,共78个病灶。术前误诊7例,其中4例误诊为肝转移瘤,1例误诊为肝内胆管细胞癌,1例误诊为血管瘤,1例误诊为良性病灶。CT检查显示病灶为不均匀低密度;MRI T1加权成像显示病灶为稍低信号,T2加权成像显示病灶为稍高信号,增强后病灶呈环形持续强化(9例)或云絮状渐进性强化(2例)。9例患者T2加权成像病灶出现晕征,5例出现多发结节互相融合,7例见肝包膜皱缩征,7例MRI增强检查门静脉期见棒棒糖征,6例病灶内见血管穿行。结论肝EHE易误诊,但仍具有一定的影像学特征。熟悉肝EHE的影像学特征有助于提高其诊断准确率。Objective To summarize the imaging characteristics of hepatic epithelioid hemangioendothelioma(EHE)and analyze the misdiagnosed cases.Methods The clinical and imaging data of 11 patients with hepatic EHE confirmed by surgical or puncture pathology from Feb.2015 to Dec.2021 were retrospectively analyzed.Results All 11 patients underwent magnetic resonance imaging(MRI)and 2 cases underwent computed tomography(CT).Ten cases showed multiple liver lesions and 1 case showed a single solid lesion.A total of 78 lesions were detected in all 11 patients.Seven cases were misdiagnosed before surgery,of which 4 were misdiagnosed as liver metastases,1 as intrahepatic cholangiocarcinoma,1 as hemangioma,and 1 as benign lesion.CT plain scan showed uneven low-density lesions.The lesions presented slightly hypointensity on T1 weighted imaging and slightly hyperintensity on T2 weighted imaging.After enhancement,the lesions showed annular continuous enhancement(9 cases)or cloud flocculent gradual enhancement(2 cases).Nine cases had Halo sign on T2 weighted imaging,5 cases showed multiple lesions fusing with each other,7 cases had liver capsule retraction,7 cases showed lollipop sign in portal vein phase of MRI enhanced scan,and 6 cases showed vascular penetration sign.Conclusion Hepatic EHE is more likely to be misdiagnosed;however,EHE has certain imaging characteristics.Knowing the imaging features of hepatic EHE can help improve the diagnostic accuracy.

关 键 词：肝上皮样血管内皮瘤 肝肿瘤 磁共振成像 计算机断层扫描 误诊 

分 类 号：R735.7[医药卫生—肿瘤]