肝脏血管肉瘤的影像表现及病理对照  

Imaging findings and pathological comparison of hepatic angiosarcoma

作　　者：王苏丹[1] 宋文艳[1] 张岩岩[1] 邵晨[2] 郑素军[3] WANG Sudan;SONG Wenyan;ZHANG Yanyan;SHAO Chen;ZHENG Sujun(Department of Radiology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Department of Pathology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Liver Disease Center,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院放射科,北京100069 [2]首都医科大学附属北京佑安医院病理科,北京100069 [3]首都医科大学附属北京佑安医院肝病中心一科,北京100069

出　　处：《实用放射学杂志》2024年第10期1641-1644,共4页Journal of Practical Radiology

基　　金：北京市医院管理中心重点医学专业发展计划(扬帆计划)项目(ZYLX202125);首都卫生发展科研专项重点攻关项目(首发2022-1-2182)。

摘　　要：目的探讨肝脏血管肉瘤(HAS)的影像表现及病理基础。方法回顾性分析经病理证实的12例HAS患者的CT及MRI表现,并与病理对照。结果12例HAS患者,根据形态学分为肿块型3例、结节肿块混合型2例、弥漫浸润型7例。9例灶内出血,12例均有不同程度坏死。肿块型动脉期边缘或灶内结节状、斑片状、环状及索条状强化,门脉期及延迟期强化范围增大;结节肿块混合型动脉期边缘或灶内斑片状及斑点状轻度强化,门脉期及延迟期扩张性强化;弥漫浸润型4例动脉期网格状强化,门脉期网格强化范围增大且弥漫,并伴渐进性增大的强化结节,延迟期部分病灶融合,3例表现为动脉期弥漫性结节样强化,门脉期及延迟期强化范围增大。本组病例不论何种分型,肝内病灶多发时延迟期出现病灶融合,出血、坏死部分不强化。结论不均匀渐进性强化伴出血、囊变、坏死是HAS的影像特点。Objective To investigate the imaging manifestations and pathological basis of hepatic angiosarcoma(HAS).Methods The CT and MRI findings of 12 patients with HAS confirmed by pathology were analyzed retrospectively and compared with pathological findings.Results Based on morphological classification,the 12 cases of HAS were categorized into three types:massive patterns(n=3),mixed patterns of mass with nodules(n=2),and diffuse infiltration patterns(n=7).Hemorrhage was observed in 9 cases,and necrosis was present in all 12 cases.The massive patterns exhibited peripheral or nodular,patchy,annular,and cord-like enhancement patterns during the arterial phase,with increasing enhancement during the portal and delayed phases.The mixed patterns of mass with nodules demonstrated mild enhancement around the margin or in patchy and spotty structures during the arterial phase,progressing to expansive enhancement during the portal and delayed phases.Four of the seven diffuse infiltration patterns presented with mesh enhancement during the arterial phase,which expanded and became diffuse during the portal phase,accompanied by progressively enlarged enhancing nodules.In the delayed phase,the lesions were fused.The other three cases showed diffuse nodular enhancement during the arterial phase followed by increased enhancement during both portal phase and delayed phase.Regardless of subtype,focal fusion occurred during the delayed phase when multiple intrahepatic lesions were present,and the hemorrhagic and necrotic parts did not enhance.Conclusion The imaging characteristics of HAS include heterogeneous and progressive enhancement,often accompanied by hemorrhage,cystic change,and necrosis.

关 键 词：肝脏血管肉瘤 计算机体层成像 磁共振成像 病理学 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学] R445.2