肝脏上皮样血管平滑肌脂肪瘤MRI影像特征分析  

作　　者：张宾 葛晓莉 陈琳 殷洁[1] 潘江峰[1] 

机构地区：[1]浙江省金华市中心医院,321000

出　　处：《浙江临床医学》2025年第3期421-423,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省自然科学基金资助项目(LSY19H180006);金华市科技计划项目(2021-3-077)。

摘　　要：目的探讨肝脏上皮样血管平滑肌脂肪瘤(HEAML)的MRI影像表现。方法回顾性分析经手术病理证实的12例HEAML患者的影像资料,总结MRI特征性表现。结果10例患者单发,2例患者多发,共14例病灶,术前6例诊断正确,4例误诊为肝细胞肝癌,2例误诊为肝腺瘤,1例误诊为FNH,1例误诊为肝血管平滑肌脂肪瘤。MRI平扫T_(2)WI多为不均匀高信号或稍高信号,T_(1)WI低信号,DWI高或高低混杂信号,ADC为等或稍低信号,化学位移成像反相位较同相位局部信号减低;增强扫描强化方式4例病灶“快进快出”,10例病灶“快进慢出”,9例病灶内部显示“中心血管征”。8例病灶显示供血动脉,9例病灶显示动脉期早显引流静脉,4例病灶见持续性强化假包膜。4例患者伴发肾脏AML。结论HEAML的MRI影像表现有一定的特征性,MRI多序列成像及动态增强扫描对其诊断及鉴别诊断有重要价值。Objective To investigate the magnetic resonance imaging(MRI)findings and misdiagnosis analysis of hepatic epithelioid angiomyolipoma(HEAML),so as to improve the preoperative diagnosis of this disease.Methods The imaging data of 12 patients with HEAML confirmed by surgery and pathology in our hospital were retrospectively analyzed,and their MRI findings were summarized.Results There were 14 lesions in 10 patients with single lesion and 2 patients with multiple lesions.The preoperative diagnosis was correct in 6 cases,4 cases were misdiagnosed as hepatocellular carcinoma,2 cases were misdiagnosed as hepatic adenoma,1 case was misdiagnosed as focal nodular hyperplasia(FNH),and 1 case was misdiagnosed as hepatic angiomyolipoma AML.On T_(2)WI of MRI plain scan,most of the signals were uneven high signal or slightly high signal,low signal on T_(1)WI,high or mixed high and low signal on DWI,and equal or slightly low signal on ADC.The reverse phase of chemical displacement imaging was lower than the local signal in the same phase;The enhancement mode of enhanced scanning was"fast in and fast out"in 4 cases,"fast in and slow out"in 10 cases,and"central vascular sign"in 9 cases.8 lesions showed blood supply arteries,9 lesions showed early drainage veins at arterial stage,and 4 lesions showed continuous enhanced pseudocapsule.Four patients were accompanied with renal AML.Conclusion The MRI manifestations of HEAML have certain characteristics.Multi sequence MRI and dynamic enhanced MRI are of great value in the diagnosis and differential diagnosis of HEAML.

关 键 词：上皮样血管平滑肌脂肪瘤 肝脏 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤]