非典型肝海绵状血管瘤的CT诊断

CT Diagnosis of Atypical Hepatic Cavernous Hemangiomas

目的:探讨非典型肝海绵状血管瘤(HCH)的CT表现及相关病理学基础。方法:回顾性分析18例共21个非典型HCH的CT表现,包括病灶大小、平扫密度、动态增强模式及邻近改变。结果:有13个病灶CT平扫呈非均匀密度。共出现4种非典型动态增强模式:Ⅰ型(5例)表现为动脉期病灶快速均匀强化,门静脉期及延迟期持续强化;Ⅱ型(13例)动脉期肿瘤周边结节状强化,门静脉期及延迟期呈向心性强化,但不能完全填充整个病灶;Ⅲ型(2例)动脉期病灶呈中央强化,门静脉期及延迟期向周边呈离心性强化;Ⅳ型(1例)动脉期病灶无明显强化,门静脉期及延迟期呈轻度周边强化或不规则强化。HCH邻近区域的改变:有9个病灶周围可见动脉-门静脉分流(APVS),4个病灶邻近可见肝包膜回缩(HCR)征。以上非典型CT表现的出现在不同大小的病灶中差异有显著性意义(P<0.05)。结论:HCH非典型CT表现的出现与病变的结构特征密切相关,认识其非典型表现对HCH的诊断和鉴别诊断有重要意义。

Objective：To study the CT features of atypical hepatic cavernous hemangioma （HCH） and correlated with pathologic findings. Methods： The CT manifestations including size, attenuation on non-enhanced CT, patterns of dynamic enhancement and appearances in adjacent regions were reviewed retrospectively in 18 cases （21 lesions） of atypical HCH. Results： Heterogeneous attenuation on non-enhanced CT were found in 13 lesions. There were 4 types of atypical patterns on dynamic enhanced CT. Type Ⅰ（n= 5） was demonstrated as immediate homogeneous enhancement during arterial phase, and persistent enhancement in venous and delayed phases;type Ⅱ （n= 13） showed peripheral and globular enhancement during arterial phase, and progressive centripetal enhancement but incomplete filling of the lesion during venous and delayed phases, type Ⅲ （n=2） revealed central enhancement at arterial phase,and progressive centrifugal enhancement during venous and delayed phases; type Ⅳ （n=1） appeared no enhancement during arterial phase, and slight peripheral or heteroge- neous enhancement during venous and delayed phases. In the adjacent region of HCH ,arterial-portal venous shunt （APVS） was found in 9 lesions and hepatic capsular retraction （HCR） in 4 lesions. There were significant difference of these atypical CT findings in different size of lesions. Conclusion： Atypical CT appearances of HCH were closely correlated with their pathologic characteristics. Understanding of these atypical CT appearances is important for the diagnosis and differential diagnosis of HCH.