原发性肝脏血管肉瘤的MRI表现与病理对照研究

MRI Findings of Primary Hepatic Angiosarcoma:Correlation with Pathology

目的:观察原发性肝脏血管肉瘤(PHA)的MRI表现,分析其病理学基础,从而提高其诊断准确性。方法:回顾性分析4例PHA的MRI表现,评价病灶部位、大小、形态、信号特点及强化方式,并与病理对照观察。结果:4例PHA均为多发,具体表现为1枚较大主灶伴数目不等子灶,边界清晰,呈类圆形或分叶状。主灶呈不均匀T1WI低、T2WI高信号,病理上可见出血、坏死和纤维化;动脉期周边或中心明显强化,强化程度低于主动脉,3例可见中心杂乱血管影;门脉期及延迟扫描呈渐进性强化,但不能完全充填。3例伴有周边肝实质楔形或地图样灌注异常。子灶呈均匀T1WI低、T2WI高信号,增强后可无强化,也可呈向心性强化、均匀强化或中心强化。结论:PHA的MRI表现具有一定的特征性,常表现为多发肿块,易出血坏死,呈明显渐进性强化。

Purpose：To evaluate the MRI findings of primary hepatic angiosarcoma （PHA） and correlate with pathologic features. Methods： MR images of 4 PHA patients confirmed by histopathology were ret rospectively analyzed. The location, size, shape and dynamic enhancement pattern were evaluated. These findings were correlated with histopathology findings. Results： Four cases appeared as well de fined dominant masses with multiple satellite nodules. The dominant mass demonstrated lobular or round in shape and heterogeneous hypointensity at TlWI and markedly hyperintersity at T~ WI, which was as sociated with internal hemorrhage, necrosis and fibrosis at pathology. They all appeared as a flecked enhancement in the center or peripheral nodular enhancement during the arterial phase with lower en hancement degree than aortic artery. Chaotic central vascularization was present in 3 cases. In the portal venous and delayed phase, the enhanced areas of the mass were extended. Three cases demonstrateded phenomenon of hepatic perfusion disorders which appeared as map - like or wedge shape. The satellite lesions showed homogeneous hypo intensity at T1WI and markedly hyper - intersity at T2WI. They showed variable enhancement patterns, such as non enhancement, homogoneous, focal, rim - en- hancement or progressive opcification from periphery to center. Conclusion： MRI is an effective tech- nique for diagnosis of PHA. PHA often appears as multiple, well defined, hyper vascular lesions with progressive enhancement on serial post gadolinium images.