肝脏少见原发性恶性肿瘤的CT表现

CT finding of rare primary malignant tumor of the liver

目的:探讨肝脏少见原发性恶性肿瘤的CT表现特点。方法:回顾性分析经病理证实的8例肝脏少见原发性恶性肿瘤的CT表现并复习相关文献。结果:血管肉瘤3例(巨块结节型2例,弥漫多结节型1例),平扫呈不均匀低密度,2例内部见云絮状稍高密度影;增强扫描动脉期,巨块结节型主灶呈斑片状不均匀强化,弥漫多结节型呈结节状强化,门脉期及延迟期病灶均呈持续向心性强化。恶性纤维组织细胞瘤4例,平扫以等密度为主,夹杂条带状低密度区;3例增强扫描动脉期轻度不均匀强化,门脉期及延迟期强化程度下降,另1例动脉期呈轻度强化,门脉期强化程度增高,延迟期强化度减低。上皮样血管内皮瘤1例,CT平扫呈较均匀低密度影;增强扫描动脉期呈不规则环形强化,门脉期强化程度增高且向中央扩展,延迟期肿瘤均匀强化且程度降低。结论:CT平扫+三期增强扫描并结合临床资料可提高肝脏少见原发性恶性肿瘤的诊断率,确诊仍需依靠病理学检查。

Objective：To investigate the CT imaging characteristics of the rare primary liver malignant tumors.Methods：A retrospective study of the CT imaging of 8 rare primary liver malignant tumors was made and the related literature was reviewed.Results：In 3 cases of angiosarcoma,including 2 cases of massive type and 1 case of diffuse nodular type,irregular low density areas were demonstrated on plain scan,cloudy increased density within the lesions was seen in 2 cases.In arterial enhanced phase,low-grade asymmetrical enhancement and irregular banding were detected in massive type sarcoma and nodular enhancement in diffuse nodular type,in portal venous phase and delayed phase,filled-in enhancement was seen in both types.In 4 cases of malignant fibrous histiocytoma,plain scan displayed equal density area;after contrast administration,3 cases demonstrated slight heterogeneous enhancement in arterial phase,enhancement decreased in venous phase and delayed phase.1 case displayed slight enhancement in arterial phase and increased enhancement in venous phase,enhancement decreased in delayed phase.In 1 case of epithelioid hemangioendothelioma,CT scan showed homogeneous low density;in enhanced scan,tumor had irregular ring enhancement in arterial phase,enhancement increased in venous phase and extended to the central area;homogeneous enhancement of tumor was displayed in delayed phase.Conclusion：The rare primary liver malignant tumor is often misdiagnosed before surgery,CT scan with triphasic enhanced scanning combined with clinical data can improve the accuracy of diagnosis.However,confirmed diagnosis still relies on pathological examination.