肝脏血管平滑肌脂肪瘤的影像诊断

Imaging Diagnosis of Angiomyolipoma of the Liver

目的 研究肝血管平滑肌脂肪瘤的影像特征及其病理基础 ,以减少对该病的误诊。材料与方法 3例肝血管平滑肌脂肪瘤均经B超和CT平扫及增强扫描 ,1例加做MRI检查。 3例经B超及CT检查显示 5个病灶。 2例 3个病灶经病理诊断 ,其中 2个病灶术前误诊为肝癌和肝血管瘤 ;另 1例肝脏含脂肪的肿块伴有肾脏多发病变及结节硬化。结果 在影像上肝血管平滑肌脂肪瘤具有特征性的表现 :( 1)瘤内脂肪 ,在B超上 ,表现为强回声区 ;CT上 ,呈明显低密度 ;MRT1WI上呈高信号。 ( 2 )肿瘤在肝动脉期明显强化 ,门静脉期中度强化。结论 肝血管平滑肌脂肪瘤易误诊为其他肝病 ,但实际上 ,一些影像学表现能反映肝血管平滑肌脂肪瘤的组织成分 ,有助于术前正确诊断。

Objective To study the imaging features and their pathologic basis of hepatic angiomyolipoma, and to reduce misdiagnosis.Materials and Methods Plain CT scan and ultrasound were performed in 3 patients with hepatic angiomyolipoma. Additional MRI was done in one case. Five lesions were found on CT and ultrasonograph in 3 cases. Of 3 lesions in 2 cases confirmed by pathology, 2 lesions were mistaken preoperatively for hepatic carcinoma or hemangioma. The other case had 2 lipomatous masses in the liver and multiple renal lesions with tuberous sclerosis.Results Hepatic angiomyolipoma demonstrated two characteristic signs. (1) Fatty content within the tumor presented as a hyperechhoic area on ultrasonograph, or a very low density area on CT, or a hyperintense area on T1WI. (2) The lesion showed marked enhancement during hepatic arterial phase, and moderate enhancement during portal phase.Conclusion Hepatic angiomyolipoma can easily be mistaken for other hepatic diseases. Actually, several imaging signs can reflect the composition of the tumor, which are helpful for making a correct diagnosis preoperatively.