肝腺瘤的综合影像诊断

Hepatic adenomas: comprehensive imaging diagnosis

目的 描述肝腺瘤的超声 (US)、CT和MRI表现与病理基础 ,探讨综合影像对肝腺瘤的诊断价值。方法 回顾性分析经手术切除、病理证实的 6例肝腺瘤的US、CT和MRI表现 ,并与病理所见对照。结果 6例肝腺瘤均为单发肿块 ,1例术前综合影像诊断为肝腺瘤 ,4例误诊为肝癌 ,1例误诊为肝局灶结节性增生。US :6例呈稍低或低回声 ,4例有低回声晕 ,彩色多普勒显示 6例肿块内有较丰富的门脉样血流和低速动脉样血流。CT :6例为稍低或低密度 ,4例有假包膜 ,4例动脉期、门脉期均轻度强化 ,1例动脉期中度强化、门脉期轻度强化。MRI:T1WI和T2 WI上 ,6例表现为以高信号为主的混杂信号 ,用脂肪抑制后T1WI上的高信号无变化 ;2例动脉期显著强化、门脉期和延迟期轻度强化 ,3例动脉期、门脉期和延迟期均轻度强化。 6例均有假包膜 ,且在门脉期或延迟期出现轻度强化。结论 肝腺瘤的综合影像表现缺乏特异性。对有假包膜和混杂高信号 (用脂肪抑制后T1WI上的高信号无变化 )

Objective To describe the US, CT, and MR imaging findings and diagnosis of hepatic adenomas. Methods The comprehensive imaging features in 6 patients with 6 hepatic adenomas confirmed pathologically were reviewed retrospectively and correlated with pathologic findings. Results One case was diagnosed correctly, four cases were mistaken for hepatocellular carcinomas (HCC), and one case was mistaken for focal nodular hyperplasia. US: six lesions were hypoechoic with hypohalo in four lesions, and there was low velocity arterial and venous flow within the six lesions. CT: six lesions were hypodense with pseudocapsule in four lesions, and the four lesions showed slight enhancement during arterial and portal venous phases, and one lesion showed moderate enhancement during arterial phase and slight enhancement during portal venous phase. MRI: six lesions had heterogeneously high signal intensity on T 1WI and T 2WI, and the high intensity on T 1WI remained unchanged after using fat saturation. Two lesions showed strong enhancement during arterial phase and slight enhancement during portal venous and delayed phases, and three lesions showed slight enhancement during arterial, portal venous, and delayed phases. Pseudocapsule detected in six lesions showed slight enhancement on portal venous or delayed phases. Conclusion The comprehensive imaging findings of hepatic adenomas were nonspecific. The presence of pseudocapsule, heterogeneous high signal intensity on T 1WI, and the high intensity remained unchanged after using fat saturation may help make a correct diagnosis of hepatic adenoma.