肝上皮样血管内皮瘤的超声造影诊断研究

The study on hepatic epithelioid hemangioendothelioma by contrast-enhanced ultrasound

目的探讨超声造影对于肝上皮样血管内皮瘤（HEHE）的诊断价值。方法对16例经病理证实的肝上皮样血管内皮瘤患者的超声造影图像进行分析，观察病灶的增强方式和增强时相。结果对16例患者中共21个病灶进行超声造影，其增强起始时间平均为（17．4±5．2）S，达峰时间为（22．0±7．2）s，出现等回声时间为（23．9±4．6）S，表现为低回声时间为（42．2±13．7）S。动脉期8个病灶整体增强，7个病灶周边环状增强，6个病灶树枝样增强。6个病灶内缘可见短毛刺样增强，8例患者部分病灶内部有始终不增强区。达峰时，10个病灶增强强度低于周围肝实质，6个病灶增强程度与周围肝实质相等，5个病灶稍高于周围肝实质。动脉期11个病灶与肝实质同步增强，8个病灶稍快于肝实质增强，2个病灶慢于肝实质增强。21个病灶在门脉期及延迟期均快速减退表现为低回声，超声造影后全部病灶边界均比二维超声显示更清晰。结论HEHE的超声造影特征表现对其诊断和鉴别诊断具有一定的价值。

Objective To investigate the value of contrast enhanced ultrasonography（CEUS） in the diagnosis of hepatic epithelioid hemangioendothelioma（HEHE）. Methods The images of CEUS had been retrospectively evaluated in 21 lesions of HEHE which were confirmed by pathology. The perfusion patterns and time of enhancement were observed, including time to begin enhancement, time to peak enhancement, the washout time and the appearance of internal structures. Results The mean time of begin enhancement, time to peak, time to isoechogenity and hypoechogenity were （17.4 ± 5.2）s, （22.0 ±7.2） s, （23.9±4.6）s and （42.2 ±13.7）s, respectively. During the arterial phase, 8 lesions showed diffuse enhancement, 7 lesions showed rim-like enhancement and 6 lesions showed branch enhancement. The inner margin in 6 lesions showed speculate enhancement. The central portion of the tumors was not enhanced in part lesions of 8 cases. As to time of peak enhancement, compared to the normal hepatic parenchyma, hypoenhancement, isoenhancement and hyperenhancement were observed in 10 lesions, 6 lesions and 5 lesions respectively. Synchronous enhancement was observed in 11 lesions on CEUS, rapid enhancement was observed in 8 lesions and slow enhancement was observed in 2 lesions. Twenty-one lesions manifested hypoechoic mass in portal phase and delayed phase. The boundary of lesions was unclear on conventional ultrasound and became distinct after contrast injection in 21 lesions. Conclusions CEUS is useful for the diagnosis of HEHE.