肝上皮样血管内皮瘤超声造影与增强磁共振表现的对比研究

Comparative study of contrast enhanced ultrasound versus contrast enhanced MRI in hepatic epithelioid hemangioendothelioma

目的比较肝上皮样血管内皮瘤（HEHE）的超声造影（CEUS）与增强磁共振成像（CEMRI）的影像学特点，提高HEHE影像学诊断的准确性。方法17例患者均经手术或穿刺病理证实为HEHE。其中13例接受术前CEUS检查，12例接受术前CEMRI检查。本文对CEUS和CEMRI图像表现进行分析。结果13例CEUS患者共选取20个病灶，动脉期均有不同程度增强，其中13个病灶（65．0％）表现为整体增强，7个病灶（35．0％）表现为边缘环状增强；17个病灶（85．0％）动脉期与肝脏同步增强，3个病灶（15．0％）稍快于肝实质。所有病灶在门脉期及延迟期均呈低回声改变，其他征象包括病灶内缘短毛刺样增强、“血管征”等。12例CEMRI患者共63个病灶。其中45个病灶（71．4％）在动脉期表现为轻度增强，在门脉期及延迟期表现为持续强化，其余18个病灶（28．6％）动脉期未见明显增强，而在门脉期及延迟期呈渐进性强化。在增强方式上，47个病灶（74．6％）表现为边缘环状增强，16个病灶（25．4％）表现为整体增强。其他征象包括“晕环征”“包膜收缩征”“棒棒糖征”及“血管征”等。结论HEHE的CEUS和CEMRI表现具有一定特征。联合应用两种影像学检查可提高HEHE术前诊断率，有助于指导临床治疗方法的选择。

Objective To analyze and compare the imaging characteristics of contrast-enhanced ultrasound （CEUS） and contrast enhanced magnetic resonance imaging （CEMRI） in diagnosing hepatic epithelioid hemangioendothelioma （HEHE） for improving radiological diagnostic accuracy. Methods The im- aging characteristics of CEUS and dynamic CEMRI in 17 patients with histopathological diagnosis of HEHE on specimens obtained after surgical resection or fine needle biopsy were retrospectively analyzed and compared. Results On CEUS, 20 lesions in 13 patients demonstrated different enhancement patterns in the arterial phase： 13 lesions （65.0%） displayed gross enhancement and 7 lesions （35.0%） displayed a rimlike enhancement. Synchronous enhancement was observed in 17 lesions （ 85.0% ） and rapid enhancement was observed in 3 lesions （ 15.0% ）. All these 20 lesions manifested as a hypoechoic mass in the portal venous and delayed phases. Other characteristics included speculated enhancement in the inner margin of the lesions and a ＂vessel sign＂. On CEMRI, 45 lesions （71.4%） manifested slight enhancement in the arterial phase and continuous enhancement in the portal venous and delayed phases. The remaining 18 lesions （28.6%） manifested no enhancement in the arterial phase but progressive enhancement in the portal venous and delayed phases. 47 lesions （74. 6% ） displayed a rim-like enhancement and 16 lesions （25.4%） displayed gross enhancement. Other imaging characteristics included a ＂halo sign＂, a ＂lollipop＂ sign, a ＂capsular retraction sign＂ or a ＂ vessel sign＂. Conclusions On CEUS, characteristic manifestations of HEHE were synchronous enhancement with a quick wash-out. At peak time, the enhancement degree was equal to the normal liver parenchyma. On CEMRI, the main radiological feature of HEHE was a rim-like enhancement. In the arterial phase, the enhancement degree was not high and there was either a continuous enhancement or a progressive enhancement in the portal venous and delayed phases. Furthermore, HEHE lesions always occurred under the liver capsule and showed a ＂ capsular retraction sign＂ , a ＂ halo sign＂ , a ＂lollipop＂ sign or a ＂vessel sign＂. The combination of CEUS and CEMRI helped to improve the diagnostic rate and contributed to selection of clinical treatment.