7例原发性肝脏神经内分泌癌患者的影像学特征分析

Imaging features of primary hepatic neuroendocrine carcinoma in 7 cases

目的探讨原发性肝脏神经内分泌癌的影像学特征。方法回顾性分析我院2009年5月—2016年12月经病理确诊的7例原发性肝脏神经内分泌癌患者的临床及影像学资料。结果 7例原发性肝脏神经内分泌癌患者中男5例,女2例,年龄30~65岁,平均年龄45.6岁,其中1例行CT平扫及增强扫描,6例行CT平扫及MRI增强扫描。7例患者共9个病灶,多发神经内分泌癌2例,均有2个病灶,其中1例合并布加综合征,1例伴发肝细胞肝癌。血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)阳性4例,癌胚抗原及糖类抗原19-9阳性2例,AFP均阴性。其影像学特征性表现包括病灶呈"快进快出"5例,病灶内可见多发偏中心囊性变区6例,延迟期可见包膜4例,粗大肿瘤血管4例,引流静脉显影4例,所有病例均未见门静脉癌栓、淋巴结转移及胆管扩张征象。结论神经内分泌癌的影像学表现具有一定的特征性,无明确肝病史的肝脏富血供占位、病灶内含有单发或多发的偏中心性囊变区、肿瘤表面粗大肿瘤血管与引流静脉的出现,结合血清AFP阴性及NSE的升高,放射科医师应考虑到原发性肝脏神经内分泌癌的可能性,确诊仍需要活检取得病理组织学证据。

Objective To analyze the imaging features of primary hepatic neuroendocrine carcinoma. Methods Clinical and imaging data of 7 patients with primary hepatic neuroendocrine carcinoma diagnosed by pathology from May 2009 to December 2016 in our hospital were retrospectively analyzed. Results Among the involved 7 patients, there were 5 males and 2 females, they aged from 30 to 65 years old with an average age of 45.6 years old. One patient underwent plain and enhanced CT scan, while the other 6 cases were detected with plain and enhanced MR examination. A total number of 9 lesions were found in 7 patients, and muhiple neuroendocrine carcinoma were found in 2 cases with 2 lesions in each case, including 1 patient with Budd Chiari syndrome and the other with hepatocellular carcinoma. Four cases were positive for neuron-specific enolase （NSE） in the serum, while 2 cases showed carciuo- embryonic antigen and carbohydrate antigen-199 positive. Besides, all the 7 cases were AFP-negative. The images of the lesions showed the following features： wash in and wash out （5/7）, multiple cystic components （6/7）, pseudocapsule in the delay phase （4/7）, thicken blood vessels （4/7）, and draining hepatic veins （4/7）. In addition, no portal vein thrombus, lymph node metastasis or bile duct dilatations were found in all 7 cases. Conclusions The imaging findings of neuroendoerine carcinoma show specific teatures. When a lesion has rich blood supply with no liver disease, single or multiple cystic components, thicken blood vessels, as well as draining veins combi,ed with AFP negative and elevated NSE in the serum, radiologists should consider the possibility of primary hepatic neuroendocrine carcinoma, and the diagnosis still requires biopsy to obtain histopathologic evidence.