超声造影与增强磁共振在诊断肝上皮样血管内皮瘤中的联合应用

Combined application of contrast enhanced ultrasound and dynamic contrast enhanced magnetic resonance imaging in hepatic epithelioid hemangioendothelioma

目的分析肝上皮样血管内皮瘤（hepatic epithelioid hemangioendothelioma，HEHE）的超声造影和增强磁共振成像（contrast—enhanced magnetic resonance imaging，CEMRI）特点，旨在联合运用两种影像学技术提高HEHE的术前诊断率。方法11例患者均经手术或穿刺后病理证实为HEHE，且11例患者术前均行超声造影和CEMRI检查，分别对其超声造影、CEMRI表现进行分析，研究两种影像的增强特点。结果11例HEHE患者共14个病灶的二维超声表现均为低回声团块，彩色多普勒血流显像示血流信号主要位于周边，阻力指数平均为0．62±0．05。动脉期超声造影的增强方式：6个病灶表现为整体增强，6个病灶表现为周边环状增强，2个病灶表现为树枝状增强。在动脉期病灶增强达峰值时，7个病灶表现为等增强，1个病灶表现为低增强，6个病灶表现为高增强。在增强时相上，8个病灶表现为“同进快出”，1个病灶表现为“慢进快出”，5个病灶表现为“快进快出”。CEMRI检查中：全部病灶T1WI为低信号，T2WI为高信号，DWI为高信号。5个病灶明显环状持续强化，1个病灶明显环状渐进性强化；4个病灶早期周边强化为主，晚期病灶内部基本充填，且该4个患者病灶全程呈渐进性强化；4个病灶早期周边强化为主，晚期病灶内部未完全充填，其中1个全程呈轻度持续性强化，3个呈渐进性强化。6例患者T2像出现“晕征”，7例患者出现“棒棒糖征”，8例患者出现“血管征”，8例患者出现“包膜凹陷征”。结论HEHE的超声造影及CEMRI表现具有各自的特征，两种影像学检查方法的联合应用对于提高HEHE的术前诊断率具有重要的意义。

Objective To analyze the imaging characteristics of contrast enhanced uhrasound（CEUS） and dynamic contrast enhanced magnetic resonance imaging （CEMRI） for diagnosis of hepatic epithelioid hemangioendothelioma, and to increase the accuracy of diagnostic imaging. Methods The imaging characteristics of CEUS and dynamic CEMRI in 11 patients with hepatic epithelioid hemangioendothelioma confirmed by surgical pathology or fine needle aspiration biopsy were retrospectively analyzed. Results On conventional ultrasound, 14 lesions in 11 patients showed hypoechoic. The peripheral blood flow was detected in most patients by color Doppler flow imaging and the average resistant index was 0.62 ± 0.05. During the arterial phase, 6 lesions showed diffuse enhancement, 6 lesions showed annular enhancement and 2 lesions showed branch enhancement. As to time of peak enhancement, compared to the normal hepatic parenchyma, hypoenhancement, isoenhancement and hyperenhancement were observed in 1 lesion, 7 lesions and 6 lesions respectively. Synchronous enhancement was observed in 8 lesions on contrast-enhanced ultrasound, rapid enhancement was observed in 5 lesions and slow enhancement was observed in 1 lesion and all lesions decreased quickly in portal phase and delayed phase. On CEMRI, all lesions showed low signal on TIWI, high signal on T2WI and DWI. There were 5 lesions showed obvious annular constant enhancement and 1 lesion showed obvious annular progressive enhancement. Progressive peripheral enhancement and fully filling in delayed phase were found in 4 lesions. While progressive peripheral enhancement and incompletely filling in delayed phase were found in 3 lesions. One lesion displayed constant enhancement and incompletely filling in delayed phase. ＂Halo sign＂,＂lollipopsign＂, ＂capsular retraction sign＂ and ＂vessel sign＂ were appeared in 6,7,8 and 8 patients respectively. Conclusions Both contrast-enhanced ultrasound and CEMRI have characteristic manifestations for the diagnosis of hepatic epithelioid hemangioendothelioma and cominbing them would be great significance to improve the preoperative diagnostic accuracy.