肝血管平滑肌脂肪瘤MRI影像学表现及其与病理特征的相关性分析

MRI Imaging Findings of Hepatic Angiomyolipoma and the Correlation with Pathology

目的探讨肝血管平滑肌脂肪瘤(HAML)MRI影像学表现及其与病理特征的相关性。方法回顾性分析70例HAML患者的临床资料,均行MRI检查,分析MRI上各序列影像特征与病理特征的相对应关系。结果 70例HAML患者中,女性(51例,72.86%)多于男性(19例,27.14%),年龄22-78(43.79±6.45)岁;54例(77.14%)无明显症状,多为单发,肿瘤直径2-18(6.47±1.84)cm;癌胚抗原阳性5例,血常规、甲胎蛋白、CA19-9无异常,肝胆红素偏高7例;HBsAg阳性8例,抗HBs抗体阳性32例。病理检查发现HAML癌灶77个,混合型31个(40.26%),脂肪瘤型20个(25.97%),肌瘤型15个(19.48%),血管瘤型11个(14.29%)。MRI显示,54个为T1WI、T2WI高低混杂信号,17个为T1WI较均匀低信号、T2WI高信号,6个为T1WI高信号、T2WI低信号。45个病灶出现斑片状或斑点状脂肪信号,32个病灶无脂肪信号特点。动脉期不均匀强化73个,门脉期和延迟期有49个病灶呈持续强化的高信号,另28个病灶呈"快进快出"的不均匀减低。57个病灶显示引流静脉,20个病灶内部可见大畸形血管影。结论 MRI检查可清晰显示HAML病灶内脂肪信号、血管影等特征,有助于疾病的诊断。

Objective To explore the MRI imaging findings of hepatic angiomyolipoma(HAML)and the correlation with pathology.Methods The clinical data of 70 patients with HAML were analyzed retrospectively,and all of them received MRI examination,and the relationship between MRI imaging findings and pathology were analyzed.ResultsAmong the 70 patients with HAML,there were more women(51 cases,72.86%)than men(19 cases,27.14%),and they were 22-78(43.79±6.45)years old.And 54 cases(77.14%)were asymptomaticand the tumor diameter range from 2-18 cm with average of(6.47±1.84)cm.There were 5 cases of positive carcinoembryonic antigen,and there was no abnormality in blood routine,alpha fetoprotein and CA19-9,and there were 7 cases of high hepatobilirubin.There were 8 cases of positive HBsAg,and 32 cases of positive anti-HBs antibody.Pathological examination revealed there were 77 HAML lesions,31 mixed types(40.26%),20 lipoma types(25.97%),15 myoma types(19.48%),and 11 angiomatous types(14.29%).MRI showed that 54 were high-low mixed signal on T1WI and T2 WI,and 17 were relatively low signal on T1 WI and high signal on T2 WI,and 6 were high signal on T1 WI and low signal on T2WI.45 lesions showed patchy or spotty fat signals,and 32 lesions showed no fat signal.There were 73 heterogeneous enhancement in arterial phase,and 49 lesions in portal phase and delayed phase showed continuous enhancement of high signal,and another 28 lesions showed a heterogeneous reduction of'fast wash in and fast wash out'.57 lesions showed drainage veins,and 20 lesions inside showed large malformations of vascular shadow.Conclusion MRI examination can clearly show the fat and vascular signal of the HAML,which help the diagnosis of the disease.