肝脏上皮样血管平滑肌脂肪瘤影像诊断与鉴别诊断

Imaging diagnosis and differential diagnosis of hepatic epithelioid angiomyolipoma

[目的]探讨肝脏上皮样血管平滑肌脂肪瘤(HEAML)的临床、CT及MR影像征象,以提高HEAML诊断准确性。[方法]回顾性分析9例经病理证实的HEAML临床及影像学征象。CT检查5例,MR检查4例。同时,收集30例经病理证实的肝细胞癌(HCC),分析2组患者临床及影像学表现,并行χ~2检验,差异有统计学意义(P<0.05)的特征纳入logistic回归分析,采用受试者工作特征曲线(ROC曲线)分析这些特征对鉴别HEAML与HCC的效能。结果9例HEAML中8例为女性、1例为男性,AFP均为阴性,病灶均为单发,平扫呈稍低密度或稍长T1稍长T2信号(8/9),增强扫描呈"快进快出"(6/9)表现,可见中心血管征(6/9)及静脉早显(5/9);统计结果显示:性别、AFP水平、中心血管征及静脉早显有统计学差异(P<0.05);联合上述4项指标行回归分析,并采用ROC曲线评估其鉴别HEAML与HCC的效能,其AUC为0.969,敏感度和特异度分别是77.8%、100%,具有较高诊断价值。[结论]患者性别、AFP水平、中心血管征及静脉早显等临床、影像征象有助于HEAML与HCC的鉴别诊断。当患者为女性、AFP阴性、具有中心血管征和静脉早显时,提示HEAML可能性较大。

[Objective] To investigate the clinical and imaging features of hepatic epithelioid angiomyolipoma(HEAML)in order to improve the diagnostic accuracy.[Methods]The clinical and imaging features of 9 cases of hepatic epithelioid angiomyolipoma confirmed by pathology were retrospectively analyzed.5 cases were examined by CT and 4 cases by MR.Chi-square test was applied between 9 cases of HEAML and 30 cases of HCC confirmed by pathology.Logistic regression analysis was performed and Receiver operating characteristics(ROC curve)was used to analyze the efficacy of clinical and imaging features in differentiating HEAML from HCC.[Results]9 patients of HEAML were mostly female(8/9),AFP negative(9/9),all single,with slightly lower density or slightly longer T1 slightly longer T2 signal(8/9),"fast forward and fast out"(6/9)performance,intra-tumoral vessels(6/9)and early draining veins(5/9)can be positive;The statistical results showed that gender,AFP level,intra-tumoral vessels and early draining veins were statistically significant(P<0.05).The regression analysis was applied by the combination of the above four indicators,and the ROC curve was used to evaluate the efficacy in differentiating HEAML from HCC.The AUC was 0.969,and the sensitivity and specificity were 77.8% and 100% respectively.[Conclusion]The gender,AFP level,intra-tumoral vessels and early draining veins could facilitate the diagnosis and differential diagnosis of HEAML.When the patient is female,AFP is negative,intra-tumoral vessels and early draining veins are positive,it is more likely to be HEAML.