肝血管平滑肌脂肪瘤的临床及超声造影特点分析:与肝血管瘤及肝细胞癌对比

Comparison analysis of clinical and contrast-enhanced ultrasound characteristics of hepatic angiomyolipoma compared with hepatic cavernous hemangioma and hepatocellular carcinoma

目的对比分析肝血管平滑肌脂肪瘤(HAML)与肝血管瘤(HCH)及肝细胞癌(HCC)的临床及超声特点。方法回顾性分析经病理证实的40例HAML患者(HAML组),并与同时期随机检索的40例HCH患者(HCH组)及40例HCC患者(HCC组),比较其临床特点、二维超声和超声造影表现。结果 HAML好发于女性(70.00%,28/40),平均发病年龄(39.8±10.6)岁,在患者性别、年龄、肝炎病毒感染方面均与HCC差异有统计学意义(P均<0.001),而与HCH差异无统计学意义(P均>0.05)。HAML二维超声多表现为边界清楚的高回声病灶。HAML组与HCC组间回声(χ~2=8.93,P=0.008)、边界(χ~2=2.03,P=0.013)差异均有统计学差异,病灶数目、大小、形态及血供差异均无统计学意义(P均>0.05);与HCH组间病灶数目、大小、边界、回声、形态及血供差异均无统计学意义(P均>0.05)。62.50%(25/40)的HAML病灶CEUS表现为"快进快退"模式,但与HCC组相比在强化消退为等增强(t=-2.46,P=0.016)及低增强的时间(t=-5.35,P<0.001)方面差异均有统计学意义。HAML组与HCH组间、HAML组与HCC组间门脉期及延迟期增强表现差异均有统计学意义(P均<0.05),而动脉期增强表现差异均无统计学意义(P均>0.05)。结论结合临床特点、二维超声和超声造影表现,有助于诊断HAML,并与HCH、HCC相鉴别。

Objective To compare clinical features and ultrasonic characteristics of hepatic angiomyolipoma(HAML), hepatic cavernous hemangioma(HCH) and hepatocellular carcinoma(HCC). Methods Data of 40 patients with HAML confirmed by pathology who underwent CEUS were retrospectively analyzed. Clinical features, imaging characteristics of conventional ultrasound and CEUS were observed. Mean while, 40 patients with HCH and 40 patients with HCC were enrolled for comparison with HAML. Results HAML mainly occurred in female(70.00%, 28/40), with an average age of(39.8±10.6) years. Distinctions of gender, age and hepatitis virus infection were statistically significant between HAML and HCC(all P<0.001), but no statistically difference was found between HAML and HCH(all P>0.05). HAML mostly presented as high echogenic lesions with clear boundaries and regular morphology on conventional ultrasound. There was no significant difference lesions’ number, size, morphology nor blood supply between HAML and HCC(all P>0.05), but the distinctions of echo(χ~2=8.93, P=0.008) and boundary(χ~2=2.03, P=0.013) were statistically different. No statistical difference of number, size, border, echo, lesion morphology and blood supply was found between HAML and HCH(all P>0.05). On CEUS, 62.50%(25/40) of HAML showed "fast in and fast out" performance, but it subsided into iso-enhancement(t=-2.46, P=0.016) or hypo-enhancement(t=-5.35, P<0.001) later than HCC. There were significant differences of enhancement level in portal and delayed phases between HAML and HCH, as well as between HAML and HCC(all P<0.05), but there was no significant difference in arterial phase(both P>0.05). Conclusion Combination of clinical features, conventional ultrasound and CEUS characteristics are helpful to distinguish HAML from HCH and HCC.