16例原发性肝肉瘤样癌CT与MRI表现特点分析

An analysis of CT and MRI features of 16 patients with primary hepatic sarcomatoid carcinoma

目的分析肝肉瘤样癌的CT和MRI表现特点。方法回顾分析2009年1月至2019年6月浙江省温州市人民医院和温州医科大学附属第二医院16例原发性肝肉瘤样癌患者资料,其中男性8例,女性8例,年龄35~71岁,平均56.8岁。观察肿瘤位置、大小、形态、边缘、密度或信号及增强强化程度等。结果16例患者肿瘤均为单发,位于肝右叶11例,肝左叶5例。肿瘤最大直径3.0~16.0 cm,平均8.5 cm。16例患者CT平扫肿瘤呈类圆形及椭圆形6例,分叶状或不规则10例;肿瘤界限清楚10例,不清楚6例。肿瘤均为低密度影,其中15例密度不均匀,中心可见大小不等坏死液化,1例密度均匀。4例患者MRI平扫肿瘤边界均较清晰,肿瘤中心见坏死液化,肿瘤实性部分T1加权成像稍低信号,T2加权成像稍高信号,中心坏死液化灶T2加权成像更高信号。12例增强CT和4例增强MRI中,动脉期肿瘤边缘强化,门静脉期及延迟期持续强化7例;动脉期肿瘤内条状分隔样及边缘强化,门静脉期及延迟期持续强化7例;动脉期肿瘤不均匀强化,门静脉期及延迟期持续强化1例;动脉期肿瘤不均匀强化,门静脉期持续强化,延迟期肿瘤内强化退出,呈边缘和间隔持续强化1例。结论肝肉瘤样癌具有肉瘤和癌的双重影像特征。肝肉瘤样癌的影像表现取决于肉瘤样成分占比,肿瘤较大伴瘤内坏死囊变,增强CT呈边缘或内部分隔样中重度持续强化。

Objective To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma.Methods A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019.There were 8 males and 8 females,with age ranging from 35 to 71 years(average 56.8 years).The site,size,shape,margin,density of signal,adjacent tissue changes and degree enhancement of tumor were analyzed.Results Tumors in the liver in the 16 patients were all solitary,with 11 in the right and 5 in the left liver.The maximum diameter of tumor ranged from 3 to 16cm(average 8.5cm).On plain CT scanning(n=16),the tumors were round or oval in 6,and lobulated or irregular in 10 patients.The margins of the tumors were clear in 10 and unclear in 6 patients.All tumors showed low density,with 15 tumors showing uneven density,with necrosis and liquefaction of different sizes in the center,while 1 tumor showing uniform density.On plain MRI scanning(n=4),four tumors had clear margins,with necrosis and liquefaction seen in the center of the tumors.The solid part showed a slightly lower signal on T1 weighted imaging and a slightly higher signal on T2 weighted imaging.The liquefaction focus of central necrosis showed higher signal intensity on T2 weighted imaging.Enhanced scanning(n=12 on CT enhancement and n=4 on MRI enhancement),the margins of the tumors were enhanced in the arterial phase.The enhancement was continued into the portal venous and delayed phases in 7 patients.Strip septate and margin enhancement in the tumor were enhanced in the arterial phase.The enhancement was continued into the portal venous and delayed phases in 7 patients.Inhomogeneous strengthening in the tumor was enhanced in the arterial phase.The enhancement was continued into the portal venous and delayed phases in 1 patient.Inhomogeneous strengthening in the tumor was enhanced in the arterial phase.The enhancement was continued into the portal venous phase.In the delayed phase,enhancement in the tumor decreased,but there was continuous enhancement of the margin and interval of the tumor in 1 patient.Conclusions Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer.The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components.Large intrahepatic tumors showed necrotic cystic degeneration,moderate or significant persistent enhancement in striped septum and margin of tumor.