肝上皮样血管内皮瘤的MRI表现特征分析

MRI features of hepatic epithelioid hemangioendothelioma

目的分析肝上皮样血管内皮瘤(HEHE)的MRI表现特征。方法回顾分析2000年4月至2019年4月浙江省温州市人民医院和温州医科大学附属第一医院26例HEHE患者资料,其中男性12例,女性14例,年龄23~65岁,平均44.4岁。观察病灶数量、大小、形态、分型、强化方式等,分析病灶MRI影像特征。结果26例患者共382个病灶,病灶直径0.5~12.0 cm,平均2.2 cm。单发结节型4例,病灶T1加权成像(T1WI)低信号,T2加权成像(T2WI)稍高信号,弥散加权成像(DWI)高信号,表观扩散系数(ADC)图中心高信号、外周环形低信号;增强后病灶环形向心或环形持续强化。多发结节型14例147个病灶,病灶T1WI低信号,T2WI高信号,DWI中心低信号、外周环形高信号,ADC图中心高信号、外周环形低信号;增强后病灶环形向心及环形持续强化;6例有24个病灶"双环征",7例有21个病灶包膜"皱缩征",7例16个病灶"棒棒糖征",5例18个病灶"瘤内血管征"。融合型8例231个病灶,病灶T1WI低信号,T2WI高信号,DWI高信号,ADC图中心高信号、外周低信号;增强后病灶云絮状或环形向心强化;8例有87个病灶"靶征"、55个病灶"棒棒糖征"和42个病灶包膜"皱缩征",5例36个病灶"瘤内血管征"。结论HEHE的MRI表现有一定特征,病灶近包膜分布,并相互融合,T2WI见"靶征"、包膜"皱缩征",门静脉期"双环征"、"棒棒糖征"及"瘤内血管征"有助于诊断。

Objective To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T1 weighted imaging (T1WI), high signal on T2 weighted imaging (T2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T1WI, high signal on T2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T1WI, high signal on T2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" .Conclusion MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other;a " target sign" on T2WI;a capsule " shriveled sign ";and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.