肝上皮样血管内皮瘤影像学对比分析

Comparative Analysis of Imaging of Hepatic Epithelioid Hemangioendothelioma

目的:总结肝脏上皮样血管内皮瘤(hepatic epithelioid haemangioendothelioma,HEHE)的影像学特点。方法:回顾性分析9例经病理证实的HEHE影像特征。7例同时行超声、CT、MR检查,2例仅行CT检查。结果:9例患者的肝脏病灶均为多中心性,其中2例合并多部位发生;结节型5例,融合型4例;HEHE好发于肝包膜下,可出现包膜皱缩;超声下病灶呈等或低回声,病灶内稀疏血流信号或无血流信号;CT平扫为不均匀低密度;MR平扫为T1不均匀低信号,T2不均匀高信号。结节型病灶在CT平扫及增强可出现特征性“靶征”;强化方式呈云絮状渐进性强化或持续环形强化或环形强化并渐进性向心性强化,增强扫描呈“慢进慢出”并廓清,门静脉期或延迟期可见门静脉或肝静脉出现于肿瘤的边缘,形成典型的“棒棒糖征”。结论:HEHE在影像学上的“棒棒糖征”、环形、云絮且向心性强化,结节型病灶的“靶征”及肝包膜皱缩,均可为该病的诊断与鉴别提供较大的帮助。

Objective:To summarize the image features of hepatic epithelioid hemangioendothelioma(HEHE)in vitro.Method:A retrospective analysis was conducted to the HEHE imaging features of 9 patients confirmed by pathology.Among them,7 patients were examined by Ultrasound,CT and MR inspection,and 2 patients were examined by CT only.Result:The liver lesions of 9 patients were all multicenter,including 2 patients with multiple sites.And 5 patients were with nodular type and 4 patients were with fusion type.HEHE tended to be find under the liver capsule,which may cause capsular shrinkage.The lesions were isochoic or hypoechoic under ultrasound,and often without blood flow signal or low blood flow signal.CT plain scan was uneven low density.MR plain scan showed uneven low T1 and uneven high T2 signals.CT plain scan and enhanced scan of nodular lesions can present characteristic“target sign”.The strengthening method was cloud flocculent gradual strengthening or continuous ring strengthening or ring strengthening,and progressive centripetal strengthening.The enhanced scan was“slow in and slow out”and cleared.The portal vein or hepatic vein could be seen at the edge of the tumor during the portal or delayed stage,forming the typical“lollipop sign”.Conclusion:All the“lollipop sign”,annular shape,clouding and centripetal enhancement in imaging,“target sign”of nodal lesions and hepatic envelope shrinkage can help greatly in the diagnosis and differentiation of HEHE.