先天性肝母细胞瘤CT表现及误诊分析

CT Findings and Misdiagnosis of Congenital Hepatoblastoma

目的探讨先天性肝母细胞瘤(CHB)的CT特征,分析误诊原因,提高对CHB的认识和诊断能力。资料与方法回顾性分析经手术病理证实的7例新生儿CHB的临床及CT表现,并与易误诊病变进行鉴别诊断。结果7例新生儿CHB中,1例甲胎蛋白阳性。7例CHB均为肝内单发肿块;最大径2.9~10.2 cm(中位值4.7 cm);类球形4例、分叶状3例,且3例肿瘤局部突向肝轮廓外;边界清晰6例,边界模糊1例;2例密度较均匀,5例密度欠均匀,其中4例可见不同程度的坏死囊变,1例肿瘤可见钙化,5例肿瘤内存在出血征象。动态增强扫描动脉期7例肿瘤中心及边缘出现多发结节状、条片状明显强化;门静脉期及延迟期强化呈进行性向心性填充,呈多发"岛屿样"强化,且以边缘强化明显,坏死囊变区无强化;1例肿瘤侵犯门静脉及肝门区胆管,并肝内胆管扩张。术前1例外生型CHB误诊为神经母细胞瘤,6例误诊为血管瘤。结论基于CT检查,术前CHB的误诊常见;但其进行性向心性填充的CT强化方式具有一定的鉴别诊断价值。

Purpose To investigate the CT features of congenital hepatoblastoma(CHB)and analyze the causes of misdiagnosis,and to improve the understanding and diagnostic ability of CHB.Materials and Methods The clinical and CT imaging of seven newborns with CHB confirmed by operation and pathology were retrospectively analyzed,making differential diagnosis with the easily misdiagnosed lesions in CHB.Results For seven newborns with CHB,one newborn was exclusively positive for serum alpha-fetoprotein,and the remaining six newborns were negative.Seven newborns with CHB all showed solitary intrahepatic mass,with maximum diameters 2.9-10.2 cm(median maximum diameter 4.7 cm).In this study,spherical shape,irregular lobulated sign,tumors that projected out of the liver contour presented as a solitary lesion in four,three and three cases,respectively.There were six lesions with well defined borders and one lesion with blurred border;two lesions with homogeneous density and five lesions with heterogeneous density.Among the lesions with heterogeneous density,there were four necrotic predominant lesions,one lesion with calcification,and five lesions with hemorrhages.In arterial phase,multiple nodular and strip obvious enhancements were showed in the center and edge of the lesion;in portal venous phase and delayed phase,progressive and centripetal filling were presented in seven cases,with multiple island-like enhancement and obvious marginal enhancement,but without enhancement in necrotic cystic area.The bile duct of portal vein and hilar area were involved by the lesion,with dilation of the intra-hepatic bile duct.One newborn with CHB was misdiagnosed preoperatively as neuroblastoma,and the remaining six newborns were all misdiagnosed as hemangioma.Conclusion Misdiagnosis of CHB before operation was common based on CT,but inhomogeneous enhancement sign of the progressive centripetal filling showed certain value in the differential diagnosis in patients with CHB.