肝脏血管肉瘤的影像学表现及临床病理分析

Hepatic Angiosarcoma:Analysis of Imaging Features and Clinicopathological Characteristics

目的分析肝脏血管肉瘤(HA)的CT、MRI表现以及临床和病理特点,以提高诊断准确率,并寻找最优影像检查方案。资料与方法回顾性分析经病理证实的13例HA的临床、病理资料和影像学特征,包括病灶分布、数目、大小、边界、密度/信号、表观扩散系数(ADC)、标准摄取值(SUV)、强化方式、有无转移等。结果11例HA有转移灶,常见转移部位包括肺、骨、软组织、脾脏。8例为肝内多发病灶,数目均多于10个并弥漫分布。CT平扫90%(54/60)的病灶呈低密度。MRI平扫病灶边界显示清晰,呈长T1长T2信号。11例肿块样病灶信号不均,可见短T1、短T2、更长T2信号,但仅40%(8/20)的结节样病灶信号不均。典型HA增强的特征为动脉期周边和(或)中心欠规则斑片状强化,门静脉及延迟期呈不完全性充填式强化,且强化程度稍减低。结论HA的CT和MRI表现具有一定的特征性,结合临床资料可提高诊断准确率。

Purpose To explore the clinicopathological characteristics and imaging features of CT and MR in hepatic angiosarcoma(HA),improving the diagnostic accuracy and seeking the most available examination scheme.Materials and Methods A total of 13 patients pathologically confirmed HA were selected,the clinical,pathological and imaging characteristics were retrospectively reviewed.The distribution,number,size,boundary,attenuation and signal intensity characteristics,ADC values,SUV,contrast enhancement patterns,and metastasis of HA lesions were included to evaluate the features in the present study.Results A total of 11 patients with metastatic lesions in other organs were found,mostly located in the lung,spine,soft tissue and spleen.And 8 patients with multifocal lesions in liver were detected,with more than ten metastatic lesions.About 90%(54/60)lesions were revealed low density on unenhanced CT images and showed clear lesion boundaries with low signal intensity on T1 WI and high signal intensity on T2 WI via unenhanced MR.A total of 11 mass-like lesions were presented with heterogeneous signal intensity,with focal hyper-intensity on T1 WI,hypo-intensity on T2 WI or very hyper-intensity on T2 WI.But only 40%(8/20)nodular-like lesions were displayed with heterogeneous signal intensity.The typical features of HA enhancement patterns were characterized by irregular patchy enhancement in the peripheral and/or center of lesion in the arterial phase,and incomplete filling enhancement pattern in the venous and delayed phase with slightly reduced enhancement degree.Conclusion CT and MRI findings of HA could be presented with some characteristic patterns,elevating the accuracy of diagnosis combining with clinical data.