超声造影在肝上皮样血管内皮瘤中的诊断价值

Diagnostic value of contrast-enhanced ultrasound in hepatic epithelioid hemangioendothelioma

目的探讨肝上皮样血管内皮瘤(HEHE)的超声造影表现特点,以期提高其术前诊断率。方法收集2004年1月至2021年8月经病理证实为肝上皮样血管内皮瘤32例患者的超声造影图像进行分析,观察病灶的增强方式,增强强度以及不同增强时相的表现特点。结果32例患者中1例单发,29例为多发,2例为弥漫型,对32例患者中共42个病灶进行超声造影,在动脉期增强方式上,18个病灶表现为整体增强,6个病灶表现为不均匀树枝样增强,16个病灶周边环状增强,2个病灶表现为仅周边轻微毛刺样增强。其中3例患者的多发病灶中既有整体增强方式,又有环状增强方式。在增强时相上,20个病灶表现为"快进",20个病灶表现为"同进",2个病灶表现为"慢进",全部病灶在动脉晚期或门静脉早期快速减退表现为低回声。增强强度达峰时,11个病灶增强强度低于周围正常肝实质,11个病灶增强程度与周围正常肝实质相等,20个病灶高于周围正常肝实质。全部16个环状增强病灶表现为高增强;在整体增强病灶中,4个表现为高增强,5个表现为低增强,9个表现为等增强。在树枝样增强病灶中,2个表现为等增强,4个表现为低增强。超声造影后全部病灶边界均比二维超声显示更清晰。结论超声造影在诊断肝上皮样血管内皮瘤中具有一定的价值。

Objective To investigate the features of contrast-enhanced ultrasound(CEUS)in hepatic epithelioid hemangioendothelioma(HEHE)in order to improve the preoperative diagnosis rate.Methods CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected.Lesions were analyzed to observe the features of enhancement mode,enhancement intensity,and distinct enhancement phases.Results Among the 32 cases,one had a solitary lesion,29 had multiple lesions,and two had diffuse-type lesions.Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases.In terms of arterial phase enhancement,18 lesions had overall enhancement,six lesions had uneven dendritic enhancement,16 lesions had rim-like enhancement,and two lesions had just slight peripheral spot enhancement around the lesions.Among the three cases,there were multiple lesions that had overall enhancement and ring enhancement.In terms of the enhancement phase,20 lesions showed"fast progression",20 lesions showed"same progression",and two lesions showed"slow progression".During the late arterial or early portal venous phases with rapid washout,all lesions manifested as hypoechoic.With peaked enhanced intensity,11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma;11 lesions had the same enhancement degree as the surrounding normal liver parenchyma;and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma.All 16 ring-enhancing lesions had marked hyperenhancement.In the typical enhancing lesions,four showed hyperenhancement,five showed low enhancement,and nine showed isoenhancement.In the dendrite-enhancing lesions,there were two isoenhancing and four hypoenhancing.Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound.Conclusion Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.