肝脏上皮样血管平滑肌脂肪瘤临床与磁共振影像分析

A clinical and imaging analysis of hepatic epithelioid angiomyolipoma

目的 分析肝脏上皮样血管平滑肌脂肪瘤(HEAML)的临床和磁共振影像特征。方法 回顾性分析2013年10月至2023年10月在解放军总医院第五医学中心住院治疗的19例HEAML患者的临床资料。结果 19例HEAML患者中,体检发现肝占位13例,腹痛腹胀4例,恶心纳差2例,3例患者为乙型肝炎,15例患者肿瘤标志物为阴性。磁共振图像上18例患者为单发病灶,病灶平均直径约5.4 cm,术前诊断14例为肝癌,16例患者肝脏病灶动脉期明显强化,6例患者延迟期可见假包膜强化。结论 HEAML好发于中年女性,多为体检发现肝占位,大部分患者实验室指标无明显异常,仅个别患者肿瘤标志物轻度异常,影像特征多为单发富血供病灶,强化模式以早期明显强化为主,部分可有假包膜强化,确诊还需要结合病理结果。

Objective To analyze the clinical and MR imaging features of 19 patients with hepatic epithelioid angiomyolipoma(HEAML).Methods The clinical data including sex,age,clinical signs,laboratory tests and imaging findings of 19 patients with pathological data of biopsy or surgery who were admitted to the fifth medical centre of PLA general hospital from October 2013 to October 2023 were summarized and analyzed.Results The clinical manifestations of these 19 HEAML patients were mainly focal liver lesions found by physical examination,symptoms of abdominal pain or distension,nausea and poor appetite.Among the 19 patients,3 patients were positive for hepatitis B viral markers and 15 patients were negative for tumor markers.On the MR images,18 patients had single lesions with an average diameter of about 5.4cm,14 patients were diagnosed with liver cancer,16 patients had obvious enhancement in liver lesions,and 6 patients had false capsule enhancement in the delayed phase.Conclusion HEAML was predisposed to middle-aged women.It was mostly discovered by physical examination.Most of the patients have normal laboratory test results.Only individual patient has mild abnormal tumor markers.The imaging features were usually single rich-blood liver lesions.The strengthening mode was early obvious strengthening.False capsule enhancement in the delayed period can be found in part of the patients.The imaging features has certain guiding significance for the diagnosis of HEAML.The diagnosis of HEAML may be confirmed by a combination of clinical data with typical pathological results.