肝上皮样血管平滑肌脂肪瘤与肝癌的MRI对比分析

Comparative analysis of MRI between hepatic epithelioid angiomyolipoma and liver cancer

目的探讨肝上皮样血管平滑肌脂肪瘤(Hepatic epithelioid angiomyolipoma,HEMAL)和无肝硬化背景的肝细胞肝癌(Hepatocellular carcinoma,HCC)的MRI征象特点。方法选取32例HEAML(HEAML组)和51例无肝硬化背景的HCC(HCC组)患者的临床及MRI影像资料。图像分析包括病灶的位置、大小、形状、有无出血及脂肪,延迟期信号、供血动脉、早期引流静脉、中心血管征、包膜及周围血管关系,对比MRI特征有无差异。结果两组病灶的位置:HEAML组左叶(15/32),右叶(16/32),尾状叶(1/32),HCC组左叶(13/51),右叶(36/51),尾状叶(2/51)。最大径为(39.28±22.68)mm vs(39.22±25.97)mm。病灶有脂肪(13/32 vs 5/51)、出血(2/32 vs 15/51),ADC值与肝脏比值(1.07±0.38)vs(0.93±0.21),差异有统计学意义(P<0.05)。动脉期明显强化(31/32 vs 42/51)、延迟期低信号(10/32 vs 45/51),强化方式:快进快出(10/32 vs 44/51),有供血动脉(1/32 vs 13/51),早期引流静脉(20/32 vs 2/51),中心血管征(14/32 vs 1/51),有包膜(7/32 vs 36/51),差异均有统计学意义(P<0.05)。而与周围血管关系:受压(11/32 vs 8/51)、肝胆期低信号(4/5 vs 19/23)差异无统计学意义(P>0.05)。结论HEAML与HCC的MRI表现有一定差异。特别是病灶在有无脂肪及出血、早期引流静脉、中心血管征和强化信号及方式有助于鉴别诊断。

Objective To explore the MRI features of hepatic epithelioid angiomyolipoma(HEMAL)and hepatocellular carcinoma(HCC)without cirrhosis background.Methods Clinical and MRI imaging data of 32 HEAML patients and 51 HCC patients without cirrhosis background were selected.Image analysis included the location,size,shape,presence of bleeding and fat,delayed phase signals,supply arteries,early drainage veins,central vascular signs,capsule and surrounding vascular rela‐tionships of the lesion,and comparison of MRI features for differences.The locations of the two types of lesions in HEAML and HCC were left lobe(15/32),right lobe(16/32),caudate lobe(1/32),left lobe(13/51),right lobe(36/51),and caudate lobe(2/51),with a maximum diameter of(39.28±22.68)mm vs(39.22±25.97)mm.The lesion had fat(13/32 vs 5/51),bleeding(2/32 vs 15/51),and ADC value to liver ratio(1.07±0.38)vs(0.93±0.21),with statistically significant differences(P<0.05).Significant enhancement in arterial phase(31/32 vs 42/51),low signal in delayed phase(10/32 vs 45/51),fast in and fast out enhancement mode(10/32 vs 44/51),presence of blood supply arteries(1/32 vs 13/51),early drainage veins(20/32 vs 2/51),central vascular sign(14/32 vs 1/51),and capsule(7/32 vs 36/51)were all statistically significant(P<0.05).However,there was no statistically significant difference in the relationship with surrounding blood vessels in terms of compression(11/32 vs 8/51),and low signal in the hepatobiliary phase(4/5 vs 19/23)(P>0.05).Conclusion There is a certain difference in MRI manifestations between HEAML and HCC.Especially,the presence or absence of fat and bleeding,early drainage of veins,cen‐tral vascular signs,and enhanced signals and manners are helpful for differential diagnosis of the lesion.