肝脏血管平滑肌脂肪瘤的钆塞酸二钠增强MRI表现及文献复习

摘要

Objective To analyze the Gd-EOB-DTPA enhanced MRI features of mixed type of hepatic angiomy-olipoma. Methods A 60 years old female patient with a hepatic nodular lesion which was accidentally found underwent plain MRI and Gd-EOB-DTPA enhanced MRI examination.Following surgical resection,a pathological diagnosis of hepatic angiomyolipoma was made. The clinical data, MRI appearances, and pathological findings of the lesion were analyzed retro-spectively, and the relevant literatures were reviewed. Result MRI showed a lesion at the top of the liver segmentⅧwith a size of 2.0 cm×1.7 cm and a well-defined margin. The signal intensity of the lesion was slightly hypointense on in-phase T1WI and heterogeneously reduced on opposed-phase T1WI at the same level.The lesion was heterogeneous hyperintense on fat-suppressed T2WI and slightly hyperintense on DWI. On Gd-EOB-DTPA enhanced T1WI at early arterial phase, the le-sion exhibited prominent hyperintense in an inhomogeneous manner, nearby a large blood vessel connecting the lesion with the branch of portal vein was identified. At late arterial phase and portal venous phase, the signal intensity of the lesion was slightly lower than that of the surrounding liver parenchyma. At equilibrium phase and delayed phase, the lesion exhibited heterogeneous hypointense. At 20 min and 50 min of the hepatobiliary phase, the lesion showed prominent hypointense. Conclusion The Gd-EOB-DTPA enhanced MRI appearances of mixed-type of hepatic angiomyolipoma and hypervascu-lar hepatocellular carcinoma overlap largely. Differential diagnosis should be made based on comprehensive analysis onclin-ical information, abdominal ultrasonagraphy, and plain MRI findings.%目的 分析混合型肝脏血管平滑肌脂肪瘤的钆塞酸二钠(Gd-EOB-DTPA)增强MRI表现及诊断要点.方法 1例因偶然发现肝脏结节性占位病变的60岁老年女性病人进行了肝脏MRI平扫和Gd-EOB-DTPA增强MRI检查,经外科手术切除肝脏病变后,病理诊断为血管平滑肌脂肪瘤.回顾性分析病人的临床资料、MRI表现及病理所见,复习相关文献.结果 MRI检查见肝Ⅷ段一类圆形异常信号影,大小2.0 cm×1.7 cm,边界清楚.病灶在化学位移双回波T1WI同相位影像呈稍低信号,同层面反相位影像病灶信号强度不均匀减低,快速反转快速自旋回波(FRFSE)脂肪抑制T2WI呈不均匀高信号,DWI呈稍高信号.静脉注射Gd-EOB-DTPA后动态增强扫描时,病灶在动脉早期因明显不均匀强化呈显著高信号,其内下方见一条迂曲增粗的异常血管连接门静脉分支;在动脉晚期和门静脉期,病灶信号强度略低于周围的肝实质;在平衡期及延迟期,病灶呈不均匀低信号;在20 min及50 min肝胆期,病灶呈明显的低信号.结论 混合型肝脏血管平滑肌脂肪瘤的Gd-EOB-DTPA增强MRI表现与富血供肝细胞癌有一定重叠,鉴别诊断需结合临床资料、超声检查及平扫MRI信号特点综合分析.