肝脏上皮样血管平滑肌脂肪瘤的CT和MRI表现特征

摘要

Objective To explore the CT and MRI characteristics of hepatic epithelioid angiomyolipomas (H EA)in order to improve recognition and diagnostic accuracy of the disease.Methods The CT and MR imaging data of 8 patients with HEA proved by pathology were analyzed retrospectively.Among these patients,4 cases underwent plain and enhanced CT scans,2 plain and enhanced MRI scans and 2 both CT and MRI scans.Results In the 8 cases,7 were female.All lesions were solitary and well-defined,with maximum diameters ranging from 42 mm to 68 mm.6 leions on plain CT displayed slightly low density,of which 1 showed fat density and other 2 showed patchy cystic areas.MRI showed 4 masses with slight hypointensity on T1 WI,slight hyperintensity or hyperintensity on T2 WI,of which one demonstrated decreased signal on out-phase of T1 WI.On enhanced MR images,7 masses were significantly inhomogeneous in arterial phase,5 showed "fast wash-in and slow wash-out",2 "fast wash-in and wash-out"and 1 "slow wash-in and wash-out".6 showed"central vascular sign"in arterial phase and 2 displayed incomplete pseudocapsule in the portal venous and delayed phases.Conclusion Inhomogeneous enhancement in arterial phase,central vascular sign,fast wash-in and slow wash-out enhancement and no pseudocapsule are imaging features of HEA,which can help to improve the diagnostic accuracy.Its diagnosis still depends on histopathology and immunohistochemistry.%目的 探讨肝脏上皮样血管平滑肌脂肪瘤(HEA)的CT、MRI表现特征,旨在提高对该病的认识和诊断准确率.方法 回顾性分析经手术病理证实的8例肝脏HEA患者的CT、MRI资料,其中4例接受CT平扫+增强扫描,2例接受MRI平扫+增强扫描,2例接受CT、MRI平扫+增强扫描.结果 8例患者中,7例为女性,均为单发病灶,病灶最大径42～68 mm,边界均清楚.6例CT表现稍低密度,其中1例可见脂肪密度,2例片状低密度囊变区.4例病灶MRI表现为T1 WI呈稍低信号,1例在反相位可见信号减低,T2 WI呈稍高、高信号.8例增强扫描,7例动脉期明显不均匀强化,5例呈"快进慢出",2例呈"快进快出",1例呈"延迟强化".6例增强扫描见"中心血管征",2例见不完整假包膜.结论 HEA影像表现具有一定特征,动脉期明显不均匀强化、中心血管征、"快进慢出"强化方式及无假包膜表现有助于提示诊断,其确诊仍有赖于组织病理学及免疫组化检查.