【摘要】 目的探讨肝脏上皮样血管平滑肌脂肪瘤(Epi-HAML)的影像学表现,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Epi-HAML的影像学及临床资料。其中4例行CT平扫和三期动态增强扫描,3例行MRI平扫和多时相动态增强扫描,1例行CT和MRI检查。结果 8例Epi-HAML中女7例,男1例。术前均误诊,其中4例术前误诊为肝癌,1例误诊为海绵状血管瘤,1例误诊为局灶性结节增生(FNH),2例误诊为腺瘤。5例位于肝右叶,3例位于肝左叶。8例Epi-HAML均为单发,边界清楚。CT平扫呈稍低密度,2例密度均匀;2例病灶中间及边缘分别见局限性斑点及弧线样低密度影,CT值约-13~-17HU。MRI平扫T1WI呈稍低信号,T2WI呈稍高信号。同反相位未见明显信号改变。增强扫描动脉期肿瘤呈不均匀或均匀明显强化。增强模式为"快进慢出"型5例、"快进快出"型3例。动脉期4例病灶可见"早期引流静脉",2例在动脉期可见中心强化血管征。结论 Epi-HAML的影像学表现具有一定特征性,可与其他肝脏肿瘤相鉴别,但其诊断与鉴别仍主要依靠组织病理学及免疫组织化学检查。更多还原

【Abstract】 Objective To evaluate the imaging features of epithelioid angiomyolipoma of the liver( Epi-HAML) and improve the knowledge and diagnostic accuracy of this disease. Methods The CT and MRI imagings,and clinical data of8 patients with Epi-HAML,which had been confirmed by surgery and pathology,were retrospectively reviewed. Among these patients,4 cases underwent both non-enhanced and contrast-enhanced CT,3 cases underwent only MRI,and one case underwent both CT and MRI. Results 8 cases of Epi-HAML( 7 female and 1 male) were all misdiagnosed. Among which,4 cases were misdiagnosed as hepatic cell cancer,1 case was misdiagnosed as cavernous hemangioma,1 case as focal nodular hyperplasia( FNH) and 2 cases as adenoma. 5 cases of Epi-HAML were located in the right lobe of liver,3 cases were located in the left lobe of liver. All cases were solitary lesions with well-defined boundaries. Non-enhanced CT images showed lesions to be slightly low density,2 of which were uniform density. There was limited spot or arc like low density in the middle or on the edge of lesions in another 2 cases,with CT values of- 13- 17 HU. All cases were slightly low signal intensity on T1 WI,and slightly high signal intensity on T2 WI. There was no obvious abnormal signal intensity on chemical-shift imaging. Contrast-enhanced MRI showed obvious enhancement in the arterial phase. 5 cases showed the enhancement with "fast in and slow out"fashion and another 3 cases showed showed a"fast in and fast out"fashion. There was early venous drainage,which appeared in 4 cases in th arterial phase. 2 cases showed"enhanced central blood vessel"sign in arterial phase. Conclusion Epi-HAML has certain characteristic imaging findings,which are distinguishable from other liver tumors. The diagnosis and differentiatial diagnoses of Epi-HAML still mainly rely on histopathology and immunohistochemistry examination.更多还原