CAJ | 학술논문

目的探讨肝脏乏脂肪型血管平滑肌脂肪瘤（mHAML）的CT诊断及其鉴别诊断，提高对肝脏不典型占位病变的认识。方法选择5例经手术或穿刺活检证实的 mHAML，均行CT平扫及三期动态增强扫描，分析薄层轴位及最大密度投影（MIP）重组图像CT表现。结果5例均为肝内单发病灶，边界清晰，CT平扫呈均匀稍低密度，未测得脂肪密度。5例CT增强动脉期均呈全瘤欠均匀明显强化，其中3例门脉期及延迟期持续强化高于周围肝实质密度，时间-密度曲线呈“速升缓降”改变；2例门脉期强化密度迅速减低，呈“速升速降”表现。5例病灶动脉期薄层及 MIP重组图像显示中央均可见迂曲粗大点、条状血管影，其中1例病灶周边见动脉期提早显示引流肝静脉影。病理组织学示5例病灶内主要含血管和平滑肌成分，脂肪含量极少（＜10％）。结论 mHAML CT动态增强扫描强化特征与其他富血供病变类似，导致鉴别诊断困难。多排螺旋 CT（MDCT）薄层及 MIP重组技术对鉴别诊断有重要价值。无肝炎病史、肝硬化背景，AFP正常，肝内病灶无包膜，动脉期其中央出现迂曲粗大点、条状血管影伴或不伴病灶周边引流肝静脉早期显影者，提示 mHAML可能。
목적탐토간장핍지방형혈관평활기지방류（mHAML）적CT진단급기감별진단，제고대간장불전형점위병변적인식。방법선택5례경수술혹천자활검증실적 mHAML，균행CT평소급삼기동태증강소묘，분석박층축위급최대밀도투영（MIP）중조도상CT표현。결과5례균위간내단발병조，변계청석，CT평소정균균초저밀도，미측득지방밀도。5례CT증강동맥기균정전류흠균균명현강화，기중3례문맥기급연지기지속강화고우주위간실질밀도，시간-밀도곡선정“속승완강”개변；2례문맥기강화밀도신속감저，정“속승속강”표현。5례병조동맥기박층급 MIP중조도상현시중앙균가견우곡조대점、조상혈관영，기중1례병조주변견동맥기제조현시인류간정맥영。병리조직학시5례병조내주요함혈관화평활기성분，지방함량겁소（＜10％）。결론 mHAML CT동태증강소묘강화특정여기타부혈공병변유사，도치감별진단곤난。다배라선 CT（MDCT）박층급 MIP중조기술대감별진단유중요개치。무간염병사、간경화배경，AFP정상，간내병조무포막，동맥기기중앙출현우곡조대점、조상혈관영반혹불반병조주변인류간정맥조기현영자，제시 mHAML가능。
Objective To discuss CT sign of hepatic angiomyolipoma with minimal fat type(mHAML).To improve diagnosis on the atypical occupying lesions of hepatic.Methods 5 cases of mHAML were confirmed by operation or biopsy.CT scan and three phase dynamic enhanced scan were conducted in these cases.The thin axial and maximum intensity projection(MIP)recombinant CT image were analyzed.Results The 5 cases of hepatic single lesion showed clear boundary and CT scan showed homogeneously low density.The fat density was not available.5 cases of CT enhancement on arterial phase and the aneurysm were under homoge-neous enhancement;for 3 out of these 5 cases,the portal and delayed phase strengthened is still higher than the surrounding liver parenchyma density.Time-density curve changed by“rise fast and drop slow”pattern;for 2 cases,the portal phase density rapidly reduced and showed a“rise fast and drop fast”pattern.The lesion during arterial phase TLC and MIP recombinant image for 5 cases displayed the visible tortuous large point bar,vas-cular shadow and 1 cases among them showed early drainage of the hepatic vein at peripheral.Pathology showed that the lesions mainly consisted of smooth muscle and vascular elements,while fat content is ex-tremely low(<1 0%).Conclusion The features for the CT enhanced scan of hepatic angiomyolipoma with minimal fat resembled that of other hypervascular lesions,thus caused difficulties in differential diagnosis. MDCT layer and MIP recombination technology are of important value in diagnosis and differential diagnosis. If the dynamic enhanced scan for a patient without a history of hepatitis,cirrhosis,normal AFP or capsular of intrahepatic lesions shows that circuity bulky points and strips of vascular shadow appear on the central part of the arterial phase with or without early development of hepatic vein in lesions peripheral drainage,a possible mHAML should be considered.