CAJ | 학술논문

目的：分析8例原发性肝脏血管肉瘤（PHA）的CT表现及相关病理特点，以提高该病的CT诊断。方法所有病例均经手术病理证实，CT上腹部平扫后行动脉期、门脉期、延迟期增强扫描，观察PHA患者的CT表现。手术切除标本，常规HE染色及免疫组织化学染色，常规显微镜观察。结果 CT平扫8例，5例为巨块型，2例混合型，1例多发结节型。病灶呈不均匀低密度影，中央见更低密度坏死区，其中4例巨块型低密度内见散在小片状高密度影，1例混合型巨块边缘见高密度结节。动脉期7例周边结节状、不规则强化，其中1例中央亦见点絮状强化，1例无明显强化。门脉期及延迟期病灶持续强化，1例病灶始终未见强化。本组9个病灶中5个病灶动脉期及门脉期边缘清晰，与周围正常肝组织界限如同＂刀切样＂表现。7个病灶外缘在门脉期发现“假包膜”。结论 PHA的CT表现为大片低密度灶内伴不规则坏死区或是散在出血灶，增强检查呈渐进性充填，中央有坏死区，边缘可见“刀切征”和“假包膜征”，通过上述特征性表现，有助于提高诊断率。
목적：분석8례원발성간장혈관육류（PHA）적CT표현급상관병리특점，이제고해병적CT진단。방법소유병례균경수술병리증실，CT상복부평소후행동맥기、문맥기、연지기증강소묘，관찰PHA환자적CT표현。수술절제표본，상규HE염색급면역조직화학염색，상규현미경관찰。결과 CT평소8례，5례위거괴형，2례혼합형，1례다발결절형。병조정불균균저밀도영，중앙견경저밀도배사구，기중4례거괴형저밀도내견산재소편상고밀도영，1례혼합형거괴변연견고밀도결절。동맥기7례주변결절상、불규칙강화，기중1례중앙역견점서상강화，1례무명현강화。문맥기급연지기병조지속강화，1례병조시종미견강화。본조9개병조중5개병조동맥기급문맥기변연청석，여주위정상간조직계한여동＂도절양＂표현。7개병조외연재문맥기발현“가포막”。결론 PHA적CT표현위대편저밀도조내반불규칙배사구혹시산재출혈조，증강검사정점진성충전，중앙유배사구，변연가견“도절정”화“가포막정”，통과상술특정성표현，유조우제고진단솔。
Objective To present the computed tomography (CT)findings and associated pathological features of eight cases of primary he-patic angiosarcoma (PHA).Methods All cases were confirmed by pathology.After a CT scan of the upper abdomen,all cases of PHA un-derwent enhanced scans in the arterial phase,portal venous phase,and delayed phase to observe the CT manifestations.The surgical speci-mens were subjected to conventional hematoxylin-eosin staining and immunohistochemistry and observed under a microscope.Results Of all patients,5 cases were massive type,2 cases were mixed type,and 1 case was multiple nodule type.CT scans revealed inhomogeneous low-density lesions,with necrosis of even lower density in the central part.In 4 cases of massive type,scattered high-density small pieces were observed in low-density areas;in one case of mixed type,high-density nodules were observed on the edge of mass.There were 7 ca-ses of peripheral nodular irregular enhancement in the arterial phase,including 1 case with flocculent central enhancement and another with no enhancement.Lesions remained enhanced in the portal venous and delayed phases,but 1 case had no enhancement.Five in 9 lesions had sharp edges in the arterial and portal venous phases,with“sharpen rim perpendicular to pleura”signs at the boundaries with the surrounding normal liver tissue.The outer edges of 7 lesions were found to have “pseudocapsules”in the portal venous phase.Conclusion CT scans showed a large hypodense lesion with irregular necrotic areas or scattered hemorrhage in PHA patients,whist enhanced scans showed a pro-gressive filling and necrotic area in the central part.There could be“sharpen rim perpendicular to pleura”and“pseudocapsule”signs at the edge.It might be helpful to improve the diagnosis through the above characteristic features.