CAJ | 학술논문

目的：探讨肝脏上皮样血管平滑肌脂肪瘤（epithelial angiomyolipomas ，EAML）的影像学表现及病理特征，提高对该病诊断的准确性。方法回顾性分析9例经病理证实的肝EAML的临床表现及影像学资料。其中3例行 MRI平扫和多时相动态增强扫描，5例行CT平扫和三期动态增强扫描，1例同时行CT和MR检查。9例均误诊，其中6例术前误诊为肝癌，1例误诊为血管瘤，1例误诊为局灶性结节增生（FNH），1例误诊为转移瘤。结果9例肝EAML均为单发的类圆形肿块，边界清楚；6例位于肝右叶，3例位于肝左叶。CT平扫呈稍低密度；MRI平扫 T1WI呈稍低信号，T2WI呈稍高信号；增强扫描动脉期呈明显不均匀强化，少数可均匀明显强化，6例动脉期可见早期引流静脉，8例动脉期或门脉期中央或周边可见明显强化的粗大畸形的血管；强化方式为快进快出或快进慢出。结论 EAML影像学表现具有一定特征性，结合临床资料，对术前正确诊断具有重要意义，但诊断有赖于穿刺活检。
목적：탐토간장상피양혈관평활기지방류（epithelial angiomyolipomas ，EAML）적영상학표현급병리특정，제고대해병진단적준학성。방법회고성분석9례경병리증실적간EAML적림상표현급영상학자료。기중3례행 MRI평소화다시상동태증강소묘，5례행CT평소화삼기동태증강소묘，1례동시행CT화MR검사。9례균오진，기중6례술전오진위간암，1례오진위혈관류，1례오진위국조성결절증생（FNH），1례오진위전이류。결과9례간EAML균위단발적류원형종괴，변계청초；6례위우간우협，3례위우간좌협。CT평소정초저밀도；MRI평소 T1WI정초저신호，T2WI정초고신호；증강소묘동맥기정명현불균균강화，소수가균균명현강화，6례동맥기가견조기인류정맥，8례동맥기혹문맥기중앙혹주변가견명현강화적조대기형적혈관；강화방식위쾌진쾌출혹쾌진만출。결론 EAML영상학표현구유일정특정성，결합림상자료，대술전정학진단구유중요의의，단진단유뢰우천자활검。
Objective To explore the imaging manifestations and pathological characteristics of hepatic epithelioid angio‐myolipoma so as to improve the diagnostic accuracy of the disease .Methods The clinical and imaging data of 9 cases with HEA proved by pathology were analysed retrospectively .Among these patients ,6 cases underwent plain and contrast‐en‐hanced CT scan ,three cases underwent MRI ,one case underwent both CT and MRI .9 cases were all misdiagnosed by im‐aging ,including 6 cases misdiagnosed as hepatic cell cancer (HCC ) ,1 case misdiagnosed as focal nodular hyperplasia (FNH) ,1 case as hemangioma and 1 case as metaststic tumor .Results Hepatic EAML of all 9 cases was the single round with mass boundary clear .6 cases were located in the right lobe of liver ,3 cases were located in the left .Plain CT showed the tumors were slightly low density .The MRI performances were slightly low signal in T1WI ,and were slightly high signal in T2 WI .On contrast‐enhanced scan ,the lesions appeared as obviously unhomogeneous enhancement in artery phase ,and homogeneous enhancement in a few of cases .There was early venous drainage ,which appeared in 6 cases in ar‐tery phase .There were enlarged malformation vessels ,which appeared obviously enhancement in 8 cases in the center or around the tumors in artery phase and in portal phase .The mode of the lesions was quick‐in and quick‐out or quick‐in and slow‐out .Conclusion The imaging manifestations have specificity for the diagnosis of HEA .Combining with clinical data is important in making a correct diagnosis preoperatively ,but ,the patients were diagnosed definitely by puncture and biop‐sy .