肝脏上皮样血管内皮细胞瘤的影像学检查特征
간장상피양혈관내피세포류적영상학검사특정
Imaging characteristics of hepatic epithelioid hemangioendothelioma
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 10期 870-874 ,共5页

    丛振杰%王彬%林俊东%董成功%张光辉

    총진걸%왕빈%림준동%동성공%장광휘

    肝肿瘤%上皮样血管内皮瘤%体层摄影术,X线计算机%磁共振成像 肝腫瘤%上皮樣血管內皮瘤%體層攝影術,X線計算機%磁共振成像
    간종류%상피양혈관내피류%체층섭영술,X선계산궤%자공진성상
    Liver neoplasms%Epithelioid hemangioendothelioma%Tomography,X-ray computed%Magnetic resonance imaging
    目的 总结肝脏上皮样血管内皮细胞瘤(EHE)的影像学检查特征.方法 回顾性分析2007年3月至2014年6月收治的6例(其中烟台市烟台山医院3例、漳州市中医院2例、章丘市中医院1例)肝脏EHE患者的临床资料.患者行CT和MRI平扫及动态增强扫描,观察病灶数目、形态、大小、部位、密度或信号、强化程度及方式等特征.采用门诊影像学检查进行随访,观察患者病灶变化情况,随访时间截至2014年6月.结果 6例患者中1例为单发病灶,5例为多发病灶.6例患者共检出125枚病灶,其中1例检出75枚.病灶多呈圆形或类圆形,融合病灶最大径为0.5 ～3.5 cm.病变发生部位以肝右叶和肝被膜下多见.6例患者病灶CT检查平扫均呈低密度,边界较清晰.4例患者病灶MRI检查平扫T1WI呈低信号,T2 WI呈高信号或略高信号,均匀或不均匀.2例患者病灶呈肝脏"包膜回缩征".6例患者行CT检查动态增强扫描,4例行MRI检查动态增强扫描,1例呈环状强化,5例基本均匀强化;所有病灶表现为延迟强化.3例患者部分病灶内可见静脉血管进入或通过病灶,血管腔正常或变窄.1例呈"棒棒糖征".6例患者中,5例影像学检查诊断为肝转移癌,1例考虑肝胆管细胞癌.6例患者行肝脏肿瘤穿刺活组织检查,病理学检查结果示肝脏EHE.2例肝脏EHE患者确诊后未行任何抗肿瘤治疗,其中1例初诊后2年行CT检查示肝脏呈"包膜回缩征",初诊后4年行MRI检查示继发性肝硬化,另1例初诊后6年半复查CT示肝硬化.1例手术治疗患者术后4年复查CT示肝左叶肿瘤复发,随访1年半年肿瘤无明显增大,后行超声引导下RFA治疗,随访半年无异常.另3例手术治疗患者术后分别随访1、4、5年均无复发、转移.结论 肝内单发或多发结节,CT和MRI检查动态增强扫描呈延迟强化是肝脏EHE的典型影像学表现,"棒棒糖征"、"包膜回缩征"及静脉进入或通过病灶具有一定特征性.病灶相互融合、纤维化,最终导致继发性肝硬化可能是该肿瘤生长特点.
    목적 총결간장상피양혈관내피세포류(EHE)적영상학검사특정.방법 회고성분석2007년3월지2014년6월수치적6례(기중연태시연태산의원3례、장주시중의원2례、장구시중의원1례)간장EHE환자적림상자료.환자행CT화MRI평소급동태증강소묘,관찰병조수목、형태、대소、부위、밀도혹신호、강화정도급방식등특정.채용문진영상학검사진행수방,관찰환자병조변화정황,수방시간절지2014년6월.결과 6례환자중1례위단발병조,5례위다발병조.6례환자공검출125매병조,기중1례검출75매.병조다정원형혹류원형,융합병조최대경위0.5 ～3.5 cm.병변발생부위이간우협화간피막하다견.6례환자병조CT검사평소균정저밀도,변계교청석.4례환자병조MRI검사평소T1WI정저신호,T2 WI정고신호혹략고신호,균균혹불균균.2례환자병조정간장"포막회축정".6례환자행CT검사동태증강소묘,4례행MRI검사동태증강소묘,1례정배상강화,5례기본균균강화;소유병조표현위연지강화.3례환자부분병조내가견정맥혈관진입혹통과병조,혈관강정상혹변착.1례정"봉봉당정".6례환자중,5례영상학검사진단위간전이암,1례고필간담관세포암.6례환자행간장종류천자활조직검사,병이학검사결과시간장EHE.2례간장EHE환자학진후미행임하항종류치료,기중1례초진후2년행CT검사시간장정"포막회축정",초진후4년행MRI검사시계발성간경화,령1례초진후6년반복사CT시간경화.1례수술치료환자술후4년복사CT시간좌협종류복발,수방1년반년종류무명현증대,후행초성인도하RFA치료,수방반년무이상.령3례수술치료환자술후분별수방1、4、5년균무복발、전이.결론 간내단발혹다발결절,CT화MRI검사동태증강소묘정연지강화시간장EHE적전형영상학표현,"봉봉당정"、"포막회축정"급정맥진입혹통과병조구유일정특정성.병조상호융합、섬유화,최종도치계발성간경화가능시해종류생장특점.
    Objective To summarize the imaging characteristics of the hepatic epithelioid hemangioendothelioma (EHE).Methods The clinical data of 6 patients with hepatic EHE who were admitted to the Yantaishan Hospital (3 patients), Zhangzhou Hospital of Traditional Chinese Medicine (2 patients) and Zhangqiu Hospital of Traditional Chinese Medicine (1 patient) between March 2007 and June 2014 were retrospectively analyzed.All the patients underwent plain scan and dynamic enhanced scan of computed tomography (CT), and the number,shape, size, location, density or signal, level and method of enhancement of the lesions were observed and analyzed.Six patients were followed up by outpatient imaging examination up to June 2014, and the changes of lesions were observed.Results Among the 6 patients, 1 solitary lesion and 5 multiple lesions were detected, and the total lesions were 125 including 1 patient with 75 lesions.The lesions were round or round-like and originated commonly from the right lobe of liver and hepatic subcapsular with a maximum diameter of 0.5-3.5 cm.Plain scan of CT showed that the lesions in 6 patients had low density with the clear boundary.MRI showed that low T1 WI signal and high or slightly high T2WI signal of the lesions were detected in 4 patients.Two patients had liver "capsular retraction" sign.The ring-like enhancement of 1 lesion and homogeneous enhancement of 5 lesions were found by dynamic enhanced scan of CT in 6 patients and enhanced scan of MRI in 4 patients.Enhanced signal in all the lesions was detected in the delayed phase.Veins into or through lesions were found in 3 lesions, with normal or narrowing vascular cavity.One patient had visible "lollipop" sign.Of the 6 patients, 5 were confirmed as with metastatic carcinoma of liver, and 1 was suggested as with cholangiocarcinoma.Six patients were diagnosed with hepatic EHE by pathological examination using hepatic biopsy technique.Among the 2 patients with hepatic EHE who didn't receive antineoplastic treatment after the diagnosis, 1 patient received CT examination at year 2 after first visit, which showed "capsular retraction" sign, and then was diagnosed as with secondary hepatic cirrhosis by MRI at 4 years after first visit.Another patient was diagnosed as with hepatic cirrhosis by CT examination at year 6.5 after first visit.One patient was diagnosed with tumor recurrence of hepatic left lobe by CT reexamination at postoperative year 4, and underwent ultrasound-guided radio frequency ablation (RFA) treatment based on no enlargement of tumor during 1-year follow-up, and then returned a normal condition after half year follow-up.Other 3 patients undergoing operation were followed up at postoperative year 1 , 4, 5 with no recurrence and metastasis.Conclusions Intrahepatic single or multiple nodules and delayed reinforcement by dynamic enhanced scan of CT and MRI are the typical imaging performances of hepatic EHE.There are certain characteristics in the liver the "lollipop" sign, "capsular retraction" sign and veins into or through the lesions.Mutual fusion and fibrosis of lesions leading ultimately to secondary liver cirrhosis may be characteristics of EHE growth.
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