单发、多发及弥漫型肝脏上皮样血管内皮瘤的CT表现-现代医学

单发、多发及弥漫型肝脏上皮样血管内皮瘤的CT表现

单位：盐城市第一人民医院影像科, 江苏盐城 224001

分类号：R735.7

出版年·卷·期（页码）：2017·36·第四期（471-474）

摘要：

目的：分析单发、多发及弥漫型肝脏上皮样血管内皮瘤（hepatic epithelioid hemangioendothelioma，HEH）的影像表现及征象，为HEH的临床诊断提供参考。方法：选取2011年1月至2015年12月收入我院的14例HEH患者为研究对象，均行腹部计算机断层扫描（computed tomography，CT）平扫+增强扫描，分析患者肝脏病变CT影像表现及病变的强化特征，将肝脏病变分为单发、多发及弥漫型。结果：1例单发型HEH，病灶位于肝左叶，CT平扫显示病灶呈小圆形低密度影，CT增强扫描显示低密度灶内点状强化。11例多发型HEH，231个病灶，其中2例病灶主要分布于右叶，4例病灶主要分布于左叶，5例病灶分布于全肝，CT平扫显示病灶多发，呈类圆形低密度影，内见更低密度影，病灶边界清楚。CT增强扫描显示4个病灶呈边缘结节样强化且逐渐向内充填的类血管瘤样变化；4个病灶边缘不明显强化，中央结节样强化，并呈白靶征，门静脉期强化区持续扩大；41个病灶动脉期呈边缘晕弧形强化，中央区不明显强化，且呈黑靶征。2例弥漫型HEH，1例病灶呈弥漫结节，结节样强化，并呈等密度影；1例病灶边界不清，增强后沿脉管走行呈渐进性强化。CT平扫显示全肝呈弥漫样低密度影，少许正常肝脏残留。CT增强扫描显示病灶动脉期呈索带状、斑片状、结节样强化，门静脉期显示强化扩大，且呈等密度影。结论：HEH临床影像表现具有一定特异性，当病灶显示逐渐强化或结节样强化，应引起注意，但是需要进行组织病理学检查确诊。

Objective: To explore the imaging manifestations and signs of HEH with solitary, multiple and diffuse type, and to provide a guide for clinical diagnosis of HEH.Methods: 14 cases of HEH from January 2011 to December 2015 were selected as the research object. They were treated with abdominal CT scan+enhanced scan. The imaging manifestations of CT were analyzed, the hepatopathy can be divided into solitary, multiple and diffuse type.Results: 1 case with solitary HEH, lesions located in the right lobe. CT scan showed irregular low-density shadow of lesions, low-density shadow in the bursa. CT enhanced scan showed inhomogeneity strengthening of lesions, not strengthen in the bursa. 11 cases with multiple HEH, 231 lesions, 2 cases of lesions were in the right lobe, 4 cases of lesions were in the left lobe, 5 cases of lesions were distributed in liver. CT scan showed multiple lesions, low density shadow, the boundaries of lesions were clear. CT enhanced scan shows 4 cases of lesions were focal nodular reinforcement, and gradually to filling hemangioma sample change. 4 cases of lesions were not obvious reinforcement, nodule samples were strengthening in central, and were white target, portal venous phase strengthening area was continue to expand. 41 cases of lesions with edge halo arc enhancement at arterial period, the central region was not obvious reinforcement, and were black target. 2 cases with diffuse HEH, 1 case of lesions with diffuse nodules, nodular reinforcement, and density. 1 case of lesions without clear boundary, was progressive enhancement. CT scan showed diffuse low density shadow in whole liver, with a little residual normal liver. CT enhanced scan showed lesions with patchy, nodular a rope belt reinforcement at arterial period, strengthening, and the density at portal venous period.Conclusion: The clinical imaging manifestations and signs of HEH have specificity. It should improve the attention, when the lesions showed gradually strengthen, or nodular reinforcement, and the final diagnose requires histopathological examination.

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