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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 analyze the imaging manifestations and signs of single, multiple and diffuse hepatic epithelioid hemangioendothelioma (HEH), and to provide a reference for the clinical diagnosis of HEH. Methods: Totally 14 HEH patients admitted to our hospital from January 2011 to December 2015 were enrolled in this study. All patients underwent computed tomography (CT) scan and contrast-enhanced scan. The CT findings of liver lesions were analyzed. Lesions enhanced features, the liver lesions are divided into single, multiple and diffuse. Results: One case of single haematoxylin-eosin (HEH) was located in the left lobe of liver. CT scan revealed a small circular low-density lesion, while CT enhanced scan showed focal enhancement in low-density lesion. 11 cases of multiple HEH, 231 lesions, of which 2 lesions were mainly distributed in the right lobe, 4 lesions were mainly distributed in the left lobe, 5 lesions distributed in the liver, CT plain lesions showed multiple round-shaped low density Shadow, see the lower density shadow, the lesion border clear. CT scans showed 4 nodular aneurysm-like lesions with gradual nodus-like margins. The margins of 4 lesions were not significantly enhanced, central nodules were enhanced and showed white target signs, while portal venous enhancement zones continued 41 lesions were enhanced at the edge of the halo curve, the central area was not significantly enhanced, and showed a black target. 2 cases of diffuse HEH, 1 case was diffuse nodules, nodular-like enhancement, and was equal density; 1 case of the border is unclear, enhanced along the vasculature progressively enhanced. CT scan shows the whole liver showed diffuse low-density shadow, a little residual normal liver. CT enhanced scan showed lesions were cord-like, patchy, nodular-like enhancement, portal venous phase showed enhanced expansion, and showed isodense. Conclusion: The clinical manifestations of HEH have a certain specificity. When the lesions show enhancement or nodular enhancement, attention should be paid, but histopathological examination is required.