马周鹏,林观生,陈炳叶,王春,周建军
MA Zhou-peng,LIN Guan-sheng,CHEN Bing-ye,WANG Chun,ZHOU Jian-jun

• 1:上海市金山区中西医结合医院放射科
• 2:上海市金山区中西医结合医院普外科
• 3:温州医科大学附属慈溪医院放射科
• 4:复旦大学附属中山医院放射科

摘要(Abstract)：

目的探讨肝脏上皮样血管平滑肌脂肪瘤的MRI表现及临床特点。方法回顾性分析5例肝脏上皮样血管平滑肌脂肪瘤的临床和MRI影像学资料。结果 5例均为单发肿瘤,位于肝右叶3例,左叶2例;4例类圆形,1例分叶状,直径平均58mm,边界均较清晰;MRI平扫示1例呈较均匀长T_1加权成像(T_1weighted imaging,T_1WI)长T_2加权成像(T_2weighted imaging,T_2WI)信号,4例信号不均匀,主体呈长T_1WI长T_2WI信号,内部见不同比例的条片高、低信号混杂,均未见明显脂肪信号;弥散加权成像均为较高信号,内见斑、点较低信号;动态增强5例动脉期均较明显强化,门静脉和延迟期4例持续强化,呈"快进慢出"模式,1例强化减弱,呈"快进快出"模式;病灶内均见明显强化的异常血管,3例见斑片无强化的出血坏死区,2例见条片状强化较弱区域;3例见薄层假包膜较明显强化,2例见病灶外较粗大的引流静脉;5例均未见腹腔积液和肿大淋巴结;2例患者有右上腹隐痛不适,其中1例扪及腹部包块,3例无明显症状;5例均经手术治疗,术后随访13~68个月,均未见复发、转移。结论肝脏上皮样血管平滑肌脂肪瘤临床罕见,缺乏特殊症状,但术后预后较好,MRI可显示病灶的病理学变化,对其诊断有较大价值。
Objective To explore the MRI characteristics and clinical features of hepatic epithelioid angiomyolipoma(HEA).Methods The MRI and clinical data of 5cases of HEA were retrospectively analyzed.Results All 5cases were found single tumor,in which 3cases were located in the right lobe and 2cases in the left lobe of liver,4cases were in oval shape and 1case was in lobular shape,with clear boundary and the mean diameter of 58 mm.On plain MRI,1case showed symmetrical long signal intensity on T_1WI and T_2WI,while the other 4cases showed asymmetrical signal,long T_1WI and long T_2WI signal on the main part of tumors,and mixed high and low signal of different proportion inside the tumors with no obvious adipose signal.Diffusion weighted imaging revealed high signal in 5cases,with spotted low signal inside the tumor.Dynamic enhanced MRI showed obvious enhancement in arterial phase in 5 cases,continued enhancement with"fast-in and slow-out"pattern in portal vein phase and delayed phase in 4cases,and damped enhancement with"fast-in and fast-out"pattern in 1case.Abnormal vessels with marked enhancement were seen in all 5tumors,including patchy hemorrhagic and necrotic areas without enhancement in 3cases,and small sheet area with moderate enhancement in 2cases.Slim pseudocapsule with obvious enhancement was found in 3cases,and thick draining vein was seen outside the tumor in 2cases.Neither ascites nor enlarged lymph nodes were seen in 5cases.Dull pain of right upper quadrant occurred in 2cases,in which 1case showed palpable mass of right upper quadrant,and the other 3cases had no obvious symptoms.All 5cases underwent operation.The follow-up for 7to 68months showed no relapse or metastasis.Conclusion HEA is clinically rare,lacking special symptom,and its prognosis is fine after operation.MRI can show the pathological change and has important value for the diagnosis of HEA.

关键词(KeyWords)： 肝脏上皮样血管平滑肌脂肪瘤;磁共振成像;病理学
Hepatic epithelioid angiomyolipoma;MRI;pathology

Abstract:

Keywords:

基金项目(Foundation): 复旦大学IBS基金资助项目(12408)

作者(Author): 马周鹏,林观生,陈炳叶,王春,周建军
MA Zhou-peng,LIN Guan-sheng,CHEN Bing-ye,WANG Chun,ZHOU Jian-jun

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