肝脏血管平滑肌脂肪瘤..docVIP

肝脏血管平滑肌脂肪瘤的影像学及病理学分析 ―――付10例报道并文献复习 张鑫 严森祥 肖文波 许顺良 作者单位：310003，杭州，浙江大学医学院第一附属医院放射科 摘要 目的 分析肝脏血管平滑肌脂肪瘤的CT及MR的影像学特点与病理基础，减少对该肿瘤的误诊。 材料与方法 回顾性分析10例11个病灶肝血管平滑肌脂肪瘤的CT及MR的影像学表现，按不同病理组织学亚型进行对照分析。结果 10例肝脏血管平滑肌脂肪瘤中，脂瘤型3例，血管瘤型1例，肌瘤型1例，混合型5例。脂瘤型以脂肪成分为主，CT、MR均可显示脂肪密度或信号。血管瘤型以血管成分为主，CT、MR增强可见动脉期明显强化，门静脉期密度或信号仍高于同期肝实质。肌瘤型主要是由平滑肌成分为主，脂肪成分很少，混合型三种成分含量相似，CT平扫为较均匀低密度，MR平扫T1W呈低信号，T2W呈稍高信号，增强扫描CT、MR均呈动脉期明显强化，门静脉期仍有强化。结论 不同病理组织学类型的肝脏血管平滑肌脂肪瘤，CT和MR表现有所不同，这取决于肿瘤所含的主要组织学成分。了解肿瘤不同的组织学亚型与影像学表现之间的关系，有助于提高肝脏血管平滑肌脂肪瘤术前诊断准确率。 关键词 肝脏 血管平滑肌脂肪瘤 体层摄影术，X线计算机 磁共振成像 Correlation between pathology and image characteristics of hepatic angiomyolipoma Zhang xin,Yan senxiang,Xiao wenbo,Xu shunliang. Department of Radiology, First Hospital, Medical College of Zhejiang University, Hangzhou, 31003, China Abstract Objective To discuss the imaging including CT and MRI characteristics of hepatic angiomyolipoma based on pathological findings, with the aim of more accurate diagnosis of the rare lesion of the liver. Material and Method Ten patients with 11 angiomyolipomas were retrospectively analyzed, and their CT and MRI appearances were correlated with the pathohistological subtypes of the disease. Results Ten patients with hepatic angiomyolipomas were subcategorized into lipomatous （3 cases）parenchyma in the portal phase. The myomatous type was predominantly composed of leiomyoid cells mixed with small amount of adipocytes. The mixed type was the most often, evenly comprising sheets of epithelioid muscle cells admixed with islands of adipocytes and abnormal vessels, and showing homogeneously low density on plain CT and low signal intensity on T1-weighted, intermediately high signal intensity on T2-weighted MRI scans. On dynamic study with both CT and MRI, the mixed type exhibited obvious enhancement, which retained to some degree during the portal phase. Conclusion In hepatic angiomyolipomas, there showed discrete CT and MRI appearances with different pathological subtypes depending on the components of th