摘要
目的探讨乏脂肪肝脏血管平滑肌脂肪瘤(hepatic angiomyolipoma with minimal fat,m HAML)的CT诊断与鉴别诊断,以提高对不典型肝脏占位病变的认识。方法回顾性分析经病理证实的6例m HAML的CT表现,6例均行CT平扫及三期动态增强扫描。结果 6例均为肝内单发病灶,形态规则,边界清晰,4例CT平扫呈欠均匀稍低密度,1例合并脂肪肝者与1例合并出血者表现为欠均匀稍高密度,6例均未测得脂肪密度。5例CT增强动脉期呈欠均匀中等强化,门脉期强化程度增加,其中4例平衡期持续强化高于周围肝实质,1例合并出血者内部可见片状无强化区。另外1例动脉期明显强化,门脉期、平衡期强化程度有减低。3例增强图像显示病灶中央可见点条状血管影,门脉期显示更明显。6例平衡期病变边界更清楚,其中1例可见假包膜形成。病理组织学示6例病灶内主要含血管和平滑肌成分,脂肪含量极少。结论 m HAML易误诊为其他富血供肝占位。对于无肝炎、肝硬化病史,AFP正常,肝内病灶形态规则,门脉期强化程度增加且平衡期持续强化,尤其是门脉期中央出现点条状血管影者,应考虑到m HAML可能。
Objective To discuss CT diagnosis and differential diagnosis of hepatic angiomyolipoma with minimal fat （mHAML）. To improve diagnosis on the atypical occupying lesions of hepatic. Methods Findings of 6 patients with mHAML proven by pathology were retrospectively analyzed. CT plain scan and three phase dynamic enhanced scan were conducted in these cases. Results The 6 cases of hepatic single lesion showed regular shape, clear boundary and CT scan showed less uniform slight- ly lower density in 4 cases. I case with fatty liver and 1 case with hemorrhage who showed less uniform slightly higher density. All 6 cases were not measured fat density. 5 cases showed less uniform medium enhancement on arterial phase and increased enhance- ment on portal phase ; for 4 out of these cases, who continued to strengthen higher than the surrounding liver parenchyma on equi- librium phase;1 case with hemorrhage who showed no enhancement region. The other 1 case showed obvious enhancement on arte- rial phase, and decreased enhancement on portal phase and equilibrium phase. Spotty and linear vascular shadow enhancement could be seen within 3 cases,which were showed more obvious on portal phase. All 6 cases, the lesion boundary showed more clear- ly on equilibrium phase ; including 1 cases with ＂capsule-like rim＂ o Histopathology showed that the lesions of 6 cases mainly con- sisted of smooth muscle and vascular elements,while fat content is extremely low. Conclusion The mHAML can easily be mis- taken for other occupying lesions of hepatic, which with rich blood supplied. For a patient without a history of hepatitis, cirrhosis, normal AFP,the intrahepatic lesions shows that regular shape, increased enhancement on portal phase and continued to enhance higher than the surrounding liver parenchyma on equilibrium phase, especially spotty and linear vascular shadow appear in the cen- tral part on portal phase, it may be considered as mHAML.
出处
《四川医学》
CAS
2015年第5期617-620,共4页
Sichuan Medical Journal
