摘要
目的总结上皮样血管内皮细胞瘤(EHE)同时累及肝脏与肺的影像学征象。资料与方法回顾性纳入2012年5月—2019年7月新疆医科大学附属肿瘤医院收治的9例EHE同时累及肝脏与肺的临床资料及CT、MRI图像,患者均经病理及免疫组化确诊,分析病变分布、数目、大小及形态、病变密度/信号、强化特点及其他侵犯情况。结果9例EHE均可见双肺多发结节沿支气管血管束离散分布,胸膜下结节多见,可见长索条牵拉胸膜,9例EHE结节直径2~10 mm。肝左叶单发病灶1例,肝脏左、右叶多发病灶8例。除1例双肺、肝脏弥漫钙化病变外,8例共检出156个肝脏病灶,其中肝周病灶129个(距离肝包膜<2 cm)。肝内11个病灶最大径≥30 mm,145个病灶最大径<30 mm。9例肝内病变多为结节状,7例合并匍匐状生长,9例出现包膜凹陷征。肺内结节多为实性灶,6例合并钙化。6例行腹部CT肝内病灶平扫均呈低密度,5例合并钙化;4例行腹部MRI平扫,T1WI呈稍低信号,T2WI呈稍高信号,扩散加权成像呈高信号。5例出现晕征。病变表现为均匀强化、环形强化、云絮状强化,且均呈渐进性强化。3例使用肝胆特异性对比剂,病变在肝胆期呈持续强化,部分病变中心可见延迟强化。9例患者中,8例出现贴边血管征,7例出现血管漂浮征,4例出现棒棒糖征。结论EHE累及肝脏及双肺时,病灶的共同影像学征象为多发、体积较小,较大者可融合匍匐生长,常合并钙化,位于器官外周,牵拉器官包膜,渐进性强化,血管漂浮征及棒棒糖征具有一定特征性。
Purpose To summarize the imaging features of epithelioid hemangioendothelioma(EHE)involving both liver and lung.Materials and Methods The clinical data,CT and MRI images of 9 patients with EHE involving both liver and lung confirmed by pathology and immunohistochemistry from May 2012 to July 2019 in the Tumor Hospital Affiliated to Xinjiang Medical University were retrospectively analyzed,the distribution,number,size,morphology,density/signal,enhancement characteristics and other aggressions of all lesions were analyzed.Results In 9 cases,multiple pulmonary nodules were scattered along the bronchial vascular bundles,and subpleural nodules were more common,with long cords pulling the pleura.The diameter of the nodules was between 2 mm and 10 mm.One patient had a single lesion in the left lobe of the liver,and eight patients had multiple lesions in the left and right lobes of the liver.In addition to one case of diffuse calcification in both lungs and liver,a total of 156 hepatic lesions were detected in the remaining 8 patients,including 129 perihepatic lesions(less than 2 cm away from the liver capsule).The maximum diameters of 11 lesions in the liver were≥30 mm,and the maximum diameters of 145 nodules were<30 mm.The hepatic lesions in 9 patients were mostly nodular,with creeping growth in 7 cases,and capsular shrinkage in 9 cases.Most of the pulmonary nodules were solid lesions with calcification in 6 cases.CT examination of the liver of 6 patients showed low density on plain scan of the lesions,and calcification was observed in 5 patients.Four patients underwent MRI examination,and plain scan showed slightly low signal on T1WI,slightly high signal on T2WI,and high signal on diffusion weighted imaging.5 patients showed halo sign.Uniform enhancement,ring enhancement and flocculent enhancement were observed,and all lesions showed progressive enhancement.3 cases were scanned with hepatobiliary specific contrast agent.Lesions showed continuous enhancement,and some showed central delayed enhancement in hepatobiliary phase.Among the 9 patients,there were 8 cases with welt vascular sign,7 cases with floating blood vessels sign,and 4 cases with lollipop sign.Conclusion When EHE is involved in the liver and both lungs,the tumor usually shows the common characteristics of multiple,small volume,and large tumor could fusion creeping growth,often associated with calcification,located in the periphery of the viscera,pulling the capsule of the viscera,and progressive enhancement.Floating blood vessels sign and lollipop sign are the characteristic manifestations.
作者
王永丽
古丽米拉·巴巴什
杨帆
WANG Yongli;BABASH Gulmira;YANG Fan(Department of CT,the Tumor Hospital Affiliated to Xinjiang Medical University,Urumqi 830011,China;不详)
出处
《中国医学影像学杂志》
CSCD
北大核心
2022年第6期575-578,585,共5页
Chinese Journal of Medical Imaging
基金
自治区卫生健康青年医学科技人才专项科研项目(WJWY-202033)。
关键词
肝肿瘤
肺肿瘤
上皮样血管内皮细胞瘤
体层摄影术
X线计算机
磁共振成像
病理学
外科
Liver neoplasms
Lung neoplasms
Epithelioid hemangioendothelioma
Tomography,X-ray computed
Magnetic resonance imaging
Pathology,surgical
