非上皮型肝血管平滑肌脂肪瘤（≤3 cm）与小肝癌的鉴别诊断

目的：通过比较分析非上皮型肝血管平滑肌脂肪瘤(HAML)(≤3 cm)与小肝癌(SHCC)的临床和 MRI 特点,提高术前诊断的准确率。方法回顾性分析经临床病理证实的20例非上皮型 HAML(≤3 cm)与26例 SHCC 的临床及 MRI 资料。结果非上皮型 HAML(≤3 cm)好发于女性；肿块内可见成熟脂肪组织5例,强化方式可表现为“快进快出”11例,病灶“快进慢出”6例,“延迟强化”3例；延迟期包膜样强化3例,病灶内见血管影13例；而 SHCC 好发于男性,强化方式表现为“快进快出”23例,延迟期“包膜样”强化17例,12例内见血管影。SHCC 的表观扩散系数(ADC)值明显低于非上皮型 HAML(≤3 cm)ADC 值,SHCC 的ADC 值明显低于正常肝实质的 ADC 值；而非上皮型 HAML(≤3 cm)的 ADC 值与正常肝实质的 ADC 值之间无明显统计学差异。肝硬化患者肝实质的 ADC 值低于无肝硬化患者肝实质的 ADC 值。结论成熟脂肪组织的存在、MRI 强化方式、ADC 值有助于非上皮型 HAML(≤3 cm)与 SHCC 的鉴别,提高术前诊断准确性。

Differential diagnosis of nonepithelial hepatic angiomyolipoma(≤3 cm)and small hepatocellular carcinoma

Objective To compare the MRI manifestations and characteristics of ≤ 3 cm nonepithelial hepatic angiomyolipomas (HAML)and small hepatocellular carcinoma (SHCC),then improve the preoperative diagnostic accuracy.Methods A retrospective analysis of 20 patients ≤3 cm nonepithelial HAML and 26 cases of SHCC,confirmed by clinical pathology,with both in clinical data and MRI characteristics.Results ≤3 cm nonepithelial HAML commonly occurs in women;The enhancement patterns“wash in and wash out”in 1 1 cases,6 cases “wash in but slow out”,3 cases with delayed enhancement;Mature adipose tissue found in 5 cases, 3 cases has pseudocapsule enhancemen in delayed phase,13 cases can see central vessels;While SHCC often occurs in men,with“wash in and wash out”enhancement pattern in 23 cases,1 7 cases with pseudocapsule enhancemen in delayed phase,12 cases can see central vessels in lesions.ADC values for SHCC was significantly lower than that for ≤3 cm nonepithelial HAML,the ADC values of SHCC significantly lower than the surrounding liver parenchyma;The ADC values between ≤3 cm nonepithelial and liver parenchyma around has no significant differences.ADC values of liver parenchyma with liver cirrhosis was lower than that without cirrhosis.Conclusion The existence of mature adipose tissue,the MRI enhancement pattern and the value of ADC can help to distinguish between ≤3 cm nonepithelial HAML and SHCC,then improve the preoperative diagnostic accuracy.