血管内乳头状内皮增生的高频超声表现

目的探讨血管内乳头状内皮增生（IPEH）的高频超声（包括二维及彩色多普勒血流）成像特征，帮助该病的诊断及鉴别诊断。 方法收集2014年1月至2019年11月于南京医科大学第一附属医院经穿刺或手术病理证实的IPEH患者21例，回顾性分析患者的年龄、性别和临床病史。其中8例患者（年龄17~63岁，平均44.8岁，女性4例，男性4例）进行了术前高频超声检查，包括二维及彩色多普勒血流成像检查。2名肌肉骨骼超声医师对该8例IPEH患者的超声表现进行回顾性分析，包括病变位置、形状、大小、内部回声、异质性、血管分布，分析超声特征与病理的关系。 结果8例IPEH灰阶超声表现为单发，平均大小23.5 mm，从皮下脂肪层至深筋膜层均可发生，呈边界清晰的不均质低回声，1例（12.5%）内部结构呈洋葱圈样改变，1例（12.5%）呈筛网状改变；彩色多普勒血流成像显示肿块内血流分级0级7例，仅1例（12.5%）肿块内可见血管穿行。病理诊断8例IPEH均为单纯型，均可见扩张血管腔内机化的血栓；典型病理表现为纤维血管轴心玻璃样变的乳头状内皮增生。所有患者均未复发。 结论IPEH（单纯型）多为孤立性肿块，其超声表现为体积较小、椭圆形、边界清晰、不均匀低回声、不伴钙化、内部可有穿支血管、质偏软。检测到的起源血管的存在可能有助于区分IPEH和其他软组织肿块。高频超声成像检查可作为IPEH首选的检查方法。

High frequency ultrasound features of intravascular papillary endothelial hyperplasia

ObjectiveTo investigate the high frequency ultrasound features of intravascular papillary endothelial hyperplasia (IPEH), in order to assist the diagnosis and differential diagnosis of IPEH. MethodsTwenty-one cases of histopathologically proven IPEH were collected from January 2014 to November 2019 at the First Affiliated Hospital, Nanjing Medical University. The age, gender, and clinical history of the patients were analyzed retrospectively. Among them, eight patients (age range, 17–63 years; mean age, 44.8 years; four females and four males) were examined by high frequency ultrasound (including B-mode ultrasonography and color Doppler flow imaging) before operation. Two musculoskeletal ultrasound doctors reviewed the ultrasound manifestations of the eight cases of IPEH, including the location, shape, size, echogenicity, heterogeneity, and vascularity. The correlations between the ultrasound and pathological features of the lesions were analyzed. ResultsThe eight cases all manifested as a single mass, and the average size was 23.5 mm. They can occur from subcutaneous fat layer to deep fascia layer, and presented as a well-defined heterogeneous hypoechogenic mass. Among all the cases, one (12.5%) had an onion ring-like structure and one (12.5%) had a cribriform network-like structure. Seven cases were shown to have grade 0 blood flow on color Doppler flow imaging, and only one (12.5%) had an origin blood vessel passing through the mass. All of the eight cases were diagnosed as pure form by pathology, and thrombus was found in the vessels of all the cases. The typical pathological manifestation was papillary endothelial hyperplasia with hyaline change of fiber vascular axis. No recurrence occurred in all patients. ConclusionIPEH (pure form) is usually an isolated mass. On ultrasound, it is always characterized by a small, well-defined, oval, soft, inhomogeneous and hypoechoic soft tissue mass without calcification. The presence of detectable origin vessel may be help to distinguish the lesion from other soft tissue masses. High frequency ultrasound imaging is the first choice for IPEH.