Hepatic cavernous hemangioma in patients at high risk for liver cancer

Cavernous hemangioma of the liver occurring in patients at high risk for liver cancer has been reviewed. Twenty-four patients with hemangioma were encountered during the past 4 years. Five lesions over 3 cm in diameter were correctly diagnosed with enhanced CT alone. Definite CT findings were however obtained in only 6 out of 19 lesions smaller than 3 cm in diameter. Ultrasonography was the most sensitive method for picking up small liver tumors even when compared with angiography, but the findings were non-specific (an echogenic mass was noted in 14 of the 19 lesions). Magnetic resonance imaging (MRI) had almost the same sensitivity as ultrasound in detecting small hemangiomas, and a prolonged T2 was highly suggestive of the diagnosis (T2 over 80 ms in 8 of 11 lesions). The results suggest that combined use of non-invasive diagnostic modalities has sufficient reliability to make a diagnosis of cavernous hemangioma even in small hepatic lesions, in patients at high risk for liver cancer.     

Magnetic resonance imaging of cavernous hemangioma of the liver: tissue-specific characterization

Twenty-one patients with hepatic hemangioma, five with hepatic cysts, and 25 with primary or metastatic cancer involving the liver were studied by magnetic resonance imaging (MRI). Benign lesions (hemangiomas, cysts) were diagnosed noninvasively by CT, radionuclide studies, and/or sonography and confirmed by follow-up examinations more than 1 year later. Malignant lesions were confirmed by liver biopsy in every case. Identical multisection/multiecho techniques were used in all patients to obtain T1-and T2-weighted spin-echo (SE) and inversion-recovery (IR) images. MRI detected more hemangiomas than any other imaging technique. Of 30 hemangiomas, 25 were spherical or ovoid with a homogeneous appearance and smooth, well defined margins. Cancer tended to have a heterogeneous appearance and poorly defined margins. On T2-weighted SE images obtained with 2000 msec TR and 60, 120, or 180 msec TE, hemangiomas had significantly greater contrast-to-noise ratios (C/N) than liver cancer (p less than 0.001). The SE 2000/120 sequence provided the single most useful image for distinguishing hemangiomas from cancers. When morphologic criteria are used in conjunction with measured C/N, MRI correctly distinguished cavernous hemangiomas from liver cancer with 90% sensitivity, 92% specificity, and an overall accuracy of 90%. Cysts had a low signal intensity on SE 500/30 images and could often be distinguished from hemangiomas and cancers that were nearly isointense relative to liver. IR images were sensitive for lesion detection but provided no tissue-specific information. The data indicate that T2-weighted SE imaging may become the procedure of choice for distinguishing cavernous hemangioma from liver cancer.     

脑实质内海绵状血管瘤的影像学诊断

目的：探讨脑实质内海绵状血管瘤(CA)的CT、MRI、MRA认和DSA表现并比较四种影像学检查方法的诊断价值。方法：回顾性分析20例CA的影像学表现，其中15例经手术病理证实，5例经影像学及临床随访证实。20例进行CT和MRI平扫、MRA认，13例行CT增强扫描，15例行MRI增强扫描，12例行DSA检查。结果：CA可发生于脑内任何部位．以单发多见(17／20，占85％)。20例CA检出25个病灶。CT和MRI平扫均发现所有病灶。CA的CT平扫均表现为高密度或稍高密度；13例CT增强扫描发现15个病灶，其中10个病灶无强化，5个病灶轻度强化。CA的MRI平扫表现为T1WI呈等或低信号12个，高信号8个，混杂信号5个；T2WI全部病灶均表现为高低混杂信号，23个病灶周围伴有低信号环，2个病灶周围有水肿带，无占位效应；15例MRI增强扫描发现17个病灶，其中7个病灶出现瘤体血管床轻中度强化，2个病灶边缘强化，8个病灶无强化。20例CA行3D TOF MRA认均未见异常血管影。12例行全脑DSA检查未见供血动脉与引流静脉。4例表现为毛细血管期或静脉窦期富血管性病变。结论：CA具有较典型的影像学表现．CT和MRI平扫对明确诊断具有重要意义，且MRI优于CT；CA的CT和MRI增强扫描无特征性表现；MRA和DSA对诊断CA价值有限。     

脑实质内海绵状血管瘤的CT和MRI诊断

目的 探讨脑实质内海绵状血管瘤(CA)的CT和MRI表现，以提高对本病的认识。资料与方法 回顾性分析经手术病理证实的CAl4例。12例行CT平扫，10例行CT增强扫描；10例行MM检查，6例行Gd—DTPA增强扫描；9例同时行CT和MRI检查。结果 CA可发生于脑内任何部位，以单发病灶多见。12例CT平扫发现16个病灶，全部病灶均呈高密度或稍高密度，7个病灶可见钙化；10例CT增强扫描发现病灶14个，9个病灶无强化，5个病灶呈轻度强化。10例MRI检查发现13个病灶，3个在T1WI上是等信号，10个为高信号；在T2WI上全部病灶为高低混杂信号，其中9个病灶周围伴有环形低信号，大多数病灶周围无水肿带，无占位效应。结论 CA具有较典型的影像学表现，CT和MRI对病变的诊断具有重要意义，且MRI优于CT。正确诊断有赖于结合临床资料和影像学征象的综合分析。     

眼眶海绵状血管瘤的影像学表现及其意义

目的 研究眼眶海绵状血管瘤的ＣＴ和ＭＲＩ征象,并着重探讨海绵状血管瘤的特异性征象即“渐进性强化”,及其在诊断和鉴别诊断海绵状血管瘤中的价值。方法 对经手术病理证实的眼眶海绵状血管瘤５８例进行回顾性分析。所有病例均行Ｂ超检查,其中ＣＴ检查４８例,ＣＴ增强扫描４３例,动态增强扫描１０例;ＭＲＩ检查２７例,动态增强扫描２４例。结果 ＣＴ增强后３６例（８３．７％）显示不同程度的片状强化,１０例ＣＴ动态增强     

Computed tomography and sonography of cavernous hemangioma of the liver

Accuracy and limitations of computed tomography (CT) and sonography in the detection and diagnosis of cavernous hemangioma of the liver were analyzed in 39 cases. In 35 of 38 lesions examined by CT before and after bolus contrast enhancement, findings were dense contrast enhancement spreading in all directions on subsequent scans and/or density (other than capsule or septa) higher than normal hepatic parenchyma after 2 min. Lesions smaller than 1 cm were not detected. Misregistration in sequential scans prevented diagnosis of three of nine lesions smaller than 2 cm. Sonography revealed various patterns of mass, but in the smaller lesions, an extremely hyperechoic pattern was dominant. The contributions of CT and sonography depend on the size of the lesions.     

磁敏感加权成像对颅内多发海绵状血管瘤的诊断价值

目的:探讨磁共振磁敏感加权成像序列(SWI)对脑内多发海绵状血管瘤的诊断价值。方法:前瞻性地采用磁共振SWI序列及快速自旋回波序列TSE-T1WI、T2WI对6例颅内多发海绵状血管瘤患者进行扫描,分析MRI不同扫描序列图像区别。结果:6例患者中TSE T1WI发现海绵状血管瘤病灶23个,TSE T2WI发现病灶92个,SWI发现病灶192个。结论:在显示颅内多发海绵状血管瘤方面,SWI较TSE序列有明显优势,特别是对于小病灶的检出。     

软组织海绵状血管瘤的MRI诊断

目的探讨软组织海绵状血管瘤的MRI表现及其诊断价值。方法回顾性分析35例软组织海绵状血管瘤患者的影像资料,全部患者均有MRI平扫和增强扫描,12例有X线平片检查,10例有CT检查。结果单发病灶31例,2~4个多发病灶者4例,共检出43个病灶。SE序列T1WI上33个病灶呈中等略高信号,T2WI上全部病灶呈高信号,信号不均匀。33个病灶内及周边可见高信号的病变,Flash2d序列21个病灶T1WI上高信号被抑制,12个病灶内T1WI上高信号未被抑制。Gd-DTPA增强扫描39个病灶呈明显强化,但强化不甚均匀,其内可见点条状不强化影。结论软组织海绵状血管瘤在MRI表现上有一定特征性,MRI对诊断软组织海绵状血管瘤有重要价值。     

Dynamic MRI of hepatic tumors using gadolinium-DTPA--preliminary results

Dynamic magnetic resonance imaging (MRI) was performed in two patients with hepatic tumors (one cavernous hemangioma and one hepatoma). A sequential timed scanning technique with spin echo images (TR: 100 msec; TE: 20 msec; data acquisition time: 26 sec) was used with a bolus injection of 0.05 mmol/kg gadolinium DTPA. Dynamic MRI findings in the two cases were similar to those obtained with dynamic CT and angiography using iodinated contrast medium. Our early experience suggested that the less invasive technique of dynamic MRI could replace conventional dynamic CT in assessing the hemodynamics of hepatic tumors.     

颅内海绵状血管瘤的CT和MRI诊断

目的:探讨脑内与脑外海绵状血管瘤的CT和MRI表现及诊断价值.方法:搜集45例颅内海绵状血管瘤的CT和MRI影像资料进行分析,MRI检查45例,CT检查30例,其中脑内型海绵状血管瘤42例,脑外型海绵状血管瘤3例,均经手术病理证实.结果:脑内型海绵状血管瘤可位于脑内任何部位,单发病灶多见,无明显占位效应,周围无或轻度水肿.CT检查的全部病例呈稍高及混杂密度影27例,增强扫描大都无强化;MRI检查T2 WI表现为"桑葚状"混杂高信号,周围有云絮状低信号环,增强后病灶仅少数轻度强化.脑外型病灶位于中颅窝鞍旁,MRI呈类似哑铃形或类圆形较均匀的稍长T1明显长T2信号,增强扫描呈明显均匀强化.结论:脑内与脑外型海绵状血管瘤的CT和MRI表现具有一定特征,MRI优于CT像,特别是MRI的T2 WI像有助于明确诊断.     

颅内海绵状血管瘤的CT和MRI诊断

目的 探讨CT和MRI对颅内海绵状血管瘤的表现和诊断价值。资料与方法 经手术病理证实的颅内海绵状血管瘤22例,其中脑内型海绵状血管瘤21例,脑外型海绵状血管瘤1例。10例行CT检查,16例行MRI检查,13例行MRA检查。结果 脑内型海绵状血管瘤可位于脑内任何部位,单发病灶多见,周围无或轻度水肿,无明显占位效应。CT平扫为稍高密度影,钙化占72．7％,增强扫描大都无强化;MR T1WI表现为桑葚状混杂高信号．周围有云絮状低信号环,增强后病灶大都无强化;MRA检查未见异常血管。脑外型病灶位于中颅窝、鞍旁,MRI呈类似哑铃形较均匀的稍长T1、长T2信号,增强扫描见明显均匀强化．MRA检查未见异常血管。结论 脑内型海绵状血管瘤的MRI表现较有特异性,结合CT和MRA可明确诊断;脑外型者易误诊,对CT和MRI表现类似的中颅窝脑膜瘤,应考虑到本病的可能。     

颅骨海绵状血管瘤的CT和MRI诊断(附11例报告)

目的:分析颅骨海绵状血管瘤的CT和MRI特点。方法:回顾性分析11例(男3例,女8例,年龄12~65岁,平均44岁)经病理证实的颅骨海绵状血管瘤的临床表现、术前CT平扫和MRI平扫和增强扫描资料,观察肿瘤的形状、密度、边界、MRI信号变化、增强表现及周围软组织情况,根据颅骨外板是否破坏,将肿瘤分两组,比较肿瘤最大径的组间差异。结果:所有病例术前均表现为无痛性皮下肿物。7例(64%)位于额骨,顶骨和枕骨各2例。病变均表现为椭圆形,边界清晰,边缘无硬化。CT值自117~1048HU不等。7例(64%)外板破坏的肿瘤最大横径为(2.7±0.80)cm,与4例(37%)外板无破坏的肿瘤大小(2.33±0.88)cm差别无统计学意义(P=0.488)。MRI平扫均表现为高低信号混杂影,增强后强化不均匀,强化幅度不一。周围软组织和脑实质信号正常。结论:颅骨海绵状血管瘤表现出一定的破坏颅骨外板向颅外生长倾向,综合CT和MRI检查有助于更好地显示该病的影像学特点。     

Hepatic tumors: differentiation by transverse relaxation time (T2) of magnetic resonance imaging

Fifty-three patients who had hepatic tumors (24 hepatomas, ten metastases, and 19 cavernous hemangiomas) underwent MR imaging using a 0.35-T superconducting imager. The transverse relaxation time (T2) was calculated from a pair of spin echo images (repetition time [TR] of 1600 msec) with echo delay times (TE) of 35 and 70 msec. The computed T2 value was obtained in a fashion similar to that used to obtain CT numbers with region-of-interest cursors. The mean T2 was 59 +/- 9 msec in hepatomas, 64 +/- 15 msec in metastases, and 100 +/- 30 msec in hemangiomas. The difference between the T2 of hemangioma and that of liver malignancies was statistically significant (P less than .001); however, differentiation between hepatoma and metastases was not possible. The T2 was shorter than 80 msec in all 24 hepatomas and in nine of ten metastases, and was longer than 80 msec in 16 of 19 hemangiomas. Forty-nine of 53 cases (92%) were correctly classified when the borderline of T2 between hemangioma and hepatic malignancies was set at 80 msec. MR with T2 calculation was valuable in differentiating between hemangioma and hepatic malignancies.     

Improved detection of small cavernous hemangiomas of the liver with high-resolution three-headed SPECT.

The purpose of this study was to review our experience with 99mTc-red blood cell scintigraphy for diagnosis of cavernous hemangiomas of the liver using a new three-headed, high-resolution dedicated SPECT system. Of 19 patients referred with a total of 38 lesions seen on CT, US, or MRI, 14 patients had 24 lesions that were hemangioma-positive with SPECT (all true-positives). Six of these 14 patients also had 9 hemangioma-negative lesions; all were less than or equal to 1.3 cm in size and false-negative. The remaining five patients had hemangioma-negative lesions only (1 false-negative, 4 true-negatives). Two hemangiomas were seen by SPECT that were not detected by CT, US, or MR. The sensitivity for hemangiomas greater than or equal to 1.4 cm. was 100% (20/20). The sensitivity was 33% for lesions 0.9-1.3 cm, and 20% for lesions less than or equal to 0.8 cm. The smallest hemangioma detected was 0.5 cm. These results show a definite improvement in sensitivity with high-resolution triple-headed SPECT over previously reported results using single-headed SPECT. High-resolution SPECT has improved our ability to detect small cavernous hemangiomas of the liver.     

颌面部海绵状血管瘤的MRI诊断价值

目的探讨颌面部海绵状血管瘤的MRI表现和诊断价值。方法回顾性分析我院经手术和病理证实的31例颌面部海绵状血管瘤的MRI表现。结果病变分布在腮腺咬肌区13例,颊部及颧颞部12例,眶部3例,唇部3例。3例为椭圆形或类圆形,2例为梭形,其余26例均表现为团状或片状的不规则形。T1WI上20例表现为长T1信号,7例为等T1信号,4例为稍长T1信号,在T2WI上27例表现为长T2高信号,4例为稍高信号。结论MRI可以明确颌面部海绵状血管瘤的诊断,并能明确病变的形态和范围,为临床诊断及手术方案的制订提供可靠的依据。     

经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤

目的：探讨CT引导下经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤的疗效及安全性。方法：选择肝海绵状血管瘤患者34例,瘤体直径为3．2～12．0cm,采用CT引导下经皮穿刺,注射平阳霉素碘油乳剂治疗肝海绵状血管瘤,注射剂量为6～20ml。所有病例术后3个月、半年、1年各复查CT1次。结果：经皮注射平阳霉素碘油乳剂后,29例血管瘤瘤体内碘油沉积良好,5例PLE不能完全充盈瘤灶。术后3～6个月,全部病例瘤体均有明显缩小,其中缩小达80％以上者18例,〉50％者14例,缩小〈50％者2例。本组病例未出现肝脏坏死、胆管毁损、胆囊坏死穿孔、急性胰腺炎等严重并发症。结论：经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤是一种操作简便且安全高效的治疗方法。     

脑实质内海绵状血管瘤MRI表现

目的分析脑实质内海绵状血管瘤的MRI表现，提高本病的诊断水平。方法回顾分析18例经临床及手术病理证实脑实质内海绵状血管瘤的MRI影像表现。结果18例共26个病灶，表现为T1WI等信号、高信号、混杂信号或环状高信号，T2WI低信号、均匀高信号或环状高信号，周围可见低信号环；大部分病灶无占位效应及周围水肿，所有病灶在梯度回波（GRE）序列上均可见到病灶边缘低信号环；Gd—DTPA增强扫描部分病灶强化。结论海绵状血管瘤MRI表现较为特异，MRI检查是诊断脑实质内海绵状血管瘤最为敏感的方法。     

鞍旁海绵状血管瘤的CT和MRI诊断

目的总结7例鞍旁海绵状血管瘤CT、MRI和磁共振波谱（MRS）表现,探讨其诊断和鉴别诊断。资料与方法7例均经手术病理证实,均行CT和MR平扫,2例行CT增强扫描,7例行MR增强扫描,5例行MR扩散加权成像（DWI）,6例行^1H MRS检查。结果鞍旁海绵状血管瘤体积大,并同时伸入到鞍内。CT平扫病变呈等或稍高密度,密度均匀,MR T1WI呈等或稍低于脑灰质信号,T2WI呈类似脑脊液高信号。增强扫描病变呈非常显著强化。DWI呈等或稍低信号,但表观扩散系数（ADC）值明显高于正常脑实质。。HMRS表现为NAA峰、Cr峰和Cho峰消失。可出现Lip峰。结论CT检查时鞍旁海绵状血管瘤与脑膜瘤和垂体瘤鉴别困难,MRI表现很有特点,T2WI呈极高信号,增强扫描非常显著强化,ADC值明显升高而DWI接近等信号,MRS检查无NAA峰、Cr峰和Cho峰,MRI可以对海绵窦海绵状血管瘤作出定性诊断。     

介入治疗肝血管瘤的临床研究

目的：探讨平阳霉素碘油乳剂超选择栓塞治疗肝血管瘤的临床疗效和治疗体会。方法：对23例肝血管瘤患者,采用平阳霉索碘油乳剂超选择性动脉插管行栓塞治疗,观察治疗前和治疗后6个月、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症。结果：所有患者在术后6个月和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘化油聚积征象。术前血管瘤直径为（8．1±2．2）cm,术后6个月血管瘤直径为（5．4±1．3）cm,术后12个月血管瘤直径为（3．4±1．2）cm。治疗前有临床症状者治疗后缓解或消失。术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生。结论：超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大肝血管瘤是一种疗效肯定、相对安全较为理想的治疗方法。     

肝脏单发性囊性转移瘤的影像学表现

目的探讨肝脏单发囊性转移瘤的CT和MRI表现。方法回顾分析14例肝脏单发囊性转移瘤的CT（5例）和MRI（9例）表现。结果肝左叶5例，右叶9例。2例包膜下转移瘤呈扁丘形，其余12例呈圆形或类圆形。肿瘤直径0．7～5．5cm，平均2．7cm。病灶表现为均匀薄壁型2例，均匀厚壁型2例，不均匀厚壁型7例和分隔型3例。病灶的囊壁和分隔CT平扫呈低密度，MRI T1WI呈低信号，MRI T2WI呈高信号、无钙化。12例有强化，3例延迟增强MR扫描呈现外周冲洗现象。病灶囊内部分为水样密度或信号、无强化，3例有液平。病灶通常不伴肝硬化、门静脉栓子以及胆道扩张，但有时同时显示肝外原发肿瘤或者腹部他处转移灶。结论肝脏单发囊性转移瘤具有一定的CT和MRI特征，了解这些特征有助于此类病变的诊断与鉴别诊断。