133例肝血管平滑肌脂肪瘤的MRI特征及分析

目的 总结上皮样型及经典型肝血管平滑肌脂肪瘤（epithelioid and non-epithelioid hepatic angiomyolipoma，Epi-HAML和non-Epi-HAML）的临床特点及磁共振（magnetic resonance imaging，MRI）特征。方法 回顾性收集并分析2011-2018年于复旦大学附属中山医院行肝脏手术且术后病理证实为HAML的133例病例资料，根据病理类型分为Epi-HAML组及non-Epi-HAML组，根据肿瘤直径分为<3.0 cm、3.0~5.0 cm及>5.0 cm组，通过对比其MRI影像资料、肿瘤标志物等血清学指标比较各组差异。结果 133例患者中，大多数患者（83.6%）无明显临床症状。相比于non-Epi-HAML组的患者，Epi-HAML组多因出现临床症状而就诊（P<0.05），两者在发病年龄、性别、慢性病史及血清肿瘤标志物等方面差异无统计学意义。共检出141枚HAML病灶，其中Epi-HAML组87枚，non-Epi-HAML组64枚，后者影像学诊断准确率较高（P<0.05）；对比两者的MRI特征，T2WI、扩散加权成像（diffusion weighted imaging，DWI）、强化方式及有无脂肪信号差异有统计学意义（P<0.05）。而以肿瘤直径作为分组时（0.7~2.9 cm、3.0~5.0 cm、5.1~20.5 cm），其影像学上出现坏死、出血、肿瘤供血动脉、引流静脉及异常灌注等特征的构成比差异存在统计学意义（P<0.05）。结果 T2WI、DWI、强化方式及有无脂肪信号在两组HAML中有差别；肿瘤直径>5 cm时，其供血动脉、引流静脉等影像学特征更突出。

MRI features and analysis of 133 cases of hepatic angiomyolipoma

Objective To summarize the clinical and MRI features of epithelioid and non-epithelioid hepatic angiomyolipoma (Epi-HAML and non-Epi-HAML). Methods We retrospectively collected and analyzed 133 cases of liver surgery performed at Zhongshan Hospital of Fudan University and postoperative pathology confirmed as HAML during 2011-2018.According to pathological type,they were divided into Epi-HAML group and non-Epi-HAML group;and were divided into three sub groups:smaller than 3.0 cm,3.0-5.0 cm and larger than 5.0 cm according to tumor diameter.We compared these groups by studying their MRI images,tumor markers and other blood tests. Results Most of the patients were diagnosed without specific symptoms (83.6%).Epi-HAML patients tended to show more symptoms compared with non-Epi-HAML patients (P<0.05).There was little difference between these two groups in age,gender,history of disease,or serum tumor makers.A total of 141 HAML lesions were discovered after surgery,87 were Epi-HAML and 64 were non-Epi-HAML.The differences of diagnosis accurateness,T2WI,diffusion weighted imaging (DWI),enhancement mode and fat component between the two groups were significant (P<0.05).When we grouped these lesions by tumor diameter (0.7-2.9 cm,3.0-5.0 cm,5.1-20.5 cm),the appearance of necrosis,cysts,hemorrhage,tumor vessels, early draining veins and perfusion disorders showed significant difference (P<0.05). Conclusion There are significant difference between the two groups of HAML in T2WI,DWI, enhancement mode and fat signal.The imaging features such as tumor vessels and early drainage veins are more prominent when the tumor diameter is larger than 5 cm.