Department of Nuclear Medicine, Changhai Hospital, Shanghai 200438, China.
Clin Nucl Med. 2013 Feb;38(2):e66-73. doi: 10.1097/RLU.0b013e318266ceca.
The aim of this study was to evaluate retrospectively magnetic resonance imaging (MRI) and (18)F fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) findings of hepatic epithelioid hemangioendothelioma (HEH).
MRI and FDG PET/CT findings were reviewed in 6 patients with HEH confirmed by pathology. All patients underwent magnetic resonance (MR) examination. Early PET/CT scans were performed 1 hour after FDG injection in all 6 patients. After an interval of 1 hour, delayed PET/CT scans were performed in 4 patients.
A total of 60 lesions were detected in all 6 patients. MRI features of HEH included multifocal hepatic disease, predominantly subcapsular location, coalescence of lesions, and capsular retraction. T2-weighted MR images frequently showed a target-like configuration of the lesions. Contrast-enhanced MR images showed variable degrees of peripheral rim enhancement with delayed central enhancement. Forty lesions (67%) with increased FDG uptake and 20 lesions (33%) with FDG uptake similar to the surrounding liver parenchyma were found in all 6 patients. The mean maximum standardized uptake value (SUV(max)) of all lesions was 3.6 ± 1.1, with a low variability of SUV(max) among lesions ranging from 1.7 to 6.6. There was no relationship between lesion sizes and corresponding SUV(max). Some larger lesions demonstrated a hypermetabolic peripheral rim reflecting hypercellular tumor regions and a relatively hypometabolic central area corresponding to hypocellular stroma. Eleven lesions with increased FDG uptake on the delayed PET/CT images were found in 3 patients, and 19 lesions with decreased FDG uptake were found in all 4 patients with total 32 lesions.
MRI demonstrated morphological features of HEH and FDG PET/CT reflected the histopathological composition of the tumors. FDG uptake of HEH may be related to tumor cellularity, but not the tumor size. Dual-time-point imaging may be not useful for differentiating benign lesions from HEH. Familiarity with the morphological and functional imaging findings of HEH is useful for recognition of this rare hepatic tumor.
本研究旨在回顾性评估肝脏上皮样血管内皮细胞瘤（HEH）的磁共振成像（MRI）和氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）表现。
对 6 例经病理证实的 HEH 患者的 MRI 和 FDG PET/CT 检查结果进行了回顾性分析。所有患者均行磁共振（MR）检查。所有 6 例患者均在 FDG 注射后 1 小时行早期 PET/CT 扫描，4 例患者在 1 小时后行延迟 PET/CT 扫描。
6 例患者共检出 60 个病灶。HEH 的 MRI 特征包括多灶性肝疾病、主要位于肝包膜下、病灶融合、包膜回缩。T2 加权 MR 图像常显示病灶呈靶样构型。增强 MRI 显示病变呈不同程度的周边环形强化，延迟期呈中央强化。6 例患者均发现 40 个（67%）病灶摄取 FDG 增加，20 个（33%）病灶摄取 FDG 与周围肝实质相似。所有病灶的最大标准化摄取值（SUV(max))平均值为 3.6±1.1，病灶间 SUV(max)的变异较小，范围为 1.7~6.6。病灶大小与相应 SUV(max)之间无相关性。部分较大病灶呈周边代谢活跃的环形，反映肿瘤细胞丰富区，中央相对代谢低下区，反映细胞稀疏的间质。3 例患者的延迟 PET/CT 图像上发现 11 个摄取 FDG 增加的病灶，4 例患者共发现 32 个摄取 FDG 减少的病灶。
MRI 显示了 HEH 的形态学特征，FDG PET/CT 反映了肿瘤的组织病理学组成。HEH 的 FDG 摄取可能与肿瘤细胞密度有关，而与肿瘤大小无关。双时相成像可能对鉴别良性病变与 HEH 无帮助。熟悉 HEH 的形态和功能成像表现有助于识别这种罕见的肝肿瘤。
