Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal.
Eur Radiol. 2018 Apr;28(4):1529-1539. doi: 10.1007/s00330-017-5102-7. Epub 2017 Oct 27.
To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI).
This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features.
Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels.
Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis.
• No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.
确定肝脏罕见原发性恶性肿瘤在磁共振成像（MRI）上是否具有一致的特征。
这项符合 IRB 标准的回顾性研究，对 2005 年至 2016 年期间来自四个大学中心病理科的记录进行了审查，以确定罕见的原发性恶性肿瘤，并与 MRI 记录进行交叉参考。对这些患者的 MRI 研究进行了回顾，以确定这些肿瘤是否表现出一致和独特的特征。
共确定了 60 例罕见的原发性肝肿瘤患者。观察到以下特征和发生频率：混合性肝细胞癌-胆管细胞癌在 19 例患者中有 7 例表现为洗脱区；6 例纤维板层样癌均表现为大的混杂性病变，伴有大的混杂性中央瘢痕；直径大于 2cm 的上皮样血管内皮细胞瘤在晚期增强扫描中表现为靶样增强 9/13 例；肉瘤（不包括血管肉瘤）中有 3/9 例存在中央坏死，5/9 例存在出血；血管肉瘤在 3/6 例中表现为向心性进行性结节样增强，并在 3/6 例中表现为出血区；7/7 例原发性肝淋巴瘤表现为血管包绕。
虽然可以识别出有助于区分肝脏罕见原发性恶性肿瘤的特征，但没有 MRI 特征似乎是特异性的，因此通常需要组织病理学确认才能做出明确诊断。
• 没有 MRI 特征似乎对罕见的原发性肝脏恶性肿瘤具有特异性。• 出血是诊断原发性肝肉瘤的有用征象。• 血管肉瘤可能表现为向中心进行性结节样增强，类似于血管瘤。• 血管包绕是诊断原发性肝淋巴瘤的一个有用征象。
