Kim B, Byun J H, Lee J H, Park B J, Kwon H-J, Lee J H, Lee S J, Won H J, Shin Y M, Kim P N
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea; Department of Radiology, Ajou Hospital, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon 16499, South Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea.
Clin Radiol. 2018 Mar;73(3):244-253. doi: 10.1016/j.crad.2017.09.015. Epub 2017 Oct 27.
To describe imaging characteristics of primary hepatic angiosarcoma on gadoxetate disodium-enhanced dynamic magnetic resonance imaging (MRI) and to determine features that differentiate angiosarcomas from similar-sized haemangiomas.
The study included 15 patients with hepatic angiosarcomas and 35 patients with size-matched hepatic haemangiomas who underwent gadoxetate disodium-enhanced liver MRI. The number, size, growth pattern, signal intensity (SI) characteristics, and SI changes on dynamic scans were evaluated and compared between the two entities.
Overall, hepatic angiosarcomas significantly more often showed lesion multiplicity (86.7%), capsular retraction (40%), prominent intratumoural vessels (66.7%), vascular invasion (20%), heterogeneous SI on T2-weighted (100%) and hepatobiliary phase images (80%), and intralesional haemorrhage (60%, all p<0.05). On dynamic scans, angiosarcomas demonstrated enhancing foci of irregular or rim-like nodular/linear or bizarre (86.7%) shapes, with centrifugal or bizarre patterns of progressive enhancement (53.3%). Enhancement of angiosarcomas was less than that of the blood pool on visual grading, but the enhancement curves followed that of the aorta. Regardless of size, angiosarcomas showed heterogeneous T2 SI, intratumoural haemorrhage, and heterogeneity during the hepatobiliary phase, whereas these findings were more common in haemangiomas >6 cm in diameter.
Gadoxetate disodium-enhanced dynamic liver MRI is capable of depicting vascular hallmarks of hepatic angiosarcomas. Heterogeneous SI on T2-weighted and hepatobiliary phase images, multiplicity, and an enhancement curve following that of the aorta are also distinctive features that differentiate angiosarcomas from haemangiomas.
描述原发性肝血管肉瘤在钆塞酸二钠增强动态磁共振成像（MRI）上的影像特征，并确定可将血管肉瘤与大小相似的肝血管瘤相鉴别的特征。
本研究纳入了15例肝血管肉瘤患者和35例大小匹配的肝血管瘤患者，这些患者均接受了钆塞酸二钠增强肝脏MRI检查。评估并比较了这两种病变的数量、大小、生长方式、信号强度（SI）特征以及动态扫描时的SI变化。
总体而言，肝血管肉瘤更常表现为病变多发（86.7%）、包膜回缩（40%）、瘤内血管明显（66.7%）、血管侵犯（20%）、T2加权像（100%）和肝胆期图像（80%）上信号不均匀，以及瘤内出血（60%，均p<0.05）。在动态扫描中，血管肉瘤表现为不规则或边缘样结节状/线状或怪异形状（86.7%）的强化灶，呈离心性或怪异的渐进性强化模式（53.3%）。在视觉分级上，血管肉瘤的强化程度低于血池，但强化曲线与主动脉相似。无论大小，血管肉瘤在T2加权像上均表现为信号不均匀、瘤内出血以及肝胆期不均匀，而这些表现在直径>6 cm的血管瘤中更为常见。
钆塞酸二钠增强动态肝脏MRI能够显示肝血管肉瘤的血管特征。T2加权像和肝胆期图像上的信号不均匀、多发以及与主动脉相似的强化曲线也是将血管肉瘤与血管瘤相鉴别的显著特征。
