Tan Y, Xie X-Y, Li X-J, Liu D-H, Zhou L-Y, Zhang X-E, Lin Y, Wang W, Wu S-S, Liu J, Huang G-L
Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhong Shan Road 2, 510080 Guangzhou, China.
Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-Sen University, 510080 Guangzhou, China.
Diagn Interv Imaging. 2020 Nov;101(11):733-738. doi: 10.1016/j.diii.2020.03.005. Epub 2020 Apr 21.
The purpose of this study was to retrospectively compare the imaging features of hepatic epithelioid angiomyolipoma (HEAML) to those of hepatocellular carcinoma negative for hepatitis B surface antigen and hepatitis C antibody (NBNC-HCC) on contrast-enhanced ultrasound (CEUS) with sulphur hexafluoride microbubbles.
Twenty-two patients (4 men, 18 women) with a mean age of 42.6±10.2 (SD) years (range: 22-63 years) with histopathologically confirmed HEMAL were included in the study. Forty-four patients (30 men, 14 women) with a mean age of 57.3±15.9 years (range: 19-85 years) with histopathologically confirmed NBNC-HCC were randomly selected from our institution's database as a control group. The CEUS characteristics of the two groups were compared.
On conventional ultrasound, significant differences in tumor diameter were found between HEAML (4.0±2.0 [SD] cm; range: 1.3-8.9cm) and NBNC-HCC (8.4±4.4 [SD] cm; range: 1.6-18cm) (P<0.001) as well as in degrees of enhancement during the portal (P=0.001) and late phases (P=0.003), contrast distribution (P<0.001) and absence of pseudocaspule (P<0.001). On CEUS, hyperenhancement during the arterial phase was observed in 21/22 (95.5%) HEAMLs and in 43/44 (97.7%) NBNC-HCCs (P>0.999). Homogeneous enhancement was more frequent in HEAMLs (20/22; 90.9%) than in NBNC-HCCs (13/44; 29.6%) (P<0.001). Pseudocapsule was observed in 0/22 HEAMLs (0.0%) and in 36/44 NBNC-HCCs (81.8%) (P=0.017). A prolonged enhancement was observed in 5/22 HEAMLs (22.7%) and in 0/44 NBNC-HCCs (0.0%) (P<0.001) during the late phase.
CEUS with sulphur hexafluoride microbubbles is helpful in discriminating between HEAML and NBNC-HCC. Homogeneous enhancement and lack of pseudocapsule are suggestive features for the diagnosis of HEAML.
本研究旨在回顾性比较肝上皮样血管平滑肌脂肪瘤（HEAML）与乙肝表面抗原和丙肝抗体均为阴性的肝细胞癌（NBNC-HCC）在使用六氟化硫微泡的对比增强超声（CEUS）检查中的影像学特征。
本研究纳入了22例经组织病理学确诊为HEAML的患者（4例男性，18例女性），平均年龄42.6±10.2（标准差）岁（范围：22 - 63岁）。从本机构数据库中随机选取44例经组织病理学确诊为NBNC-HCC的患者（30例男性，14例女性）作为对照组，平均年龄57.3±15.9岁（范围：19 - 85岁）。比较两组的CEUS特征。
在常规超声检查中，HEAML（4.0±2.0[标准差]cm；范围：1.3 - 8.9cm）与NBNC-HCC（8.4±4.4[标准差]cm；范围：1.6 - 18cm）在肿瘤直径上存在显著差异（P<0.001），在门静脉期（P = 0.001）和延迟期的增强程度（P = 0.003）、造影剂分布（P<0.001）以及有无假包膜（P<0.001）方面也存在显著差异。在CEUS检查中，21/22（95.5%）的HEAML在动脉期表现为高增强，43/44（97.7%）的NBNC-HCC在动脉期表现为高增强（P>0.999）。HEAML中均匀增强更为常见（20/22；90.9%），而NBNC-HCC中均匀增强较少见（13/44；29.6%）（P<0.001）。22例HEAML中0例（0.0%）观察到假包膜，44例NBNC-HCC中有36例（81.8%）观察到假包膜（P = 0.017）。在延迟期，5/22（22.7%）的HEAML观察到延迟增强，44例NBNC-HCC中0例（0.0%）观察到延迟增强（P<0.001）。
使用六氟化硫微泡的CEUS有助于鉴别HEAML和NBNC-HCC。均匀增强和无假包膜是诊断HEAML的提示性特征。
