Samad S A, Maimunah A, Zulfiqar A, Zaharah M
Department of Radiology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur.
Med J Malaysia. 1995 Mar;50(1):82-6.
The sonographic and CT appearances of 9 large cavernous hemangiomas of the liver were studied. On sonography, 6 masses (67%) exhibit heterogenous echo pattern; where in 2 patients the echotexture was a mixture of hypoechoic and isoechoic areas and in 4 patients there are varying amounts of bright hyperreflective areas similar to the texture typical of small hemangiomas. The masses were predominantly hypoechoic in the remaining 3 patients (33%). Incremental bolus or bolus-infusion dynamic CT showed peripheral contrast enhancement of varying intensities and thickness in all patients. The lesions were incorrectly diagnosed as hepatomas in 4 patients, suspected as hemangiomas with a differential diagnosis of hepatomas in 4 patients and an early liver abscess in 1 patient. It is concluded that large cavernous hemangiomas of the liver do not exhibit the typical homogenous hyperreflective echotexture as exhibited by small lesions and they mimic primary and secondary hepatic neoplasms. However, the diagnosis of hemangioma should be entertained when such a mass contains bright hyperechoic areas within its heterogenous echo pattern and exhibit peripheral enhancement on contrast enhanced CT. In addition to correlation with appropriate clinical information, confirmation of diagnosis include delayed scanning during a routine incremental bolus dynamic CT, single-slice dynamic contrast enhanced CT, angiography or isotope scintigraphy and magnetic resonance imaging depending on the availability of facility.
对9例肝脏巨大海绵状血管瘤的超声及CT表现进行了研究。超声检查时，6个肿块（67%）表现为不均匀回声模式；其中2例患者的回声纹理为低回声区和等回声区的混合，4例患者有不同数量的明亮高回声区，类似于小血管瘤的典型纹理。其余3例患者（33%）的肿块主要为低回声。团注增强或团注动态CT显示所有患者的病变周边有不同强度和厚度的对比剂强化。4例患者的病变被误诊为肝癌，4例患者疑似血管瘤但需与肝癌鉴别诊断，1例患者被误诊为早期肝脓肿。结论是，肝脏巨大海绵状血管瘤并不表现出小病变所具有的典型均匀高回声纹理，且它们类似原发性和继发性肝脏肿瘤。然而，当这样的肿块在其不均匀回声模式内包含明亮的高回声区且在增强CT上表现为周边强化时，应考虑血管瘤的诊断。除了与适当的临床信息相关外，诊断的确认还包括在常规团注动态CT期间进行延迟扫描、单层动态对比增强CT、血管造影或同位素闪烁扫描以及磁共振成像，具体取决于设备的可用性。
