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1、肝脏血管平滑肌脂肪瘤的影像学及病理学分析―――付10例报道并文献复习张鑫严森祥肖文波许顺良作者单位：310003，杭州，浙江大学医学院第一附属医院放射科摘要目的分析肝脏血管平滑肌脂肪瘤的CT及MR的影像学特点与病理基础，减少对该肿瘤的误诊。材料与方法回顾性分析10例11个病灶肝血管平滑肌脂肪瘤的CT及MR的影像学表现，按不同病理组织学亚型进行对照分析。结果10例肝脏血管平滑肌脂肪瘤中，脂瘤型3例，血管瘤型1例，肌瘤型1例，混合型5例。脂瘤型以脂肪成分为主，CT、MR均可显示脂肪密度或信号。血管瘤型以血管成分为主，
2、CT、MR增强可见动脉期明显强化，门静脉期密度或信号仍高于同期肝实质。肌瘤型主要是由平滑肌成分为主，脂肪成分很少，混合型三种成分含量相似，CT平扫为较均匀低密度，MR平扫T1W呈低信号，T2W呈稍高信号，增强扫描CT、MR均呈动脉期明显强化，门静脉期仍有强化。结论不同病理组织学类型的肝脏血管平滑肌脂肪瘤，CT和MR表现有所不同，这取决于肿瘤所含的主要组织学成分。了解肿瘤不同的组织学亚型与影像学表现之间的关系，有助于提高肝脏血管平滑肌脂肪瘤术前诊断准确率。关键词肝脏血管平滑肌脂肪瘤体层摄影术，X线计算机磁共振成像C
3、orrelationbetweenpathologyandimagecharacteristicsofhepaticangiomyolipomaZhangxin,Yansenxiang,Xiaowenbo,Xushunliang.DepartmentofRadiology,FirstHospital,MedicalCollegeofZhejiangUniversity,Hangzhou,31003,ChinaAbstractObjectiveTodiscusstheimagingincludingCTandMRI
4、characteristicsofhepaticangiomyolipomabasedonpathologicalfindings,withtheaimofmoreaccuratediagnosisoftherarelesionoftheliver.MaterialandMethodTenpatientswith11angiomyolipomaswereretrospectivelyanalyzed,andtheirCTandMRIappearanceswerecorrelatedwiththepathohist
5、ologicalsubtypesofthedisease.ResultsTenpatientswithhepaticangiomyolipomasweresubcategorizedintolipomatous（3cases）,angiomatous(1),myomatous(1)andmixed(5)types,wherelesionsofthelipomatoustypeweremainlycomposedofadipocyteswhichcouldbeeasilyrecognizedonbothCTandM
6、RI.Abnormalvesselswerecommonlyseenintheangiomatouslesions,whichshowedpronouncedenhancementintheearlyarterialphaseandremainedhigherthanorisodensewiththenormalparenchymaintheportalphase.Themyomatoustypewaspredominantlycomposedofleiomyoidcellsmixedwithsmallamoun
7、tofadipocytes.Themixedtypewasthemostoften,evenlycomprisingsheetsofepithelioidmusclecellsadmixedwithislandsofadipocytesandabnormalvessels,andshowinghomogeneouslylowdensityonplainCTandlowsignalintensityonT1-weighted,intermediatelyhighsignalintensityonT2-weighte
8、dMRIscans.OndynamicstudywithbothCTandMRI,themixedtypeexhibitedobviousenhancement,whichretainedtosomedegreeduringtheportalphase.ConclusionInhepaticangiomyolipomas,thereshoweddiscreteCTandM
