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  • Title: [MRI manifestations of 40 cases with the hepatic epithelioid hemangioendothelioma classification based on the morphology and size].
    Author: Lu Q, Chen LL, Zeng MS, Wang ML.
    Journal: Zhonghua Gan Zang Bing Za Zhi; 2024 Jun 20; 32(6):545-550. PubMed ID: 38964897.
    Abstract:
    Objective: To explore the MRI characteristics of the hepatic epithelioid hemangioendothelioma (HEHE) classification according to morphology and size. Methods: The clinical, pathological, and MRI imaging data of 40 cases with HEHE confirmed pathologically from December 2009 to September 2021 were retrospectively analyzed. A paired sample t-test was used for comparison between the two groups. Results: There were 40 cases (5 solitary, 24 multifocal, 9 local fusion, and 2 diffuse fusion) and 214 lesions (163 nodules, 31 masses, and 20 fusion foci). The most common features of lesions were subcapsular growth and capsular depression. The signal intensity of lesions ≤1cm was usually uniform with whole or ring enhancement. Nodules and mass-like lesions ≥1cm on a T1-weighted image had slightly reduced signal intensity or manifested as a halo sign. Target signs on a T2-weighted image were characterized by: target or centripetal enhancement; fusion-type lesions; irregular growth and hepatic capsular retraction, with ring or target-like enhancement in the early stage of fusion and patchy irregular enhancement in the late stage; blood vessels traversing or accompanied by malformed blood vessels; focal bleeding; an increasing proportion of extrahepatic metastases and abnormal liver function with the type of classified manifestation; primarily portal vein branches traversing; and reduced overall intralesional bleeding rate (17%). Lollipop signs were presented in 19 cases, with a high expression rate in mass-type lesions (42%). The fusion lesions were expressed, but the morphological manifestation was atypical. The diffusion-weighted imaging mostly showed high signal or target-like high signal. An average apparent diffusion coefficient of lesions was (1.56±0.36) ×10(-3)mm(2)/s, which was statistically significantly different compared with that of adjacent normal liver parenchyma (t=8.28, P<0.001). Conclusion: The MRI manifestations for the HEHE classification are closely related to the morphology and size of the lesions and have certain differences and characteristics that are helpful for the diagnosis of the disease when combined with clinical and laboratory examinations. 目的： 探讨肝脏上皮样血管内皮瘤（HEHE）按照形态学及大小分类的MRI特征。 方法： 回顾性分析2009年12月至2021年9月经病理证实的40例HEHE患者的临床、病理及MRI影像资料。两组间比较采用配对样本t检验。 结果： 40例病例（5例孤立型、24例多灶型、9例局部融合、2例弥漫融合）214个病灶（163个结节、31个肿块、20个融合灶）；包膜下生长及引起包膜凹陷是大多数病灶的共性；≤1 cm病灶信号常均匀，整体或环形强化；≥1 cm结节及肿块型病灶T1加权成像稍低信号或表现为晕征，T2加权成像靶征为其特点，靶样或向心性强化；融合型病灶常不规整匍匐于肝包膜下生长，融合早期环形或靶样强化，晚期絮片状不规整强化；血管穿行或伴畸形血管、灶内出血，肝外转移及肝功能异常比例增高随分型表现率递增，穿行血管多为门静脉分支，灶内出血率总体不高（17%）；19例患者表现出"棒棒糖"征，且肿块型病灶表达率高（42%），融合性病灶即使表达但形态学表现不典型；弥散加权成像大多表现为高信号或靶样高信号，病灶的平均表观扩散系数值为（1.56±0.36）×10(-3)mm(2)/s，较邻近正常肝实质差异具有统计学意义（t = 8.28，P < 0.001）。 结论： HEHE的MRI表现与病灶的形态、大小分类关系密切，具有一定差异性及特征性，结合临床及实验室检查，有助于疾病的诊断。.
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