目的:鉴别肝上皮样血管内皮瘤(EHE)和血管肉瘤(AS),肝脏中两种最常见的血管瘤,是重要的,因为在他们的预后和治疗的差异。我们旨在比较这两种肿瘤的临床和MRI特征。
方法:这项回顾性研究包括经病理证实的AS或EHE患者,他们在2008年至2023年之间使用gadoxetate二钠进行了MRI检查。两名放射科医生独立审查了MR图像。使用Wilcoxon秩和和Fisher精确检验来比较临床和影像学特征。使用3年的限制性平均生存时间比较总生存期。
结果:32例AS患者(18例女性[56.3%];中位年龄,包括68岁)和38名EHE患者(24名女性[63.2%];51岁)。AS患者年龄普遍较大(81.3%≥60岁;P<0.001),有更频繁的实验室异常(P≤0.018),和较差的总生存率(11.2vs.31.8个月;P<0.001)。核磁共振成像,一个大的显性肿块伴有较小的结节(14/32,43.8%),通常边缘不明确(15/32,46.9%)在AS中普遍存在;与EHE中边缘明确(30/38,78.9%;P=0.002)的大小相似的结节(24/38,63.2%;P=0.015)相比。肝硬化在AS中更常见(62.5%,P<0.001),随着肝胆期实质增强的减少(31.3%,P<0.001)和腹水(37.5%,P=0.010)。经常表现为异常形状的病灶的强烈增强,具有离心增强模式。相比之下,Targetoid外观是EHE的特征(T2加权的78.9%,扩散加权54.1%,多相图像为65.8%)(P≤0.002),增强程度通常低于主动脉。在肝胆阶段,所有的AS都表现出低强度,而39.5%的EHE表现为靶向性(P<0.001)。
结论:年龄≥60岁的患者出现实验室异常,通常具有大的显性肿块,伴有较小的结节,展示狂热,离奇,和离心增强-特别是在出现肝硬化的肝脏中-提示AS超过EHE的可能性。
OBJECTIVE: Differentiating hepatic epithelioid hemangioendothelioma (EHE) and angiosarcoma (AS), the two most common vascular tumors in the liver, is important due to disparities in their prognosis and treatment. We aimed to compare clinical and MRI features of the two tumors.
METHODS: This retrospective study included patients with pathologically-confirmed AS or EHE who underwent MRI using gadoxetate disodium between 2008 and 2023. Two radiologists independently reviewed MR images. Wilcoxon rank sum and Fisher\'s exact tests were used to compare clinical and imaging features. Overall survival was compared using restricted mean survival time at 3 years.
RESULTS: 32 patients with AS (18 women [56.3%]; median age, 68 years) and 38 with EHE (24 women [63.2%]; 51 years) were included. Patients with AS were generally older (81.3% ≥ 60 years; P < 0.001), had more frequent laboratory abnormalities (P ≤ 0.018), and poorer overall survival (11.2 vs. 31.8 months; P < 0.001) than those with EHE. On MRI, a large dominant mass accompanied by smaller nodules (14/32, 43.8%), often with ill-defined margins (15/32, 46.9%) was prevalent in AS; compared with nodules of similar sizes (24/38, 63.2%; P = 0.015) with well-defined margin (30/38, 78.9%; P = 0.002) in EHE. Cirrhotic appearance of the liver was more frequent in AS (62.5%, P < 0.001), along with decreased parenchymal enhancement on hepatobiliary phase (31.3%, P < 0.001) and ascites (37.5%, P = 0.010). AS frequently presented with avid enhancement of bizarrely-shaped foci, with a centrifugal enhancement pattern. In comparison, targetoid appearance was characteristic of EHE (78.9% on T2-weighted, 54.1% on diffusion-weighted, 65.8% on multiphase images) (P ≤ 0.002), with enhancement degree typically lower than that of the aorta. On hepatobiliary phase, all the AS exhibited hypointensity, while 39.5% of EHE showed targetoid appearance (P < 0.001).
CONCLUSIONS: Patients aged ≥ 60 years presenting with laboratory abnormalities, typically with a large dominant mass accompanied by smaller nodules, exhibiting avid, bizarre, and centrifugal enhancement-particularly in the cirrhotic-appearing liver-suggests the likelihood of AS over EHE.