目的分析肝上皮样血管内皮瘤（HEHE）的影像学征象及肝动脉栓塞（TAE）联合微波消融（MWA）的治疗效果。方法回顾性分析4例经肝穿刺活检病理诊断证实的HEHE患者,先行TAE术,再行MWA治疗。结果 4例患者肿瘤均为多发,直径0.6~7 cm,影像学表现各异。CT平扫为低密度,MRI扫描T_1加权成像呈低信号,T_2加权成像呈中高信号。增强扫描以周边环形强化为主,或不均匀强化,可出现＂晕征＂＂包膜回缩征＂等。数字减影血管造影（DSA）显示动脉中晚期可见肿瘤染色影,实质期染色加深,但中央区无染色。栓塞术后碘油呈环行或部分沉积。4例患者经TAE联合MWA治疗后,随访12~52个月,1例患者出现复发,余3例未见复发。未出现严重并发症。结论HEHE影像学征象为周边环形强化或不均匀强化,可见＂晕征＂＂包膜回缩征＂等。TAE联合MWA治疗HEHE是一种安全、微创、有效的方法。
Objective To analyze the imaging signs of hepatic epithelioid hemangioendothelioma（HEHE） and the effect of transhepatic arterial embolization（TAE） combined with microwave ablation（MWA） in the treatment of HEHE.Methods A retrospective analysis of 4 patients with HEHE diagnosed by pathological diagnosis of liver biopsy was performed. The patients underwent TAE, followed by MWA treatment. Results The tumors were multiple in 4 cases, and the diameter ranged from 0.6 to 7 cm. The imaging signs were different. Plain scan of CT images showed hypodense. MRI scan showed hypointensityon T1 weighed imaging（T1 WI）, isointensity-hyperintensity on T2 weighed imaging（T2 WI）. The enhanced scan was mainly based on peripheral annular enhancement, or uneven enhancement. It could appear ＂halo sign＂, ＂capsule retraction sign＂ and so on. Digital subtraction angiography（DSA） showed tumor staining in the middle and late stages of the arteries. The tumor staining showed a strong staining in the parenchymal phase, but no central staining. After embolization, lipiodol appeared to be circular or partly deposited. Four patients were followed up for 12~52 months after TAE combined with MWA, and 1 patients relapsed. There were no recurrences in the remaining 3 cases. No serious complications occurred. Conclusion The imaging sign of HEHE is peripheral annular or uneven enhancement. It can appear ＂halo sign＂, ＂capsule retraction sign＂ and so on. TAE combined with MWA is a safe, minimally invasive and effective method for the treatment of HEHE.
Beijing Medical Journal
transhepatic arterial embolization（TAE）