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移植肝少见肿瘤或肿瘤样病变的影像学表现

陈炳辉 谢佩怡 全力 谢斯栋 孟晓春 单鸿

陈炳辉, 谢佩怡, 全力, 等. 移植肝少见肿瘤或肿瘤样病变的影像学表现[J]. 器官移植, 2014, 5(3): 161-168. doi: 10.3969/j.issn.1674-7445.2014.03.008
引用本文: 陈炳辉, 谢佩怡, 全力, 等. 移植肝少见肿瘤或肿瘤样病变的影像学表现[J]. 器官移植, 2014, 5(3): 161-168. doi: 10.3969/j.issn.1674-7445.2014.03.008
Chen Binghui, Xie Peiyi, Quan Li, et al. Imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(3): 161-168. doi: 10.3969/j.issn.1674-7445.2014.03.008
Citation: Chen Binghui, Xie Peiyi, Quan Li, et al. Imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(3): 161-168. doi: 10.3969/j.issn.1674-7445.2014.03.008

移植肝少见肿瘤或肿瘤样病变的影像学表现

doi: 10.3969/j.issn.1674-7445.2014.03.008
基金项目: 

国家自然科学基金 81201090

国家自然科学基金 30901465

广东省自然科学基金 S2012010008367

教育部第43批留学回国人员科研启动基金广东省科技计划项目 2010B031600053

广东省大学生创新创业训练计划项目 1055812300

详细信息
    通讯作者:

    孟晓春, Email:mengxch1972@163.com

  • 中图分类号: R617

Imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation

  • 摘要:   目的  研究移植肝少见肿瘤或肿瘤样病变的影像学表现。  方法  回顾性分析2006年12月至2013年8月间中山大学附属第三医院收治的肝移植术后移植肝少见肿瘤或肿瘤样病变的4例患者的影像学资料, 重点分析患者肝脏病变的计算机体层摄影术(CT)和(或)磁共振成像(MRI)平扫及动态增强表现。  结果  4例患者中, 误诊3例, 分别为肝未分化肉瘤、继发性淋巴瘤、嗜酸性肉芽肿; 正确诊断1例, 为胆囊癌肝转移。肝未分化肉瘤表现为囊实性占位, 周围实性部分及分隔显著持续性强化, 囊性部分无强化, 短期内迅速增大; 病灶周围无水肿带; 可见较多钙化灶。肝继发性淋巴瘤表现为肝内多发结节灶, 多数信号均匀, 增强各期强化程度较低, 不伴肝内血管侵犯, 伴随肝外淋巴结肿大; 少数病灶内见出血。肝嗜酸性肉芽肿表现为肝脏多发病灶信号及强化方式多样, 提示病灶由多种成分组成, 处于病变的不同阶段, 多数病变呈环形进行性强化表现。胆囊癌肝转移肝移植术后复发表现为肝内稍低密度灶, 动脉期轻度强化, 门静脉期呈稍低密度, 伴有腹膜后淋巴结肿大、融合。  结论  移植肝少见肿瘤或肿瘤样变的影像学征象各有特点, 影像学检查有助于早期发现上述少见移植肝肿瘤或肿瘤样病变, 结合病史及临床表现, 有助于正确诊断。

     

  • 图  1  肝移植术后未分化肉瘤的磁共振成像表现(肝移植术后6个月)

    注:肝Ⅶ段不规则形结节灶(箭头所指),A图去相位T1WI呈不均匀低信号,B图脂肪抑制T2WI病灶呈稍高信号,C图DWI序列,病灶呈不均匀稍高信号,D图和E图分别为平衡期及延迟期增强扫描,病灶周围部分进行性强化,强化范围逐渐增大,病灶内见分隔样强化

    Figure  1.  Magnetic resonance imaging findings of undifferentiated sarcoma in the liver graft at 6 months after liver transplantation

    图  2  肝移植术后未分化肉瘤的计算机体层摄影表现(肝移植术后10个月)

    注:CT检查见肝Ⅶ段病灶较前显著增大,病灶内囊变及灶周钙化均较前明显,右侧腹膜、腹壁及膈肌明显受累,多发钙化灶形成,肝周及右侧胸腔内少量积液

    Figure  2.  Computerized tomography findings of undifferentiated sarcoma in the liver graft at 10 months after liver transplantation

    图  3  肝移植术后继发性淋巴瘤的磁共振成像表现(肝移植术后6年)

    注:肝内多发结节灶,多数病灶信号均匀(短箭头所示),A图示在相位T1WI病灶呈低信号,B图示脂肪抑制T2WI病灶呈稍高信号,C图示DWI序列病灶呈高信号,D图示动脉期增强扫描,病灶轻度强化接近等信号,E图和F图分别为门静脉期及平衡期增强扫描,病灶强化程度低于周围肝实质而呈相对低信号。肝左外叶病灶(长箭头)于同相位T1WI呈高低混杂信号,脂肪抑制T2WI呈不均匀稍高信号,DWI序列呈环形高信号,增强各期(D~F图)病灶主体均无明显强化,内见斑点状强化区

    Figure  3.  Magnetic resonance imaging findings of secondary lymphoma in the liver graft at 6 years after liver transplantation

    图  4  肝移植术后嗜酸性肉芽肿的磁共振成像表现(肝移植术后25个月)

    注:肝内病灶信号多样。Ⅴ/Ⅷ段交界区炎性肉芽肿(短箭头所示)于去相位T1WI(A图)呈稍低信号,脂肪抑制T2WI(B图)呈稍高信号,DWI序列(C图)呈高信号,动脉期(D图)显著强化,门静脉期(E图)及平衡期(F图)均呈相对稍低信号。Ⅲ段病灶(长箭头所示)于去相位T1WI呈低信号,脂肪抑制T2WI病灶中央部分为稍高信号,周围见低信号环,DWI呈较高信号,动脉期病变环形强化,周围见高灌注区,门静脉期及平衡期病变呈进行性环形强化,符合脓肿及急性活动期病灶表现

    Figure  4.  Magnetic resonance imaging findings of eosinophilic granuloma in the liver graft at 25 months after liver transplantation

    图  5  胆囊癌肝转移肝移植术后复发灶的计算机体层摄影表现(肝移植术后9个月)

    注:A图CT平扫肝Ⅳ段结节(短箭头所示)呈略低密度,边界模糊;B图动脉期增强扫描,病灶轻度强化,与周围肝实质分界不清;C图静脉期增强扫描,病变呈稍低密度;D图为静脉期下方层面,见腹膜后淋巴结明显肿大(长箭头所示)

    Figure  5.  Computerized tomography findings of graft metastasis of gallbladder carcinoma at 9 months after liver transplantation

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出版历程
  • 收稿日期:  2014-02-07
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2014-05-15

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