移植肝少见肿瘤或肿瘤样病变的影像学表现

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。

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

Objective To investigate the imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation. Methods Imaging data of 4 patients with rare tumors or tumor-like lesions in the liver grafts of patients after liver transplantation from December 2006 to August 2013 in the Third Affiliated Hospital of Sun Yat-sen University were reviewed. Findings of computerized tomography （ CT ） and （ or ） magnetic resonance imaging （ MR1 ） plain scan and dynamic enhanced MRI of liver lesions in these patients were analyzed specially. Results In the 4 patients, 3 cases were misdiagnosed, including undifferentiated liver sarcoma, secondary lymphoma and eosinophilic granuloma. One case was diagnosed correctly with hepatic metastases of gallbladder carcinoma. The undifferentiated liver sarcomas appeared as cystic and solid space occupying masses with significant and persistent enhancement in the surrounding solid and separating parts. No enhancement was observed in the cystic parts, which increased rapidly in a short term. No edema area around the lesions was observed, but many calcifications were detected. The secondary hepatic lymphoma appeared as intrahepatie multiple nodules, most of which presented uniform signal intensity with moderate enhancement in every phase. No intrahepatic vascular invasion was observed but extrahepatic lymphadenectasis was detected. Bleeding was observed in a few lesions. The fiver eosinophilic granuloma appeared as multiple liver lesions with variable signal intensity and enhancement modes, which suggested that the lesions were consisted of variety ofelements and in the different disease stages. Most of the lesions were observed with progressive circled enhancement. The recurrence of gallbladder carcinoma and hepatic metastasis after liver transplantation appeared as a intrahepatic hypodensity lesion with slight enhancement in arterial phase and slight hypodensity in portal phase. Retroperitoneal lymph nodes were observed swelled and fused. Conclusions Rare tu