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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (4): 439-445    DOI: 10.3785/j.issn.1008-9292.2019.08.15
    
Prenatal diagnosis and management of fetal hepatic hemangioma
ZHANG Dandan(),WANG Junmei*()
Department of Ultrasonography, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Abstract  

Objective: To review the application of medical imaging in diagnosis and management of fetal hepatic hemangioma. Methods: Clinical data and imaging findings of 14 cases of fetal hepatic hemangioma, who were diagnosed prenatally and followed up in Women's Hospital of Zhejiang University School of Medicine from February 2014 to September 2018 were retrospective reviewed. Results: The fetal hepatic hemangiomas were single lesions in all 14 cases, and most of them were located in the right lobe of the liver (13/14). Ultrasound images were mainly hypoechoic with heterogeneity, the honeycomb-like or grid-like anechoic regions were presented in 9 lesions and circumferential blood flow was observed with low to moderate blood flow resistance index. MRI findings showed well-defined lesions with low signal intensity on T1WI, and high or slightly high signal intensity on T2WI. Among 14 cases, there were 8 cases of induced labor and 6 cases of continuing pregnancy. In 6 cases of successful delivery, 2 were treated with propranolol, 4 cases were followed-up without treatment. The growth and development of 6 children were normal. The lesions of hepatic hemangioma showed no significant changes in 3 children and were reduced in the other 3 children, of whom the lesion was complete disappeared in 1 case. Conclusions: Fetal hepatic hemangiomas present relatively typical imaging characteristics, and prenatal diagnosis can be made with ultrasound and MRI. If there are no complications, the fetus with hepatic hemangioma can be delivered at full term with a good outcome.



Key wordsPrenatal diagnosis      Liver neoplasms/diagnostic imaging      Hemangioma/diagnostic imaging      Ultrasonography, prenatal      Magnetic resonance imaging      Retrospective studies     
Received: 04 April 2019      Published: 30 October 2019
CLC:  R714.5  
  R715  
Corresponding Authors: WANG Junmei     E-mail: 5517061@zju.edu.cn;wangjmxin@zju.edu.cn
Cite this article:

ZHANG Dandan,WANG Junmei. Prenatal diagnosis and management of fetal hepatic hemangioma. J Zhejiang Univ (Med Sci), 2019, 48(4): 439-445.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.08.15     OR     http://www.zjujournals.com/med/Y2019/V48/I4/439


胎儿肝血管瘤的产前影像学诊断和管理

目的: 探讨胎儿肝血管瘤的产前诊断和处理方法。方法: 回顾性分析浙江大学医学院附属妇产科医院2014年2月至2018年9月产前诊断并随访的14例胎儿肝血管瘤病例,观察胎儿产前超声和MRI表现,总结其影像学特征,随访其结局。结果: 14例胎儿肝血管瘤病例均为单发病灶,多位于肝右叶(13例),超声表现以低回声为主,内部回声不均,9例患儿的病灶内见“蜂窝状”或“网格状”无回声,病灶周边见环状血流,或可见分支进入内部,测得低至中等血流阻力指数。MRI表现为T1加权像呈低信号、稍低信号,T2加权像呈高信号、稍高信号。14例胎儿中引产8例;继续妊娠6例,均足月分娩,患儿出生后经影像学方法诊断肝血管瘤,其中2例患儿口服普萘洛尔,4例患儿未予治疗,定期复查。随访结果显示,6例患儿生长发育情况与同龄儿无异,3例患儿肝血管瘤病灶无明显变化,3例患儿病灶逐渐缩小,其中1例完全消失。结论: 胎儿肝血管瘤有相对典型的影像学特征,结合超声和MRI检查结果可实现产前诊断。如无并发症,肝血管瘤胎儿可足月分娩,并且预后良好。


关键词: 产前诊断,  肝肿瘤/影像学诊断,  血管瘤/影像学诊断,  超声检查, 产前,  磁共振成像,  回顾性研究 
Fig 1 Two-dimensional ultrasound and MRI images of fetal hepatic hemangioma
Fig 2 Color doppler ultrasound image of fetal hepatic hemangioma
序号 孕妇年龄(岁) 孕周(周) 病灶位置 超声表现 MRI表现 妊娠结局 诊断 随访
大小(cm) 回声 血流
“—”无相关资料;*羊水指数19.5 cm;#心胸比增大(>1/2).T1WI:T1加权像;T2WI:T2加权像;DWI:弥散加权成像;RI:阻力指数.
1 36 38 肝右叶 4.3× 3.2× 3.5 不均低回声,边界清,内见迂曲条状无回声 环状血流并见分支进入肿块内部 T1WI呈低信号,T2WI呈不均匀高信号,DWI未见明显弥散受限 阴道分娩活产胎儿 肝血管瘤 定期复查,病灶无明显变化
2 31 37 肝右叶 4.2× 4.1× 4.3 不均回声,界尚清,内可见无回声,见液体样流动 周边见环状血流信号,RI=0.5 T1WI呈低信号,T2WI稍高信号影,DWI未见明显弥散受限 剖宫产分娩活产胎儿 肝血管瘤 口服普萘洛尔,复查中病灶逐渐变小
3 28 31 肝右叶 3.8× 3.8× 3.2 不均低回声,似“蜂窝状”,边界清 周边见环状血流 T1WI见病灶中央部分呈高/低混杂信号,周边部分呈环状高信号,T2WI呈稍高信号、信号不均。DWI未见明显弥散受限 剖宫产分娩活产胎儿 肝血管瘤 未予治疗,复查中病灶未见明显增大
4 25 34 肝右叶 5.7× 4.8× 5.0 不均回声,内散在无回声,边界尚清 周边见血流信号 T1WI呈低信号,T2WI呈稍高信号,DWI未见明显弥散受限 剖宫产分娩活产胎儿 肝血管瘤 口服普萘洛尔,复查中病灶逐渐变小,2年后完全消退
5 27 35 肝右叶 0.9× 0.6× 0.7 低回声边界清 未见明显血流信号 阴道分娩活产胎儿 肝血管瘤 定期复查,无明显变化
6 28 38 肝右叶 2.4× 2.0× 1.6 低回声边界尚清 内见少许血流信号 T1WI呈稍低信号,T2WI呈稍高信号,DWI未见明显弥散受限 阴道分娩活产胎儿 肝血管瘤 定期复查, 病灶稍缩小
7 30 38 肝左叶 6.9× 7.9× 6.0 不均低回声,边界尚清,内见多个“蜂窝状”暗区 周边见血流信号 T1WI呈稍低信号,T2WI呈稍高信号,DWI未见明显弥散受限 引产 肝海绵状血管瘤
8 21 37 肝右叶 5.9× 5.9× 5.1 低回声,边界清 周边见血流信号 T1WI呈稍低信号,T2WI呈稍高信号,DWI未见明显弥散受限 引产 肝血管内皮细胞瘤
9* 23 31 肝右叶 6.6× 5.8× 4.7 不均回声,内呈蜂窝状 周边见环状血流,RI=0.48 T1WI呈稍低信号,T2WI呈稍高信号为主,夹杂条片状高信号 引产 肝海绵状血管瘤
10 25 35 肝右叶 4.4× 3.0× 3.8 不均低回声,见“蜂窝状”暗区,边界尚清 周边见环状信号 T1WI呈稍低信号T2WI呈稍高信号,DWI未见明显弥散受限 引产 肝血管内皮细胞瘤
11 27 40 肝右叶 2.2× 2.2× 1.5 低回声边界清 周边见环状血流,内部见散在血流 T1WI呈低信号,T2WI呈高信号,DWI未见明显弥散受限 引产 肝海绵状血管瘤
12# 29 36 肝右叶 12.5× 7.3× 8.6 不均质强回声,内部呈网格状回声 周边见血流信号,RI=0.61 T1WI呈稍低信号,T2WI呈稍高信号,局部信号欠均,弥散加权成像未见弥散受限 引产 肝海绵状血管瘤
13 27 37 肝右叶 3.2× 3.2× 2.8 低回声边界清 周边见环状血流,内见条状血流RI=0.55 引产 肝海绵状血管瘤
14 26 26 肝右叶 7.7× 6.6× 5.6 不均低回声,边界清,内见多个无回声 周边见环状血流,见分支血流进入肿块内部 引产 肝海绵状血管瘤
Tab 1 Prenatal ultrasound, MRI findings and outcomes of 14 fetal hepatic hemangioma cases
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