Specific imaging features indicate the clinical features of patients with hepatic perivascular epithelioid cell tumor by comparative analysis of CT and ultrasound imaging

Abstract

ObjectiveThe objective of the study was to explore the CT and ultrasound features and clinical significance of perivascular epithelioid cell tumor (PEComa) of the liver.MethodsEleven hepatic PEComa patients treated in our hospital were retrospectively analyzed based on the characteristics of the imaging results of the patients, including conventional ultrasound, CDFI, contrast-enhanced ultrasound (CEUS), and contrast-enhanced CT (CECT).ResultsCT scans showed that all lesions were hypodense. Ultrasonography showed that lesions were either hyperechoic (4/11, 36.36%), hypoechoic (4/11, 36.36%), isoechoic (1/11, 9.09%), or heterogeneously echoic (2/11, 18.18%). CDFI showed that most of the lesions had an abundant blood supply (9/11, 81.82%). Whether on CT scan or ultrasonography, the margins of the lesions were dominated by clear margins. Ultrasonography revealed more features: hyperechoic patterns around lesions (3/11, 27.27%) and lateral shadow (5/11, 45.45%). The CDFI showed that large blood vessels were observed around the lesions (9/11, 81.82%). CECT shows two enhancement patterns: “fast in and fast out (FIFO)” (8/11, 72.72%) and “fast in and slow out (FISO)” (3/11, 27.27%). CEUS shows that all lesions had the enhancement pattern of “FISO,” which was different from CECT. All lesions displayed rapid enhancement during HAP in CEUS during 7–20 s. Four patients (36.36%) washed out at 60–180 s, another four (36.36%) washed out at 180–300 s, and the remaining three patients (27.27%) showed no signs of washout even at 360 s.ConclusionSome imaging features, such as clear margins, peripheral hyperechoic around the lesion, lateral shadow, the large blood vessels around lesions, and the “FISO” enhancement pattern, may indicate expansive growth of the tumor and be helpful in the diagnosis of PEComa. Ultrasound images may provide more details for clinical reference.

Perivascular epithelioid cell tumors of the liver misdiagnosed as hepatocellular carcinoma: Three case reports

“…Hepatic PEComa lesions exhibit a significantly delayed washout compared with other malignant tumors, such as HCC and metastatic liver cancer. Color Doppler flow imaging demonstrated that the larger blood vessels surrounding the lesion may also represent a potential feature of hepatic PEComa[ 19 , 20 ]. Using Sonazoid ® contrast agent in CUES may assist in the diagnosis of hepatic PEComa[ 21 ].…”

Multimodal imaging study of hepatic perivascular epithelioid cell tumors: a case report

“…PEComas can occur in various parts of the body, especially in the genitourinary system, which accounts for approximately 40% of cases, followed by lung, pancreas and so on ( 2 ). In recent years, reports of hepatic PEComas have increased with increasing attention to the disease ( 3 , 4 ). The incidence of PEComas in the liver is approximately six times higher in women than in men, with a wide age range and a peak incidence in young and middle-aged individuals ( 5 ).…”