HYPERVASCULAR LIVER LESIONS IN RADIOLOGICALLY NORMAL LIVER

ABSTRACT Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.

摘要 研究背景：富血管性肝脏病变（hypervascular liver lesions）一直是临床诊断的难点。研究目的：旨在明确影像学检查显示肝脏正常的非血管瘤性富血管性肝病变患者发生癌变的危险因素。研究方法：本前瞻性研究纳入影像学提示肝脏正常的富血管性肝病变患者，诊断通过活检确认，或基于1年随访期内影像学表现稳定推定；排除肝硬化患者及具有典型血管瘤（haemangioma）影像学特征的病例。研究结果：本研究共纳入88例患者，平均年龄42.4岁。绝大多数病变为单发，直径多介于2~5 cm之间。约1/3的患者接受了肝脏活检。81.8%的病变为良性或高度疑似良性，12.5%的病例确诊为癌症。单因素分析显示，年龄＞45岁（p＜0.001）、个人癌症病史（p=0.020）、结节数＞3个（p=0.003）以及碱性磷酸酶（alkaline phosphatase）升高（p=0.013）为癌变的显著危险因素。研究结论：对于年龄≤45岁、丙氨酸氨基转移酶（alanine aminotransaminase）正常、结节数≤3个且无个人癌症病史的肝脏正常的富血管性肝病变患者，可安全采取随访观察策略。对于非典型病变患者实施病灶活检安全性良好，可明确大部分此类患者的后续治疗方案。