CT imaging and quantitative analysis in the differential diagnosis of hepatic epithelioid hemangioendothelioma and hepatic metastasis

Objective To study the use of abdominal enhanced CT imaging and quantitative index analysis in the differential diagnosis of hepatic epithelioid hemangioendothelioma (HEH) and hepatic metastasis. Methods A study group of 12 patients with HEH who underwent abdominal enhanced CT scanning at the First Affiliated Hospital of Zhengzhou University from February 2014 to October 2018 was retrospectively compared with a control group of 52 patients with hepatic metastases diagnosed clinically and by imaging examinations. The general information and imaging data of these patients were collected and analyzed. Results The lesions in the 2 groups mainly presented as multiple and diffuse lesions. The diffuse lesions of HEH often fused into strips. The hepatic metastasis group showed a higher CT attenuation and TNR in the portal vein phase than the HEH group (P<0.05). The area under the ROC curves of the two indexes were 0.756 and 0.841 respectively. The centers of the lesions showed almost no or slightly homogeneous enhancement in the HEH group, while the liver metastasis group showed slightly and moderately heterogeneous enhancement, with a significant difference between the two groups (P<0.05). Female, subcapsular distribution, capsular contraction, target ring sign and lollipop sign were independent risk factors for HEH (P<0.05), while a high CT attenuation and TNR in the portal vein phase, elevated tumor markers and lymph node metastasis were independent risk factors for liver metastasis on logistic regression analysis (P<0.05). Conclusions CT attenuation, TNR, central enhancement features in the portal vein phase, special signs and secondary changes of lesions were helpful for the differential diagnosis between HEH and liver metastasis. Key words: Hemangioendothelioma, epithelioid; Hepatoma; Tomography, X-ray computed; Tumor metastasis; Differential diagnosis