Objective To study the CT manifestations of malignant hepatic perivascular epithelioid cell carcinoma(PEComa).Methods Clinical data of nine patients undergoing surgery with histologically confirmed malignant hepatic PEComa in Yueqing People's Hospital,Wenzhou People's Hospital,and Yongjia County People's Hospital from January,2010 to June,2022 were retrospectively collected,including two males and seven females with a median age of 47(43,56)years old.The CT findings,including tumor size,shape,boundary,density,and enhancement patterns,were analyzed.Results CT scans showed that all nine tumors were single lesions.Five tumors were located in right liver lobe,three in left lobe,and one in caudate lobe.The median tumor diameter was 5.7(range,3.3-16.0)cm.In terms of tumor shape,three were round,four were quasi-circular,and two were irregular.Eight tumors had well-defined bounda-ries,while one was ill-defined.Nine tumors showed uneven densities and were lower than the adjacent liver parenchyma.Four tumors had a false capsule,one contained fatty tissue,and six had necrotic and cystic changes.In the arterial phase of contrast-enhanced CT scanning,two tumors showed moderate enhancement and seven showed significant enhancement.In the portal venous and delayed phases,enhancement decreased significantly in four cases,showing a"fast-in and fast-out"pattern.In four cases,the enhancement persis-ted,showing a"fast-in and slow-out"pattern.One case showed no enhancement in any phase but had a strip-like enhanced vessel inside the tumor.Five cases had significantly thickened vessels around the tumor.Conclusion The CT manifestations of PEComa are as follows:round or quasi-circular lesions with well-defined boundaries,uneven low densities,significant enhancement in the arterial phase and rapid washout or persistent enhancement in the portal venous and delayed phases.
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