Hepatic angiomyolipoma (HAML) comprises epithelioid angiomyolipoma (EAML) and classic hepatic angiomyolipoma (CAML). The imaging appearance of HAML varies widely, and EAML is more easily misdiagnosed as hepatocellular carcinoma (HCC) than as CAML. The clinical and contrast-enhanced ultrasound (CEUS) features of CAML, EAML and HCC with negative alpha-fetoprotein protein expression (HCC[AFP–]) were retrospectively reviewed. The hyper-vascular type was more commonly found in CAML and EAML lesions than in HCC lesions. Most lesions were hyper-enhanced in the arterial phase. CAMLs showed prolonged hyper-enhancement or iso-enhancement during the portal and late phases on CEUS, making them easily distinguishable from HCC(AFP–). Some EAML lesions (41.7%) were hypo-echoic, similar to HCC(AFP–). However, the hypo-enhancement of EAML lesions occurred later than that of HCC(AFP–) lesions. Thus, our findings may be useful in distinguishing among these lesions to improve diagnostic accuracy.

肝血管平滑肌脂肪瘤（HAML）包括上皮样血管平滑肌脂肪瘤（EAML）和经典的肝血管平滑肌脂肪瘤（CAML）。HAML的影像表现差异很大，EAML比CAML更容易误诊为肝细胞癌（HCC）。回顾性回顾了甲胎蛋白表达阴性 (HCC[AFP–]) 的 CAML、EAML 和 HCC 的临床和对比增强超声 (CEUS) 特征。与 HCC 病变相比，CAML 和 EAML 病变中更常见的血管类型。大多数病变在动脉期过度增强。CAMLs 在 CEUS 的门静脉期和晚期显示出长时间的超增强或等增强，使它们很容易与 HCC（AFP-）区分开来。一些 EAML 病变 (41.7%) 是低回声，类似于 HCC(AFP–)。然而，EAML 病灶的低增强发生晚于 HCC（AFP-）病灶。因此，我们的发现可能有助于区分这些病变以提高诊断准确性。