肝脏多灶性结节状脂肪浸润的影像诊断与鉴别诊断
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摘要
目的:探讨肝脏多灶性结节状脂肪浸润(HMNFI)的MSCT和MRI影像特点。方法:回顾性分析2017年1月—2018年3月经手术病理及随访复查证实的10例HMNFI;10例均行MSCT和MRI平扫+增强扫描,对结节数量、部位、大小、密度/信号、形态、强化程度和方式进行评估。结果:8例表现为肝实质内弥漫分布的多发结节,2例为孤立结节;10例MSCT平扫均为不均匀稍低密度;10例在MRI同相位病灶呈稍高信号,反相位呈低信号,T2WI脂肪抑制序列1例孤立结节表现为稍低信号,在其余序列所有结节均未见确切显示;MSCT和MRI增强扫描强化方式一致,结节强化程度始终低于正常肝实质,强化曲线与肝实质一致或在门脉期及延迟扫描相对肝实质略下降。结论:MSCT及MRI成像能够明确显示HMNFI的影像特点,尤其是MRI同反相位对诊断与鉴别诊断有重要参考价值。
Objective: To discuss the imaging characters of MSCT and MRI in hepatic multifocal nodular fatty infiltration.Methods: 10 cases of hepatic focal nodular fatty infiltration were diagnosed by histopathologic examination from January 2017 to March 2018. They were examined by plain and enhanced scan with MSCT and MRI, and retrospectively analyzed for the nodules number, location, size, density/signal, shape, degree and pattern of enhancement. Results: 8 cases were multiple nodules, and the other 2 showed isolated nodule. 10 cases of the lesions were low density in MSCT. All the lesions were with hyper-intensity on in-phase(IP) images and hypo-intensity on out-of-phase(OP) images. 1 case with isolated nodule showed a slightly hypo-intensity on T2-FS. All the lesions didn't show in other MRI sequences. The pattern of enhancement in MSCT and MRI showed the same way. The degree of enhancement of the lesions were lower than that of liver parenchyma, the curve of reinforcement of the lesions were the same as the liver parenchyma or slightly lower in portal and delayed scanning.Conclusion: MSCT and MRI imaging can clearly display the features of HMNFI, especially on the in-phase and out-of-phase images, which are helpful for accurate diagnosis.
Objective: To discuss the imaging characters of MSCT and MRI in hepatic multifocal nodular fatty infiltration.Methods: 10 cases of hepatic focal nodular fatty infiltration were diagnosed by histopathologic examination from January 2017 to March 2018. They were examined by plain and enhanced scan with MSCT and MRI, and retrospectively analyzed for the nodules number, location, size, density/signal, shape, degree and pattern of enhancement. Results: 8 cases were multiple nodules, and the other 2 showed isolated nodule. 10 cases of the lesions were low density in MSCT. All the lesions were with hyper-intensity on in-phase(IP) images and hypo-intensity on out-of-phase(OP) images. 1 case with isolated nodule showed a slightly hypo-intensity on T2-FS. All the lesions didn't show in other MRI sequences. The pattern of enhancement in MSCT and MRI showed the same way. The degree of enhancement of the lesions were lower than that of liver parenchyma, the curve of reinforcement of the lesions were the same as the liver parenchyma or slightly lower in portal and delayed scanning.Conclusion: MSCT and MRI imaging can clearly display the features of HMNFI, especially on the in-phase and out-of-phase images, which are helpful for accurate diagnosis.
引文
[1]李勤勍,杨军,丁莹莹,等.肝脏多灶性结节状脂肪浸润的CT和MRI诊断[J].临床放射学杂志,2015,34(11):1845-1848.
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[9]Tebala GD,Jwad A,Khan AQ,et al.Multifocal Nodular Fatty Infiltration of the Liver:A Case Report of a Challenging Diagnostic Problem[J].Am J Case Rep,2016,17(3):196-202.
[10]Siripongsakun S,Lee JK,Raman SS,et al.MRI detection of intratumoral fat in hepatocellular carcinoma:potential biomarker for a more favorable prognosis[J].AJR,2012,199(5):1018-1025.
[11]Min JH,Kim YK,Lim S,et al.Prediction of microvascular invasion of hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging:Impact of intra-tumoral fat detected on chemical-shift images[J].Eur J Radiol,2015,84(6):1036-1043.
[12]任洪伟,安维民,董景辉,等.扩散加权成像对肝脏常见含脂质肿瘤的鉴别诊断[J].中国医学影像学杂志,2017,25(6):457-460;464.
[13]张学琴,陆健,王霄英,等.DWI对乙肝肝硬化背景微小肝癌(≤1 cm)的检测价值[J].实用放射学杂志,2015,31(2):247-250.
[14]张岩岩,张琦,李宏军.HBV相关肝硬化结节演变的多模态MRI研究[J].放射学实践,2017,32(1):37-42.
[15]夏林峰,闫瑞芳,闫海龙,等.多b值DWI对肝脏局灶性占位性病变的诊断价值研究[J].中国医学计算机成像杂志,2016,22(2):138-142.
[16]霍英杰,袁静,杨景震,等.3.0T MRI在肝癌随访中检出新发微小癌灶的影像研究[J].中国临床医学影像杂志,2014,25(2):98-102.
[17]王亚婷,朱艳,陆洋,等.表观弥散系数平均值及最小值与肝癌病理学特征的相关性研究[J].中国临床医学影像杂志,2017,28(11):805-809.
[18]黄雅琴,饶圣祥,曾蒙苏,等.原发性肝透明细胞癌的CT及MRI表现[J].实用放射学杂志,2014,30(11):1842-1844.
[2]Korncke TJ,Taupitz M,Kivelitz D,et al.Multifocal nodular fatty infiltration of the liver mimicking metastatic disease on CT:imaging findings and diagnosis using MR imaging[J].Eur Radiol,2000,10(7):1095-1100.
[3]Loomis AK,Kabadi S,Preiss D,et al.Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease:Two Electronic Health Record Prospective Studies[J].J Clin Endocrinol Metab,2016,101(3):945-952.
[4]Singh D,Das CJ,Baruah MP.Imaging of non-alcoholic fatty liver disease:A road less travelled[J].Indian J Endocrinol Metab,2013,17(6):990-995.
[5]宋彬.肝脏脂肪变性的CT与MR定量研究[J].放射学实践,2017,32(5):434-435.
[6]Pais TP,Fernandes S,Fraga J.Multiple liver lesions of unusual benign etiology mimicking metastatic disease[J].Gastroenterology,2014,147(2):e10-11.
[7]Parente DB,Oliveira Neto JA,de Araújo ALE,et al.Fat-containing liver lesions:a pictorial review[J].Radiol Bras,2018,51(1):52-57.
[8]Tamai H,Shingaki N,Oka M,et al.Multifocal nodular fatty infiltration of the liver mimicking metastatic liver tumors:diagnosis using the liver-specific late phase of Levovist-enhanced sonography[J].J Ultrasound Med,2006,25(3):403-406.
[9]Tebala GD,Jwad A,Khan AQ,et al.Multifocal Nodular Fatty Infiltration of the Liver:A Case Report of a Challenging Diagnostic Problem[J].Am J Case Rep,2016,17(3):196-202.
[10]Siripongsakun S,Lee JK,Raman SS,et al.MRI detection of intratumoral fat in hepatocellular carcinoma:potential biomarker for a more favorable prognosis[J].AJR,2012,199(5):1018-1025.
[11]Min JH,Kim YK,Lim S,et al.Prediction of microvascular invasion of hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging:Impact of intra-tumoral fat detected on chemical-shift images[J].Eur J Radiol,2015,84(6):1036-1043.
[12]任洪伟,安维民,董景辉,等.扩散加权成像对肝脏常见含脂质肿瘤的鉴别诊断[J].中国医学影像学杂志,2017,25(6):457-460;464.
[13]张学琴,陆健,王霄英,等.DWI对乙肝肝硬化背景微小肝癌(≤1 cm)的检测价值[J].实用放射学杂志,2015,31(2):247-250.
[14]张岩岩,张琦,李宏军.HBV相关肝硬化结节演变的多模态MRI研究[J].放射学实践,2017,32(1):37-42.
[15]夏林峰,闫瑞芳,闫海龙,等.多b值DWI对肝脏局灶性占位性病变的诊断价值研究[J].中国医学计算机成像杂志,2016,22(2):138-142.
[16]霍英杰,袁静,杨景震,等.3.0T MRI在肝癌随访中检出新发微小癌灶的影像研究[J].中国临床医学影像杂志,2014,25(2):98-102.
[17]王亚婷,朱艳,陆洋,等.表观弥散系数平均值及最小值与肝癌病理学特征的相关性研究[J].中国临床医学影像杂志,2017,28(11):805-809.
[18]黄雅琴,饶圣祥,曾蒙苏,等.原发性肝透明细胞癌的CT及MRI表现[J].实用放射学杂志,2014,30(11):1842-1844.