非均匀性脂肪肝声像图分型的再探讨

Further Study on Sonographic Patterns of Non—uniform Fatty Liver

51例非均匀性脂肪肝全部获得组织病理诊断,其声像图可以分为四型:Ⅰ型,局限浸润型,6例,占11.8%,好发于右半肝,呈强回声团(脂肪浸润区),易被误认为强回声型的血管瘤或肝癌;Ⅱ型,多灶浸润型,4例,占7.8%,全肝多发散在分布的强回声团,可有融合,正常肝实质为低回声区,相间其间。本型可酷似肝转移癌。Ⅲ型,叶段浸润型,7例,占13.7%。脂肪浸润区以叶段分布,界线平直,不难鉴别。Ⅳ型,弥漫非均匀浸润,残存小片正常区(低回声区),34例,占66.7%,系非均匀性脂肪肝中最常见型,易误诊为低回声肿块甚或小肝癌。非均匀性脂肪肝最大特征是无占位效应。值得注意的是在脂肪肝基础上发生的肝癌、肝转移癌,与之鉴别较困难,应作细针组织活检确诊。

Fifty—one patients with non-uniform fatty infiltration of the liver were studied by ultrasonography. The ultrasound appearances of the lesions were classified into four patterns ; pattern Ⅰ, focal infiltration(6 cases), it showed a focal highperechoic area and might be confused with echogenic hemangioma or hepatoma; pattern Ⅱ, multiple nodular infiltration (4 cases), the livers were characterized by multiple hyperechoic 'nodules' mixed with hypoechoic sparing areas, mimicking hepatic metastases; pattern Ⅲ, lobe/segmental infiltration(7 cases), the areas of fatty infiltration just involved a lobe or some segments of the liver, showing hyperechoic areas, Diagnosis of this pattern generally is not difficult; pattern Ⅳ, focal sparing in generalized infiltration(34 cases), this pattern is the most common in our materials and liable to be mistaken for a hypoechoic mass, particularly for a small liver carcinoma. In many cases the final diagnosis should be accomplished by ultrasound- guided percutaneous needle biopsy.