含脂肪原发性肝癌的影像诊断及鉴别诊断

Imaging Diagnosis and Differential Diagnosis of Fat-containing Primary Hepatocarcinoma

目的:探讨CT与MRI对含脂肪原发性肝癌的诊断及鉴别诊断价值。方法:回顾性分析我院病理证实的22例含脂肪原发性肝癌的CT、MRI表现。结果:22例含脂肪肝癌中,巨块型16例,结节型4例,弥漫型2例。肿瘤单发17例,多发5例;5例多发肿瘤内均只有1个含脂肪病灶,共有含脂肪肿瘤22个。18例肿瘤以实质成分为主,肿瘤内脂肪呈散在、小簇状分布;4例肿瘤以脂肪成分为主,瘤内脂肪呈球状表现,实质成分较少。CT显示肿瘤内斑片状、球状脂肪密度影,MRI脂肪抑制序列及化学位移梯度回波序列正反相位均明确显示脂肪的存在。22例动态增强扫描均较好地显示"快进快出"的影像强化特征,其中15例显示肿瘤假性包膜。结论:CT、MRI能较好显示原发性肝癌的影像特征及肿瘤内所含的脂肪组织,对诊断与鉴别诊断具有重要价值。

Objective： To investigate the value of CT and MRI in diagnosis and differential diagnosis of fat-containing primary hepatic carcinoma. Method： CT and MR imaging features of twenty-two patients with pathologically confirmed fat-containing primary hepatic carcinoma were retrospectively analyzed. Result： In 22 cases with fat-containing primary hepatic carcinoma,16 cases showed a giant mass, 4 cases were nodular type , and 2 cases were diffuse type. Of 22 cases, there were 17 cases of single lesion and 5 cases of multiple lesions. 1 lesion with fatty tissue can be discovered in every case of multiple lesions. 18 cases appeared as mainly solid masses, and fat was scattered with a small cluster distribution within the masses; 4 cases appeared as mainly fat masses and less solid components, and intratumoral fat showed a spherical performance. CT can show patchy and globular fat density within the lesions, MRI with fat suppression and chemical shift imaging of gradient echo sequence can identify the presence of fat. All 22 cases showed ＂fast in, fast out＂ enhancement features on dynamic contrast-enhanced imaging, and pseudocapsule was observed in 15 cases. Conclusion： CT and MRI can well demonstrate the imaging features of primary hepatic carcinoma and the adipose tissue within the tumor, which is valuable for diagnosis and differentiation.