含脂性肝细胞肝癌的影像学特征与病理对照分析

Comparative analysis of imaging features and pathological features of lipid bearing hepatocellular carcinoma

目的探讨含脂性肝细胞肝癌的影像学特征。方法回顾性分析经手术病理证实的13例含脂性肝细胞肝癌的影像学及临床病理资料。患者术前均行CT检查,6例同时行MRI检查,5例体积较大者行术前DSA造影及介入栓塞,术后均进行病理检查。结果 13例肝内病灶含脂肪区域呈局限性或弥漫性分布,CT值约-26~7HU,T1WI上呈高信号,T2压脂序列上呈低信号,T1WI梯度回波正相位图像呈高信号,反相位图像信号减低。CT动态增强扫描7例动脉期明显不均匀强化,6例门静脉期及延迟期强化减退,1例门静脉期实质部分呈等及稍高密度强化,延迟扫描可见线样及网格状持续强化区;4例动脉期、门静脉期和延迟期均呈不均匀低密度改变;1例动脉期未见强化,静脉期呈结节状明显强化,延迟扫描强化减退。13例病灶延迟扫描均出现边缘完整或不完整的包膜/假包膜样强化。MRI动态增强表现与CT相似。DSA显示肝内病灶为肝动脉分支供血,呈现富血供肿瘤染色。大体标本上肿瘤可见纤维包膜,切面呈灰白或灰黄色,部分呈胶冻状。HE染色镜下见肝癌细胞浸润,部分肿瘤细胞脂肪变性、坏死,呈弥漫或区域状分布;瘤周有纤维包膜围绕,伴不同程度淋巴细胞浸润。结论含脂性HCC内的脂肪分布多样,易与其他肝内含脂性病变相混淆。CT及MRI动态增强扫描肿瘤的实性成分有典型HCC表现时容易作出正确诊断;随着病灶内脂肪含量及坏死组织的增多,容易呈现不典型的强化表现,假包膜延迟强化的特征可作为提示诊断的依据。

Objective To explore the imaging features of hepatocellular carcinoma(HCC)with lipid bearinghepatocellular carcinoma(HCC).Methods Imaging and clinical pathological data of13cases of hepatocellularcarcinoma containing lipid proved by operation and pathology were retrospectively analyzed.Results In13cases ofliver lesions,the fat containing region was localized or diffusely distributed.The CT value was about-26-7HU,andthe T1WI signal was high,the T2pressure sequence showed low signal,and the T1WI gradient echo phase image washigh signal,and the anti phase image signal was decreased.CT dynamic enhanced scan showed7cases of abnormalinhomogeneous enhancement of arterial phase,6cases of portal vein and delayed phase of enhancement,1casesof portal vein parenchyma showed equal and slightly higher density enhancement,selayed scan showed visible linepattern and grid like persistent enhancement region.4cases showed heterogeneous low density changes in arterialphase,portal vein phase and delayed phase.The arterial phase was not enhanced in1cases,nodular enhancement invenous phase and delayed enhancement was in delayed phase.Incomplete or incomplete capsule/pseudo capsule likeenhancement appeared in13cases was with delayed lesion scan.MRI dynamic enhancement was similar to CT.DSAshowed that intrahepatic lesions were supplied by hepatic artery branches and stained with rich blood supply.Thegross tumor fibrous capsule,the cross section was gray or yellowish gray,partially tremelloid like.HE staining showedthe infiltration of liver cancer cells,and some tumor cells showed fat degeneration and necrosis,showing diffuse orregional distribution.The tumor was surrounded by fibrous envelope with lymphocytes infiltrating at different degrees.Conclusion Lipid containing HCC is rich in lipid distribution,and it is easily confused with other lipid containingliver lesions.It is easy to make correct diagnosis when CT and MRI are dynamically scanned for the solid componentsof the tumor with typical HCC findings.With the increase of fat content and necrosis tissue in the lesion,atypicalenhancement is easy to appear.The characteristics of delayed enhancement of the false envelope can be used as abasis for prompt diagnosis.