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Fatty Metamorphosis in Hepatoma: Magnetic Resonance Imaging and Histologic Correlation-Case Report
脂肪浸潤性肝細胞癌：磁振造影檢查與病理相關性－病例報告
摘要
超音波，電腦斷層與磁振造影為偵測原發性肝癌和次發性肝轉移病灶的最佳診斷工具。脂肪組織於各種造影工具常可呈現特異影像，而得到正確診斷。於超音波掃描為高回音性反射，電腦腦斷則為低吸收（密度）區域，而磁振造影則因脂肪的特殊短T1弛緩時間與長T2弛緩時間特性，於T1為主影像形成較強的訊號強度得到診斷。雖然T2為主影像，對於肝臟局部病灶的偵測，具有較高的靈敏度，但脂肪組織的特性，於T2為主影像，則不容易表現出來。一例界限清楚的右肝腫瘤，經超音波、電腦斷層與血管攝影檢查後，臆診為局部結節性增生。於門診由生化與影像學檢查追蹤，經過將近四年後腫瘤變大，手術切除病理證實為分化良好的肝細胞癌伴同脂肪變性，同時部份肝細胞質內含脂肪液泡。完整的影像學檢查皆呈現典型的影像特徵，特於此提出報告。肝細胞癌合併脂肪變性，於病理檢查常可發現。如影像學檢查時（特別磁振造影較為敏感），於肝臟腫瘤內找到脂肪組織，假性被膜及／或血管侵犯現象，則必須考慮到脂肪浸潤性肝細胞癌的診斷。
並列摘要
Ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging are good imaging modalities in detecting primary and secondary focal hepatic tumors. Fatty tissue usually produces characteristic features on these images that it can be accurately diagnosed. An echogenic reflection is usually found on sonogram and low attenuation area is presented on CT. MR image is more specific for tissue characterization. The short Ti relaxation time enables Ti weighted image to have higher signal intensity. Though T2 weighted image is sensitive in detecting focal hepatic lesion, it is not specific for differentiating fatty component. A well-encapsulated hepatoma with fatty metamorphosis was originally diagnosed as focal nodular hyperplasia after US, CT and angiographic studies. After four-year follow-up in out-patient department, an operation was done because the tumor mass was getting bigger. The pathology revealed hepatocellular carcinoma (HCC) with fatty metamorphosis and fat vacuoles were demonstrated in the cytoplasm of hepatocytes. The complete imaging studies including US, CT and MR showed characteristic findings. Comparisons between MR findings and pathology are presented. Fatty degeneration of HCC is a common pathologic feature. If imaging studies (especially MR images) reveal fatty tissue, pseudocapsule and/or vessel invasion, it is reasonable to consider it as hepatoma with fatty metamorphosis.
延伸閱讀
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