随访时肝脏局灶性脂肪保留的表现及意义：基于超声、CT 和 MRI 的初步研究。

Findings and implications of focal fatty sparing of the liver at follow-up: a preliminary study based on sonography, computed tomography, and magnetic resonance imaging.

机构信息

Department of Medical Imaging, Affiliated Hospital of Hainan Medical College, 31 Longhua Rd, 570102 Haikou, China.

出版信息

J Ultrasound Med. 2013 Oct;32(10):1695-702. doi: 10.7863/ultra.32.10.1695.

DOI:10.7863/ultra.32.10.1695

PMID:24065249

Abstract

OBJECTIVES

The purpose of this study was to investigate the stability of focal fatty sparing of the liver and its clinical implications.

METHODS

This prospective study consisted of 2 parts. In the first part, patients who underwent sonography and computed tomography (CT) or magnetic resonance imaging (MRI) were selected, and abnormal findings including focal and diffuse liver abnormalities were documented. In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean ± SD, 35.9 ± 1.14 months). Some cases of focal fatty sparing that were not appreciable on sonography in the third year were reevaluated with CT.

RESULTS

A total of 6781 patients with nonalcoholic hepatic steatosis and focal abnormalities were found among 35,337 people undergoing liver sonography; 2133 underwent CT, MRI, biopsy, or a combination thereof. Eighty-nine of those patients (63 male and 26 female; mean age, 37.6 ± 17.5 years; range, 18-72 years) with hepatic steatosis and focal fatty sparing were finally included. In the second part of the study, focal fatty sparing was appreciable on follow-up sonography in 78 cases (87.6%) and 61 cases (68.5%) in the second and third years, respectively. The hepatic steatosis resolved in the third year in 4 patients, and 26 of 28 cases (92.8%) of focal fatty sparing that were not appreciable on follow-up sonography were found on CT in the third year.

CONCLUSIONS

Focal fatty sparing may change with fatty liver changes over time, and it is sometimes not appreciable on sonography, although it is often evident on CT. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor.

摘要

目的

本研究旨在探讨肝脏局灶性脂肪保留的稳定性及其临床意义。

方法

本前瞻性研究分为两部分。在第一部分中，选择接受超声和计算机断层扫描（CT）或磁共振成像（MRI）检查的患者，并记录异常发现，包括肝脏局灶性和弥漫性异常。在第二部分中，纳入非酒精性肝脂肪变性和局灶性脂肪保留患者，并在第二年和第三年进行超声随访（研究间隔为 34-37 个月；平均±标准差为 35.9±1.14 个月）。在第三年，对一些超声检查未能显示局灶性脂肪保留的病例进行 CT 复查。

结果

在 35337 例行肝脏超声检查的人群中，发现 6781 例非酒精性肝脂肪变性和局灶性异常患者；其中 2133 例行 CT、MRI、活检或联合检查。最终纳入 89 例（63 例男性，26 例女性；平均年龄 37.6±17.5 岁；范围 18-72 岁）有肝脂肪变性和局灶性脂肪保留的患者。在研究的第二部分，78 例（87.6%）和 61 例（68.5%）分别在第二年和第三年的随访超声中观察到局灶性脂肪保留，第三年有 4 例肝脂肪变性消退，28 例（92.8%）在随访超声中未观察到局灶性脂肪保留的病例在第三年的 CT 中发现。