Duvivier A, Goyers J F, Radermacher J, Namur G
Étudiant Master 3 Médecine, ULiège, Belgique.
Service de Radiodiagnostic, CHC MontLégia, Liège, Belgique.
Rev Med Liege. 2022 Jul;77(7-8):430-434.
Fatty liver disease is a common condition that rarely occurs on a multifocal mode. In this form, the differential diagnosis with hepatic carcinomatosis is not obvious, especially when a neoplastic condition coexists. Radiologically, MRI can almost systematically differentiate these two entities. However, concerning metabolic imaging with [18F]FDG PET/CT it is important to keep in mind that a multifocal hepatic steatosis may appear hypermetabolic in rare cases. By mimicking a typical presentation of metastatic carcinomatosis, it may lead to a false positive result. Here we report the case of a 73-year-old woman with a recent diagnosis of colorectal cancer. As part of the initial assessment, a MRI of the liver is performed and shows multiple lesions described as multifocal steatosis. A [18F]FDG PET/CT subsequently describes the same liver lesions but assimilates them to colorectal metastatic carcinomatosis. Due to this mismatch between the two different imaging modalities, several biopsies of the liver lesions are performed, first echoguided (two different lesions) then surgically (removal of a third lesion). The pathological analysis of the specimens fails to highlight any malignant lesion and the diagnosis of multifocal steatohepatitis is made.
脂肪肝是一种常见疾病，很少以多灶性形式出现。在这种形式下，与肝癌转移瘤的鉴别诊断并不明显，尤其是当存在肿瘤性疾病时。在放射学上，MRI几乎总能区分这两种情况。然而，关于[18F]FDG PET/CT代谢成像，必须记住，多灶性肝脂肪变性在罕见情况下可能表现为代谢增高。通过模仿转移性癌的典型表现，可能会导致假阳性结果。在此，我们报告一例73岁近期诊断为结直肠癌的女性病例。作为初始评估的一部分，进行了肝脏MRI检查，显示多个病变，诊断为多灶性脂肪变性。随后的[18F]FDG PET/CT检查描述了相同的肝脏病变，但将其诊断为结直肠癌肝转移。由于这两种不同成像方式之间的这种不匹配，对肝脏病变进行了多次活检，先是超声引导下活检（两个不同病变），然后是手术活检（切除第三个病变）。标本的病理分析未发现任何恶性病变，最终诊断为多灶性脂肪性肝炎。
