肾假性肿瘤的CT诊断与鉴别诊断  

Renal pseudotumors: CT diagnosis and differential diagnosis

作　　者：李苏建[1] 肖俊强[1] 

机构地区：[1]南京军区南京总医院医学影像科,江苏南京210002

出　　处：《医学研究生学报》2006年第9期788-792,共5页Journal of Medical Postgraduates

基　　金：江苏省社会发展计划(面上)基金项目资助(批准号:BS2006053)

摘　　要：目的:探讨肾假性肿瘤的CT表现及其与肾癌、肾良性肿瘤的鉴别诊断,分析肾假性肿瘤的成因以及误诊因素。方法:对23例肾肿块患者行螺旋CT平扫加增强扫描,观察其类似肾肿瘤的肿块性病变的CT特征。13例行肿块切除,其中炎性假瘤5例,黄色肉芽肿性肾盂肾炎2例,脂肪瘤样增生1例,纤维血管脂肪瘤样增生1例,子宫内膜异位症1例,肉芽肿性炎1例,肾盂血肿2例。另10例尿脱落细胞阴性,经动脉内数字减影血管造影(IA-DSA)确诊或经治疗后观察病变明显好转。结果:大多数炎性或增殖性病变表现为实性或囊实性肿块,与正常肾实质的分界多不清楚,密度不均,可合并有钙化、脂肪等成分。增强后实性部分轻到中度强化,其中有囊变区;病灶周围可见多发条索状浸润影,以及肾周筋膜受累征象。血肿及动脉瘤表现为边界清楚的略高密度肿块。动脉瘤明显强化,其增强的方式、程度与腹主动脉相同;急性血肿可有轻度强化。结论:CT对肾假性肿瘤的诊断与鉴别诊断有一定的价值。Objective ： To evaluate the CT features of renal pseudotumors and the differential diagnosis with renal carcinomas and other benign tumors, emphasis on the origin of pseudotumors and the factors liable to be misdiagnosed. Methods：Unenhanced and enhanced spiral CT findings in 23 cases of renal mass were retrospectively evaluated. 13 of them （inflammatory pseudotumor, 5 cases; Xanthogranulomatous pyelonephritis, 2 cases; granulomatous inflammation, 1 case; liparomphalus hyperplasia, 1 case; fibroangiolipoid hyperplasia, 1 case; adenomyosis, 1 case; and hematomas, 2 cases） were resected and pathologically confirmed. The others [ urine cast-off cells （ - ） ] were diagnosed by IA-DSA or followed up after the treatment. Results：Most inflammatory and hyperplasia diseases appeared as a solid or solidcystic heterogeneous mass, with an ill-defined margin; Calcification or fat tissues sometimes could be seen. After intravenous administration of iodinated contrast media, the solid components enhanced mildly or moderately. Cystic components, infiltration of fatty renal capsule and thickening of renal fascia could be seen. Hematomas and aneurysms appeared as isoattenuation to hyperattenuation lesions, with a welldemarcated margin. Aneurysms demonstrated intense enhancement similar to the abdominal aorta. Acute hematomas could enhanced mildly. Conclusion：CT is helpful to the diagnosis and differential diagnosis of renal pseudotumors.

关 键 词：肾似性肿瘤 肾癌 体层摄影术 X线计算机 

分 类 号：R737.11[医药卫生—肿瘤]