MSCT对肾血管平滑肌脂肪瘤的诊断价值  

Multi-slice CT Diagnosis Value to Renal Angiomyolipoma

作　　者：包迎伟[1] 傅立平[1] 纪建松[2] 卢陈英[2] 赵中伟[2] 王祖飞[2] 徐民[2] 

机构地区：[1]浙江省遂昌县人民医院放射科,遂昌323300 [2]浙江省丽水市中心医院放射科,丽水323000

出　　处：《中国中西医结合肾病杂志》2010年第12期1081-1083,1140,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:探讨多层螺旋CT(MSCT)在肾血管平滑肌脂肪瘤诊断中的价值。方法:对手术证实的38例肾血管平滑肌脂肪瘤的术前多层螺旋CT资料进行回顾性分析,并在工作站行MPR、MIP图像重建,分析肾血管平滑肌脂肪瘤的MSCT表现,并与手术病理结果对照。结果:38例肾血管平滑肌脂肪瘤中,CT诊断血管平滑肌脂肪瘤的病灶被手术病理证实正确诊断的有32例,另外6例被病理证实为上皮样血管平滑肌脂肪瘤的病灶,其中3例CT误诊为肾癌,后期的3例被正确诊断。总诊断准确率达92.1%(35/38)。32例的血管平滑肌脂肪瘤CT平扫呈等、低、高低混杂密度的,其中31例显示有脂肪密度,多期增强扫描该31例皮质期肿块呈均匀或不均匀强化,但低于肾皮髓质强化,脂肪、坏死囊变、出血区无强化,分泌期肿块持续强化;1例整个病灶显示为高密度出血灶,多期增强扫描无明显异常强化;6例上皮样血管平滑肌脂肪瘤CT平扫呈均匀等密度,多期增强扫描显示皮质期明显强化,分泌期强化减弱。MIP显示其中31例血管平滑肌脂肪瘤的肿内迂曲、增粗的血管,其中1例无明显增粗迂曲血管影;6例上皮样血管平滑肌脂肪瘤内显示细小血管。结论:多层螺旋CT及多期增强扫描能对术前正确诊断肾血管平滑肌脂肪瘤有重要价值,但对上皮样血管平滑肌脂肪瘤的诊断尚需结合临床和实验室检查,甚至需要穿刺活检。Objective：To investigate the value of multi-slice CT in the diagnosis of the renal angiomyolipoma.Methods：38 cases with renal angiomyolipoma underwent preoperative contrast-enhanced multi-slice CT（MSCT）.The raw date were transferred to the workstation and then processed with multiplanar reconstruction（MPR）,maximum intensity projection（MIP）.The MSCT manifestations of the renal angiomyolipoma were analysed and compared with surgical and pathological findings.Results：32 cases of angiomyolipoma proved by operation are correct diagnosed by CT,the other 6 cases of epithelioid angiomyolipoma proved by pathological findings are misdiagnosed for renal carcinoma in 3 cases and correct diagnosed in the later 3 cases by CT.The diagnosis accurate rate is 92.1%（35/38）.32 cases of angiomyolipoma on plain scan were isodense,hypodense,or hyperdense,fat density were displayed in 31cases.After contrast scan,the lesion were homogeneous or heterogeneous enhancement on arterial stage but were lower than the renal cortex in 31 cases,prolonged enhancement on venous stage.There are no enhancement in the fat,necrosis cystic and hemorrhage areas.6 cases of epithelioid angiomyolipoma on plain scan were homogeneous isodense.After contrast scan,the lesion were strengthened obviously on arterial stage and weakened on venous stage.Curved and enlarged vessels were found in 31 cases of angiomyolipoma on MIP,no obvious curved or enlarged vessel was found in 1 case.Minute blood vessels were displayed in 6 cases of epithelioid angiomyolipoma.Conclusion：Multi-slice CT and the enhanced model is a valuable technique for diagnosis of the renal angiomyolipoma,but for diagnosis of the renal epithelioid angiomyolipoma,we must to combine together with clinic and laboratory examination and even demand puncture biopsy.

关 键 词：血管平滑肌脂肪瘤 肾肿瘤 体层摄影术 X线计算机 

分 类 号：R737.11[医药卫生—肿瘤]