非腔内生长型原发性下腔静脉平滑肌肉瘤的CT表现及文献复习  

CT Performance of Primary Leiomyosarcoma of the Inferior Vena Cava and Literature Review

作　　者：汪国余[1] 徐忠飞[1] 黄抒佳 胡明华[1] 吴玉林[1] 

机构地区：[1]浙江省台州市中心医院影像中心,318000

出　　处：《中国全科医学》2015年第3期358-360,共3页Chinese General Practice

摘　　要：目的：探讨非腔内生长型原发性下腔静脉平滑肌肉瘤（PIVCLMS）的 CT 表现及其诊断价值，并复习相关文献。方法选取2004—2013年台州市中心医院经手术病理证实为非腔内生长型 PIVCLMS 患者4例，均行 CT 平扫、双期增强扫描和多方位重建。结果男1例，女3例；年龄47~62岁，平均56岁；肿块直径61~113 mm，平均83.8 mm；肿块呈圆形或类圆形，边界尚清，病灶内均伴多发斑片状液化坏死区，未见钙化及出血密度；增强双期扫描肿块 CT 值平均升高27.4、18.5 HU。4例病灶皆起源于下腔静脉右前方，2例起源于中段（Ⅱ段），1例起源于下段（Ⅰ段），1例同时累及中段及下段，肿块紧贴下腔静脉，下腔静脉增粗但均无移位，增强扫描管腔消失被不均匀强化软组织填充，1例同时累及左肾静脉，2例伴侧支循环形成。CT 所见与手术及病理结果基本相符。结论 CT 扫描能客观判断肿块与下腔静脉的关系及肿块本身的影像特点，为术前正确诊断和制定合适的临床治疗方案提供可靠的依据。Objective To study the imaging features of primary leiomyosarcoma of the inferior vena cava（PIVCLMS） that was not intraluminal and review the literatures to improve the diagnostic accuracy. Methods The clinical data and CT findings of four cases with pathologically - proved PIVCLMS that was not intraluminal from 2004 to 2013 in Taizhou Central Hospital were retrospectively summarized and analyzed. Both non - contrast,contrast scans and multiplanar reconstruction （MPR）with spiral CT were performed in the four cases. Results Three cases were females and one case was male,with an average age of 56 years. The diameter of tumors ranged from 61 mm to 113 mm with a mean diameter of 83. 8 mm. The masses appeared to be round or oval with clear border. Cystic necrotic areas were found in all cases,and visible bleeding and calcification were not found. The CT value average increased 27. 4 HU and 18. 5 HU on the arterial phase and the portal venous phase respectively. Four lesions originated from the right anterior of inferior vena cava,two lesions from segment Ⅱ,one lesion from segment Ⅰ,one lesion involved both segment Ⅰ and Ⅱ. The masses were quite close to the inferior vena cava and could be hardly separated. The inferior vena cava were dilated and non - displaced in all cases,and the lumen were filled by heterogenous enhancing soft tissues,involving the left renal vein in one case and forming collateral venous circulation in two cases. The CT performance was consistent with operation and pathology. Conclusion The CT findings can estimate the imaging characteristic and the relationship between the mass and the inferior vena cava objectively,and provide reliable basis for preoperative correct diagnosis and clinical treatment.

关 键 词：腔静脉 下 平滑肌肉瘤 体层摄影术 X 线计算机 诊断 

分 类 号：R730.266[医药卫生—肿瘤]