肾上腺髓性脂肪瘤的CT诊断与鉴别诊断  

CT diagnosis and differential diagnosis of adrenal myelolipoma

作　　者：王晴柔[1] 陈克敏[1] 黄蔚[1] 徐学勤[1] 林晓珠[1] 柴维敏[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025

出　　处：《诊断学理论与实践》2014年第5期491-494,共4页Journal of Diagnostics Concepts & Practice

基　　金：国家临床重点专科建设项目;上海市科委一流学科(B类)建设项目;上海市科委重点课题项目(11411952000)

摘　　要：目的 :分析肾上腺髓性脂肪瘤的典型及不典型CT表现,并探讨其诊断及鉴别诊断要点。方法 :收集2011至2014年本院经手术病理证实的肾上腺髓性脂肪瘤患者26例,术前行CT平扫、增强动脉期(延迟时间30 s)和门脉期(延迟时间70 s)扫描,分析其CT征象并与病理结果对照。结果:26例患者共发现27个病灶,其中22例患者计23个肿块呈类圆形,有完整纤维包膜,内部密度不均匀,可见较多的脂肪密度内混杂少量轻、中度强化的软组织密度影,术前CT诊断为髓性脂肪瘤,诊断准确。另4例患者术前CT误诊,其中2例病灶内未见成熟脂肪成分,1例术前诊断为肾上腺腺瘤,1例诊断为节细胞神经瘤;其余2例中,1例病灶边缘有粗大钙化,诊断为畸胎瘤或错构瘤,另1例体积较大,向肾上腺前下方生长,考虑为腹膜后脂肪肉瘤。结论:肾上腺髓性脂肪瘤的一般CT征象较典型,当肿块体积较大、合并出血或脂肪成分较少时,应与其他肾上腺及肾上腺外肿瘤鉴别。Objective： To analyze the essential points of diagnosis and differential diagnosis of adrenal myelolipoma by their typical and atypical CT features. Methods： CT features of 26 cases with pathologically proven adrenal myelolipoma during 2011-2014 were analyzed retrospectively. Results： All the 26 cases underwent dual-phase enhanced CT scan preoperatively. Twenty-two cases had masses presented unilaterally, round and oval in shape,with a diameter ranging from 1.7-9.0 cm; the surface was smooth without adhesion, and was shrinking with fibrous capsule formation. Most of the masses were composed of dominant mature adipose tissue and normal hematopoietic tissue, with mild-moderate enhancement of the hematopoietic tissue after administration of contrast medium. These 22 cases were diagnosed correctly, while the other 4 were misdiagnosed as adrenal adenoma, ganglioneuroma, teratoma and retroperitoneal sarcoma. Conclusions：The CT manifestation of adrenal myelolipoma is usually characteristic and can be used for diagnosis preoperatively. When the mass was of huge size, lack of mature adipose or with spontaneous hemorrhage may mimic other adrenal and extra-adrenal neoplasm on imaging, and differential diagnosis should be made carefully.

关 键 词：肾上腺髓性脂肪瘤 多排螺旋计算机断层扫描 鉴别诊断 

分 类 号：R445.4[医药卫生—影像医学与核医学]