不典型肾血管平滑肌脂肪瘤的多层CT诊断及误诊分析  

MSCT diagnosis and analysis of misdiagnosis of atypical renal angiomyolipoma

作　　者：左敏静[1] 黄小宁[1] 李晓[1] 严辉峰 

机构地区：[1]南昌大学第二附属医院影像科,江西南昌330006

出　　处：《现代肿瘤医学》2015年第16期2348-2351,共4页Journal of Modern Oncology

摘　　要：目的:探讨不典型肾血管平滑肌脂肪瘤(ARAML)的多层CT(MDCT)表现及误诊原因。方法:分析经手术病理证实的19例ARAML误诊病例的MDCT资料,观察病灶边界、密度、强化特征及其多发、伴发病灶等,分析误诊原因。结果:18例边界清楚锐利,1例合并出血、周围见渗出;所有病例肾皮质均见不同程度缺损。乏脂肪或无脂肪16例:密度均匀10例,其中延时强化7例、强化呈"快进快出"3例;密度不均匀6例,其中瘤内出现"黑斑征"5例、瘤内合并出血1例。瘤内见粗大强化血管影1例。外生富脂肪型1例,无明显强化。多房囊性1例,囊壁及分隔明显强化。4例多发,其中1例为结节性硬化症并肺内、骨骼多发高密度结节改变;1例伴发肝血管平滑肌脂肪瘤。术前误诊为肾癌17例(包括多房囊性肾癌1例),腹膜后脂肪肉瘤1例,肾转移瘤1例。结论:ARAML的MDCT表现为边界清楚锐利,增强扫描延时强化常见,伴或不伴一些特征性征象("黑斑征"、粗大血管影、皮质缺损征等)。但少数表现极不典型者(如多房囊性、明显外生富脂性)易造成误诊。临床工作中需综合分析,仔细观察病灶及周围征象,尤其增强扫描及多平面重建有助于提高诊断正确性。Objective： To explore atypical renal angiomyolipoma（ ARAML） multidetector CT（ MDCT） imaging features and reason of misdiagnosis. Methods： The MDCT data of 19 cases of ARAML confirmed by operation and pathology,including the lesion boundary,density,enhanced features and multiple or concomitant lesions. The imaging findings of the misdiagnosed lesions were analyzed. Results： In 18 cases the boundary was clear and sharp. Hemorrhage in 1 cases,the peripheral exudation; all cases of renal cortex were seen in varying degrees of defects. The lack of fat or fat free in 16 cases： Homogeneous density in 10 cases,of which 7 cases were delayed enhancement,strengthen the ＂ fast in fast out＂ in 3 cases. Uneven density in 6 cases,the tumor appeared in ＂ black spots＂ sign in 5 cases,combined with intratumoral hemorrhage in 1 case. Intratumoral thick vessels enhancement in 1 case. Exogenous fat lesions showed no enhancement in 1 case. 1 case of multilocular cystic lesions,cystic wall and septa obvious enhancement. 4cases of multiple,including 1 case of tuberous sclerosis which kidney,lung and skeletal had multiple high density tubercle; 1 case with concomitant hepatic angiomyolipoma. Before operation 17 cases were misdiagnosed as renal cell carcinoma（ including 1 case of multilocular cystic renal cell carcinoma）,1 case of retroperitoneal liposarcoma,1 case of metastatic tumor of kidney. Conclusion： ARAML showed a clear boundary of sharp,enhanced scan common delayed enhancement,with or without some characteristic signs（ ＂ black spots＂ sign,Intratumoral thick vessels,cortical defect syndrome）. A few ARAML performances hardly typical（ such as multilocular cystic,obvious exogenous lipid rich） are easy to be misdiagnosed. The accuracy of correctly diagnosis preoperative can be improved with comprehensive analysis and observing the imaging signs carefully,especially with enhanced scan and multi-planar reconstruction.

关 键 词：不典型 肾血管平滑肌脂肪瘤 肾错构瘤 误诊 CT 

分 类 号：R737.11[医药卫生—肿瘤]